A few weeks ago, Russ Branzell gave industry leaders at the AHIMA convention something to cheer about when he said he was “mad as hell” — about the rapid pace of change in the industry and the toll it’s taking on hospitals and health systems. Branzell wanted to get people talking, and it worked. But he believes it’s going to take much more. In fact, the CHIME CEO believes it’s going to take “revolutionary action” by those who are willing to stick out their necks to create the transformation needed to improve patient care. In this interview, he discusses his thoughts on the Meaningful Use final rule, why it’s time to redefine success, the prioritization challenges facing CIOs, and what’s in store at the upcoming CHIME Fall Forum.
- Thoughts on MU final rule
- “Let’s just create a little flexibility.”
- Addressing AHIMA
- Patient identifiers — “It’s going to take some revolutionary action.”
- Interoperability timelines
- IT staff burnout
- “We cannot adapt to this much change as fast as we can deploy the technology.”
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We don’t want to sound like it’s doom and gloom. They just need to recognize that people aren’t all the same. A small physician office isn’t the same as a giant IDN. They don’t all have the same resources. Let’s just create a little flexibility.
It just seems like we’ve impeded the entire progress of this by not allowing the very fundamental portion of the DNA of how health information exchange and patient management of data should be working.
We’re not going to be passive in this. We’re going to continue to be as aggressive in partnering with people and trying to make this a number one priority for people across the country.
Success isn’t technical implementation; it’s technical implementation with the appropriate process change and with the appropriate cultural change that needs to go with it.
Gamble: Hi Russ, thank you, as always, for taking some time to speak with us.
Branzell: Thank you for having me today.
Gamble: Sure. So I know we have a lot to talk about, and I wanted to start with Meaningful Use — everyone’s favorite topic, but there is so much there. Last month the final rule was published which granted more flexibility for Meaningful Use requirements, but it didn’t grant a shorter reporting period. I wanted to get your thoughts on this because we know that this is significant, but I want to talk about how this specifically affects CIOs.
Branzell: I think we were generally encouraged that ONC, and in particular CMS and HHS, are recognizing that there’s need for flexibility in the program. As you look at the flexibility that was granted, it really didn’t help a vast majority of the industry, because it really was 2014 reporting period flexibility for Stage 2. It really was just a finalization of what they recognized now six months ago, which is what we and many other associations were telling them 12 and 18 months ago. By the time they finalized the rule, it was actually too late for most people. So if they did delay, it actually it actually put them behind for 2015 because there was no flexibility going into 2015.
If they delayed their software implementation staying on an older version, hoping for this flexibility to really help them — and even if it did, it actually impeded their progress into 2015 where they needed to be ready on October 1 for the new rule reporting period, which they needed to be 365. It would have been perfect if they would have said, ‘okay, you can do this, but now you really don’t have to have your software installed, and the 90 days of reporting will work starting in Q2 or Q3. But they actually created a rule that caused damage in later periods of time.
Gamble: As we’ve heard the reporting has been a challenge for a lot of organizations.
Branzell: Even as of this week they came out with new possibilities for hardship exemptions due to the fact that physicians couldn’t get their data in because their website had issues. So even if somebody got done what they needed to get done, they were impeded because they had problems reporting the data in through HHS’s website.
So again, we’re heading in the right direction — we don’t want to sound like it’s doom and gloom. They just need to recognize that people aren’t all the same. A small physician office isn’t the same as a giant IDN. They don’t all have the same resources. Let’s just create a little flexibility so people can move at slightly different paces and at different timings and all still be successful.
Gamble: Let’s talk a little bit about the AHIMA Conference. You talked about the need for clarity in the industry and the need for patient identifier, which is something that we have heard so many people talk about, and your quote was “I’m mad as hell,” which was very well received. I want to talk about why you think it’s important to put yourself out there and be so candid and open about how you really feel about this.
Branzell: Well sometimes you’re just fortunate or lucky rather than being good, and in this case, we got so more applause than I was allowed to finish the entire rest of the statement, but I’ll take credit for it now because it got so much positive momentum in the industry. We are concerned, and I think that’s the best way to put it. I think you would be concerned if you had family members in hospitals where you knew patient matching was an issue, and I think everyone would. I think this is an area where we really just can’t continue on the status quo and think somehow this is going to be magically solved over some period of time. It’s going to take some revolutionary action by some folks sticking their necks out a little bit and making some people mad and being willing to have those really tough conversations out in a public forum like that. I was hoping that we would create some national debate on this. Fortunately, I think it did occur.
