Anyone who knows Russ Branzell knows that he doesn’t shy away from making big statements, and he doesn’t mince words. So when the CHIME President says, “Everyone has to up their game,” he means it — and it be would be wise to listen. In this interview, Branzell talks about the skillsets all health IT leaders will need to help transform the industry, what he hopes to see in the Meaningful Use stage 3 final rule, and the enormous impact a 90-day reporting period would have on both hospital and physician practices. He also discusses CHIME’s Patient ID challenge, the personnel moves that he believes will help improve the organization, why CIOs shouldn’t be afraid to plagiarize, and what attendees can expect at the upcoming Fall Forum.
- State of Meaningful Use
- Stage 2 modifications — “The relief I know the industry’s been wanting”
- Focus of Stage 3: security, clinical decision support & patient engagement
- Potential impact of a 90-day reporting period
- CHIME’s Patient ID challenge
- Crowdsourcing — “We’ve tried since day 1 for this to be 100 percent transparent.”
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People are placed in a pretty precarious position to either assume that it’s going to occur, or assume it won’t occur, and then try to have to go back and try to deal with a year-long reporting period, which in many cases most won’t be able to do.
I don’t think we are in massive disagreement conceptually with stage 3’s overall direction. I think our concern more still is timing and whether we’ve let stage 2 mature enough to get the process improvements and the outcome improvements.
We continue to believe that an entire year of reporting is burdensome for most that are out there, because not all of this is completely integrated into the processes and the solutions that they’ve purchased, so there’s some degree still of work that needs to occur that’s distracting from patient care.
We think it will not only enable advancement of patient care and patient safety and reduce costs, but more importantly, this is about enabling the patients out there in our industry and the families that are trying to navigate care systems that are out there.
This isn’t going to be the wherewithal of all solutions; it’s still going to take other technologies to be all brought together under an umbrella called a patient identification system. But we still need everybody else in the industry continuing to advance their areas of specialty, whether it’s biometrics or patient matching algorithms or anything of that nature.
Gamble: Hi Russ, thank you so much for taking some time to speak with us, as you always do.
Branzell: Absolutely, my pleasure. Thank you.
Gamble: When I was thinking of some of the things I wanted to talk about, I always want to check in on Meaningful Use and I think I figured that by the time we spoke, we would have more answers, but that’s not really the case. So if you wouldn’t mind, let’s kind of give an update on where things are with Meaningful Use as far as stage 3 moving closer to finalization, and the stage 2 modifications.
Branzell: Absolutely. We’ll start with stage 2. I think we’re all anxiously watching for email, maybe even as soon as today, on the possibility of getting the final rule adjustments that we need. We know that has taken a little bit longer than it should and we’re waiting for that final release of the rule modification that gives a similar relief that I know the industry’s been wanting for the most part, as well as the opportunity to set us up possibly for a greater success moving into stage 3.
Speaking of stage 3, we continue to look forward for finalization of that rule. I know there are a lot of different thoughts in the industry relative to stage 3, everything from when it should be sequenced to what should be in there, but I think consistently, ONC’s pushing forward for good and bad with stage 3 for what they’ve intended it for, which is really to push us forward for clinical support and clinical outcomes that they’re trying to achieve.
Gamble: And I guess stage 3 is going to have the continued focus toward patient engagement?
Branzell: I think that’s the case. I think they’ve got many different priorities for stage 3. Obviously, if this becomes the last true stage, I would think we’ll continue to see government direction on utilization of technology, but in particular, all probability that this will be the last final stage of this program the way it’s been built and funded, we will continue to see some effort toward, I think, multiple areas.
One which we’re actually pleased with is the continued emphasis and actually strong emphasis on security and understanding the need for security and privacy of all this electronic information. I don’t think a week goes by that we don’t hear of some major breach happening somewhere in the industry. As you and I talked about, last year we launched a new organization, the Association for Executives and Health Information Security (AEHIS), which really focuses on the chief information security officer which has grown a lot faster than we even thought it would with well over 400 members and a new association. But their real focus is on the security and ensuring the secure exchange of that information that’s out there, and so I think that’s probably one of the primary focuses now — making sure we have a secure environment to do all of the work that we need to get done.
