These days, Marc Probst spends a good deal of his time helping to create a framework for the development and adoption of Meaningful Use as a member of the Health IT Policy Committee. But his first priority is his role as VP & CIO at Intermountain Healthcare, a nonprofit health system based in Salt Lake City that includes 23 hospitals, a large physician group, and health insurance plans. In this interview, Probst talks about how he balances his CIO duties with his committee obligations, his concerns that Meaningful Use is surging ahead too quickly, and the challenges brought on by the start of attestation.
- The cost of volunteering
- PCAST implications
- The new National Coordinator
- The government process — “It’s not the way you’d run a business, for sure”
- Thoughts on Stage 2
- Prepping for the future
We’re trying to do this behemoth thing called Meaningful Use and to layer on the levels of something called PCAST that has some pretty fundamental changes required that are just not practical.
My sense is that David [Blumenthal] had the job at the perfect time…There were big, big strokes that could be made and they were made; meaningful use is happening. The industry is out deploying all these technologies, and there is a big focus on interoperability and data interchange.
What I didn’t hear is, ‘let’s completely modify the direction where we are headed.’ What I heard is, ‘let’s temper that direction. Let’s understand how long it takes to do these things.’ And ultimately it may push out in the future—or even out of the Meaningful Use time frame—some of the things we wanted to accomplish.
I think people should be involved. I love hearing from people. It gives me reinforcement when I can go into the meetings and offer up what I’ve directly heard from individuals or from groups like CHIME.
Guerra: In terms of the (EMR usability) hearing, that’s what really makes me think about how much work this is for you and for the people that volunteer, because that’s tremendous—putting together the panels, getting people recruited to appear on the panels and then all the political issues of who gets on the panels, who’s represented. Everybody wants to be out there for different reasons—for their own personal reasons, to promote their own organization. Everybody wants to be on the panels, but you can’t have everybody, and you can’t represent every view. So it’s incredibly difficult, I would imagine, putting together a day of panels.
Probst: It is very difficult, and it takes a lot of time. Let me plug Judy Sparrow at ONC. We gave her a round of applause at the meeting. She’s awesome; she does most of the legwork. We’ve had a series of probably five or six phone calls. We met at the last Policy Committee—Larry Wolfe and I—on some of things we’d like to see done on that. For example, coming up with the question you want to ask so hopefully you get a relatively coherent panel and get the information that’s useful.
ONC has participated quite a bit, so the staff has been great. But yes, I do think it takes a lot of time, and every time I go to DC it’s at least two days between the travel and the time that you spend there. And we do that twice a month—that’s four days. That’s coming up to nearly 20 percent of your month. So it is a use of time at this point, and I think moving forward, it’s well worth the time.
Guerra: Let’s just jump back a little bit to PCAST. We talked about and described the process of everything bubbling up from the work groups; the Policy Committee and so on. But in December, we also got a top-down issue with the PCAST report coming down with the sample of approval from the President, as far as I understand, to Blumenthal saying, ‘This is something we want you to run with, and we’re not kidding.’ That’s my interpretation. Based on everything I’ve heard and everyone I’ve talked to, this was not likely put before ONC, but interestingly enough the work group developed, which also includes a member of your team. Stan Huff, professor of Biomedical Informatics at University of Utah College of Medicine and your CMIO at Intermountain was on that work group. He was really one of the voices of reality and I really love his perspective which was, ‘We really can’t do this. It’s not going to work right now. It’s too much, too soon, too fast.’ Anyway, give us your thoughts on the PCAST report and its implications. I don’t know if you’re allowed to talk whether or not you think it’s overall worthwhile, but the work group was not supposed to do that, which is interesting in and of know itself. But give us your thoughts on PCAST.
Probst: Yes, and thank you for bringing up Stan and saying that. He’s awesome. And just to put some contexts to his remarks, I think that Stan, because he and I have had conversations, look at PCAST say, ‘That’s a pretty well thought-out report and approach to data and data sharing and data management and storage in the whole 9 yards.’ It was one of the more detailed reports that could be a platform for really facilitating health care information systems in the future. So he came into that meeting thinking those things, and I think what really came down to is that it’s just not practical at this moment, given where we are with the vended systems and where everyone is with the industry. And we’re trying to do this behemoth thing called Meaningful Use and to layer on the levels of something called PCAST that has some pretty fundamental changes required that are just not practical. Plus, I don’t think we believe it’s been fully tested out or vetted out.
Conceptually, yeah, it’s very much aligned with us at Intermountain and what we think about how data can be better tagged and used. However, it’s just not practical right now. So my opinion would be exactly the same as what Stan outlined. I think it’s a good vision for the future. I think it needs some testing, and that I think we need to get some goals out there. And I’ve said for years now, at least for the last three or four years, that if the government would set us a goal, at least 20 years out there, I think the industry could figure out how to get there trying to embed in Meaningful Use Stage 2, but that could be a little crippling to what the industry is trying to do right now.
Guerra: Right, and you may not want to touch this question with a 10-foot poll, but at the last meeting, Judy Faulkner brought up an issue with her conflict of interest around PCAST, just a preliminary look at the whole process, and said she was concerned that Microsoft is promoting the PCAST vision for the benefit of its HealthVault PHR platform. That’s basically what she said, and that’s in a story I published. Do you want to touch that question with a 10-foot poll?
Probst: Well, a couple comments on that. She never mentioned the company, and I think Judy has been tremendously unbiased through this process, particularly given the role that she has with Epic. She’s brought a lot of knowledge and intellectual capability to the Policy Committee; we would have missed out a lot if Judy hadn’t been part of it. Now with that said, yeah, I think she did see some potential bias in the report, which people that were on the Committee put together. That’s exactly what she said, and I guess that’s as much as I want to touch it.