With patient matching — even if you give up on the concept, which we won’t, of a true patient identifier — just clear, regulated everyone-does-it-the-same-way patient matching standards should be so simple of a foundation cornerstone of what we did in Meaningful Use. But we don’t even have that, and then we don’t understand why HIEs can’t match patients and why hospitals have mismatches of patients because there’s not a simple, consistent way of doing it. I’ll even give up on simple — just a consistent way of doing it.
Because we’ve got really smart people in this industry that know how to make this work, and at this point, it just seems like we’ve impeded the entire progress of this by not allowing the very fundamental portion of the DNA of how health information exchange and patient management of data should be working. I’ve yet to meet anybody, other than a few zealots in privacy — and even they don’t disagree in this concept; they want patients to be appropriately connected and matched. They just want it done in a correct way. Somehow we’re forgetting this very premise. It should be almost the number one priority list of everybody in our country right now involved in HIT.
Gamble: It’s a bit of a head scratcher. The whole issue of having some kind of patient matching standard, like you said, you’d think would be a foundation for everything else.
Branzell: We understand and actually respect the folks that come out very strongly on privacy and security of information. We agree with that 100 percent. We’ve got to do it in a way that protects peoples’ privacy and allows people to opt out of anything they may not want to be involved in. But for the vast majority that are concerned more about patient safety and patient quality, we want to make sure that we have solutions out there for them, and we’re working on some of that right now behind the scenes. Nothing to talk about quite yet, but we’re not going to be passive in this. We’re going to continue to be as aggressive in partnering with people and trying to make this a number one priority for people across the country.
Gamble: Now I want to talk a little bit about patient safety and interoperability. A few months ago, CHIME and AMDIS filed comments in response to the FDA/SIA Health IT report stating that the biggest gains to patient safety could be obtained by retooling ONC certification program to require more rigorous interoperability testing. I just wanted to get your thoughts on that — the role of interoperability in increasing patient safety, and how this testing can help.
Branzell: Well if you just look at what’s occurred over the last four weeks — a clear roadmap and vision from ONC and HHS on the plans for interoperability the irony in this is that it’s a 10 year roadmap. When you look at the beginning of Meaningful Use, we believed — and those that put this together believed — that we needed to have somewhere in the neighborhood of Stage 2 at the earliest, Stage 3 at the latest, full interoperability to achieve the goals of the program. So there’s a significant mismatch between our needs in the industry for interoperability and timelines being laid out to get there.
And so the only true tool in ONC’s, and really HHS’, tool bag to make this enforceable is certification. They have no other enforcement capability. So they need to create certification requirements for interoperability, therefore driving performance both on the vendor side and provider side to make it all work together. That’s the only tool they have that can make it work, which is why we’re so strong in saying that if there were other tools that we weren’t aware of, i.e., more public policy as far as laws, but we just know how impeded that process is. At this point they have a tool they can execute on. We’d love to see them use it in a more adamant way.
Gamble: Right. It’ all comes down to being able to have the data work together and speak to different systems.
Gamble: Now obviously you have the ear of the CIOs — you talk with so many of them. One of the most common concerns we’ve heard is about the burden being placed on the IT staff and the challenges it poses, particularly for some organizations, in holding on to good people. I just wondered if you had any thoughts on that or any insights you can provide there, just because this is such a big issue.
Branzell: Yeah, this is the true definition of a double edged sword. We need to do so much, and there’s so much we’re not even getting to. But at the exact same time we’re doing too much, we’re not doing it as well as we can, and we’re burning individuals out. Not just on the IT staff — in organizations as a whole, we cannot culturally change and adapt to this much change as fast as we can deploy the technology, therefore we’re creating an environment where technology solutions fail, because we don’t have time to create process and cultural change to go with it. And I think that’s part of it. We have to change the equation of success. Success isn’t technical implementation; it’s technical implementation with the appropriate process change and with the appropriate cultural change that needs to go with it.
We used to say an IT project wasn’t successful just because it went live; you needed to have all the process change. I think what’s being recognized now is that very successful projects have to have all three legs of the stool, that being technical change, process change, and cultural/behavioral change to go with that, and those are very, very hard. The latter two, the culture and cultural change, are ones that truly are difficult to absorb in an organization. You can get a technical project done in six months, but to truly get process and cultural change hardwired in an organization, it could take months or years to actually get that ingrained in an organization to be successful.
Gamble: That really seems to be one of the sticking points — change management, and doing that in a way that isn’t forcing change too fast. But at the same time, there are deadlines, so that’s a tough one.
Branzell: A lot of this has to do with the fact that successful organizations prioritize well. Just because they have 10 projects that are all positive, it doesn’t mean they do all 10. They pick the best of those 10 and what’s most important, and try to focus on those and do those really well. It is, though, a dilemma with organizations that are trying to change so fast to get ahead of this industry transformation process, but at the same time, they could be hurting their organization to get ready for that by trying to do too much too quickly.