But obviously as you said, both clinical decision support and patient engagement are obviously great focuses, which it should be if we’re really truly ending up in stage 3. If you look at the early adoption of technology in stage 1 and stage 2 being about starting to accumulate data and the flow of information, stage 3 really should be about clinical decision support and the outcomes for the patients and engaging patients in their health and wellness. Whether we’re ready for that or not, that’s a different question, but stage 3 as it’s laid out from its original vision and mission, that really should be what it’s about.
Gamble: You mentioned before about the stage 2 modifications, which everyone’s kind of really waiting for. And I know there’s been a lot made of the delay, but it really has been frustrating for CIOs and other leaders. Any thoughts on what they can kind of do in the waiting period and how likely you think it is that we’re going to see that 90-day reporting period?
Branzell: Well, I’ll answer backwards to forwards in that we have all expectation that we’ll see that and actually see that hopefully any day now, literally within the next day or so, we’re expecting to see the final release of that. And so we are expecting to see the 90-day reporting, the sequencing and matching up of hospitals and eligible providers, at the same time the eligible physicians, all in the same sequence of timing, which we’ve been asking for quite a while, as well as for stage 2 the 90-day reporting period. So we should see that in, like I said, almost any day.
Now, timing-wise, I think you’re right. But I don’t think this is just CIOs that are frustrated; I think the entire industry’s frustrated with the normal governmental process that it takes to get something like this through. We know everyone’s busy in Washington and I know we have good people in ONC and CMS trying to do the best they can. I think this, in all probably, took a little bit longer than it should, mainly because people are trying to make good quality decisions in the field on how to not only implement technology, but how to build the process and the support that’s needed to be successful.
And without this guidance coming out — which, again, we expect to come out any day now, and you can make the assumption it’s there and make your bets in the field — sooner than it is, people are placed in a pretty precarious position to either (A) assume that it’s going to occur or (B) assume it won’t occur, and then try to have to go back and try to deal with a year-long reporting period, which in many cases most won’t be able to do.
The feedback we got when the initial guidance came out that there will be a 90-day reporting period instead of a year was a lot of people jumped back in the game that said, ‘we couldn’t do it because the early processes and software delivery and all the things that needed to occur, now with a 90-day reporting period, we’ve got a decent chance of making this happen.’ And this was not just small and rural organizations; this was everything from very large integrated health systems down to small physician offices. So I think overall, the concept of moving to a 90-day reporting period was good, but waiting until the very end of the reporting cycle to get the final rule is a little bit precarious.
Gamble: Okay. And I know I jumped around a little bit, but was there anything else wanted to add about stage 3? We talked about the continued emphasis on security, but any of the other components that you see coming from there?
Branzell: Well, I think it’s probably less about the components. Anything in specific, you can argue detailed numbers or detailed facts. I don’t think we are in massive disagreement conceptually with stage 3’s overall direction. I think our concern more still is timing and whether we’ve let stage 2 mature enough to get the process improvements and the outcome improvements and let this mature a little bit more to be ready for stage 3, especially for our physician partners that are out there, whether they’re really ready for stage 3. We did see a slide-off of physician participation in stage 2, and we think we would see an additional one for stage 3.
So I think more the question is, should this be sequenced in such a way that it’s reasonable timing-wise, because people are still trying to get stage 2 moving in where it should be, which is a positive thing. We want to continue down this path, we want to see continued adoption in both hospitals and physicians, and I think there’s more just to question in stage 3 what’s the right timing and sequence to get this done successfully.
Gamble: Is there anything else that you think could help make an impact as far as the physicians go in trying to avoid the further slide-off as you get to stage 3?
Branzell: Well, consistent with stage 2, we continue to believe that an entire year of reporting is burdensome for most that are out there, because not all of this is completely integrated into the processes and the solutions that they’ve purchased, so there’s some degree still of work that needs to occur that’s distracting from patient care. It’s not always about the patient care, it’s about also the administration of these programs.
We’ve continued to say that 90-day reporting for this is a reasonable approach for individuals and organizations to deal with that act, so that’s part of this. And then also, we continue to look at ways of, is there the appropriate measures to work within that structure that makes this program less burdensome, sequencing of all the clinical measures across all these different components of the health system that’s out there, and all the different governmental components of quality reporting along with all the insurer’s requirements. There’s a lot of mix-match that’s there. We want to see if that can be sequenced a little bit better. I know they’re trying to work on that.