Guerra: No problem at all, I completely understand. Let’s just talk briefly about Blumenthal versus Farzad. Give us your observations in terms of the differences in style and any thoughts on how things might change or be different.
Probst: Well—and I mentioned this to Farzard so it’s not a secret—my sense is that David [Blumenthal] had the job at the perfect time. It was a big job, but the government put aside a tremendous amount of money. There were big, big strokes that could be made and they were made; meaningful use is happening. The industry is out deploying all these technologies, and there is a big focus on interoperability and data interchange, and all these different things that are going on. So I thought that David had it at the perfect time. As I looked at his transition and the job going forward, now it’s time to implement all these great ideas, and it’s going to be a very challenging job. I really liked David Blumenthal; he was bright and he listened and he made some big decisions. His presence was terrific. With Farzad, I didn’t quite know what to expect. I’d spoken at a few events with him so I’d heard him speak and had interacted with him at that level and a few times with the Policy Committee. But last week, having been able to spend well over an hour with him up in his office—it kind of just happened organically, it wasn’t something we planned on. I found him incredibly willing to listen. His questions were very insightful, so we talked a lot about the issues of ICD-10 and how they relate to Meaningful Use, at least from my perspective. We talked about accounting for disclosure and why I have opinions on accounting for disclosure, but there wasn’t any defensiveness. It was really Farzad listening and hearing what I had to say. Now what happens with that, we’ll see. But I’m very impressed by someone who will listen and asks insightful questions. He is a bright guy. I think his style will be a little bit different than Dr. Blumenthal’s, but I was really encouraged based on that meeting with him.
Guerra: Listening is good, but like you said, we’ll see, right?
Probst: Well again, he doesn’t have a magic wand. His hands have some of the same handcuffs that all the rest of the people in Washington have—is it the person or the process, and with the government process, I think sometimes it can be very difficult to achieve some of the outcomes we’d like to see happen.
Guerra: Conservatives are not the biggest fans of government, and I wonder if being intimately involved with a government process has reinforced your conservative nature.
Probst: Oh yes.
Guerra: Alright, and I don’t know if you want to expand on that or leave that one alone.
Probst: We can leave that one. I mean it’s kind of obvious. It’s very convoluted; it’s not the way you’d run a business for sure.
Guerra: Right, right. Well again, I won’t touch it either. Let’s just talk finally about Stage 2. How is it evolving and what are your thoughts on where it’s going and whether or not there are going to be adjustments to the staging. Everything seems to be on the table—it’s probably kind of frustrating to CIOs trying to stay in tune with what’s happening. But what are your thoughts on Stage 2, and is there any final advice you can give to your CIO colleagues on how they can stay best engaged with the process so they can manage it when it’s handed off to them?
Probst: Okay. Well as far as Stage 2, I was quite encouraged in the last Policy Committee because the conversation turned from one of a blind eye to one of the data of what’s been occurring prior to now. Basically, it’s been a blind eye to what the outcomes of the Stage 1 had been, whether that’s lack of data or just not wanting to look at it. And you know, damn the torpedoes, here we go to, ‘Oh we really ought to listen and we ought to hear what we can understand from Stage 1.’ And if you listened in on the Committee meeting—and it sounds like for sure you did—the timing issue was the biggest issue out there. And I felt like that work group is going to go try to tackle that, and that to me, as a CIO, is very positive.
Because what I didn’t hear is, ‘let’s completely modify the direction where we are headed.’ What I heard is, ‘let’s temper that direction. Let’s understand how long it takes to do these things.’ And ultimately it may push out in the future—or even out of the Meaningful Use time frame—some of the things we wanted to accomplish. But we’ll get the things in place that the industry can reasonably get in place. So I was encouraged by that.
Paul Tang was really into meaningful use and still he is. I really like Paul, but again, I sensed a little more, ‘Okay we’re getting it, we see what’s happening. We understand what you’re saying.’ Not just me, but industry, and that was very positive. So I’m pretty hopeful that Stage 2 will be much more aligned with the reality of the situation, and if that’s the case, that’s a very good thing.
I really hesitate in giving out advice to my CIO colleagues. What I find is 99 percent of them are brighter than I am and are doing things that are amazing. My situation at Intermountain Healthcare is different than most CIOs; I don’t necessary have exactly the same kind of struggles they have. So my advice is, stay involved. I can tell you the comments get read that come into meaningful use or into certification or whatever this strategic plan that’s out there. The comments are being digested and understood, and they make a difference. So to one degree, I think people should be involved. I love hearing from people. It gives me reinforcement when I can go into the meetings and offer up what I’ve directly heard from individuals or from groups like CHIME.
My advice on ICD-10 is that from my perspective, it’s going to happen on October 1, 2013. That’s going to be huge amount of work and it’s going to be overlapping with what we’re doing with Meaningful Use, but we have to get it done. That’s what they pay us for, so I stay involved, and let’s get it done.
Guerra: Alright Marc, that’s all I have for you today. Is there anything you want to add?
Probst: No, Anthony, I appreciate it. I appreciate your articles a lot. I don’t read the whole lot of the rags, whether it’s because we have somewhat of a relationship, or because of the format it comes in or the size—it’s not such huge bites that you can’t consume it, but I really appreciate what you’re doing, so thank you for involving me.
Guerra: Thank you so much, Marc, and I’ll talk to you again soon.