There are obviously other things and it really leads into another discussion, but there’s still a pretty significant void of clearly defined standards that are out there. There’s lots of standards, but clearly defined and enforceable standards is still an area that the government and the industry as a whole can continue to work on and propagate on that would make this a little bit easier. Obviously, the big one for CHIME is we still believe that there’s a cornerstone issue that we should have solved at the very beginning, and that is the ability to clearly identify and ensure you have the right individual, which is patient education and matching.
Gamble: Yeah, it is really kind of hard to fathom how it wasn’t addressed earlier, but I guess that’s really a moot point. But in relation to that, I know CHIME announced back in the spring plans to launch the Patient ID Challenge — is here any update on that initiative?
Branzell: Absolutely. We have been working through the process of that challenge steadily and almost on a daily basis. We announced the intention and the contractual relationship with HeroX and the XPRIZE Foundation to start that process. We’ve been working through criteria development over the last six months, we have a panel of subject matter experts from the field of clinical and technology-based ministry of leaders — CIOs mostly — working on a good set of criteria to prime the challenge.
So we are probably within the next 30 to 60 days of formally launching the challenge. We’re through that criteria development process. It has been vetted out even into the industry, and our goal is to probably in the next 30 to 60 days launch the challenge. Most challenges take about 12 to 18 months to go through a process of the applications, the actual review, the actual assurance of compliance of the criteria, but we are absolutely primed for launch on this. And we’re excited about getting some more momentum in the industry.
It is interesting, when we started this a little more than six months ago, how it was kind of a quiet dead subject in the industry, and now I don’t know if a day goes by where you don’t see somebody in the industry talking about the need for improved patient identification, if not at least to the minimum improved patient matching. But really, patient identification has become something back in the mainstream of knowing we need to solve this to be able to successfully do some of the other things we need to get done in the industry.
Gamble: Do you think it’s being discussed a little bit more in the political sphere as well?
Branzell: Yeah, we’ve actually had a lot of conversations, both on the agency side as well as the congressional side, if nothing else just to get an understanding of what is needed in the industry and/or why this is even a problem, even to the point where occasionally there are individuals both on the hill and within agencies that don’t even understand that there’s actually a federal prohibition against spending federal funds and/or federal effort towards solving patient identification issues. It still dates all the way back to 1999. It gets re-voted in almost every single year — actually, every single year — and that was actually a surprise to some that that even existed and was out there.
We continue to try to educate and advocate for not only easing of that burden so the government can participate on whatever ends up happening out in the industry — hopefully, our efforts continue to bear the fruit we’re hoping — but more importantly, ease the burden for them to be able to support and assist this. And if you recall, there was actually a patient identification in the original regulations that actually got pulled out in 1999 from the original HIPAA regulations. It actually took something needed for the country and turned it the opposite, which made it something illegal for the government to work on it. It never said the private sector can’t work on it, but that the public sector, and in particular the government, couldn’t spend funding on it.
Gamble: I’m surprised there are a lot of people who don’t know about that. It’s kind of hard to believe the ban still exists, but somehow, like you said, it gets voted in every year.
Branzell: It’s just one of those things where, at that time, there was still a fairly low adoption of technology from a patient data perspective, but if you look where we’re at relative to 1999 now in 2015, we are in such a different world that without good patient identification, we actually have the higher likelihood of creating harm and actually injuring patients or not presenting the most accurate information to caregivers to be able to make the best decisions, because so much of the information is electronic. It’s just a different world, and without great identification, you actually inhibit the process rather than advance it, and that’s what our goal is at this point, is to try to make this as smooth as possible to improve patient care and patient safety and reduce costs.
Gamble: I thought it was really interesting that you decided to go the crowdsourcing route. Do you want to just talk about what your feelings were there or why CHIME decided to do it that way?
Russ: We’ve tried since day one in this, even prior to deciding if we would go down the HeroX/XPRIZE Foundation model, for this to be 100 percent transparent. With every part of this, we want feedback from the industry — the advocates for this, as well as the naysayers, or the ones who at least have concerns about it. So we wanted to hear from everyone through this process and be 100 percent transparent, because this is not a solution for CHIME. CHIME doesn’t want to make money off this time; CHIME wants to do this because we think it will not only enable advancement of patient care and patient safety and reduce costs, but more importantly, this is about enabling the patients out there in our industry and the families that are trying to navigate care systems that are out there. So if we do this right and we’re transparent and we get everyone’s feedback, take it all into consideration, then we have a much higher likelihood of being successful in meeting those goals.
Crowdsourcing, which is the way XPRIZE actually does most of their challenges, gives everybody in the industry — not just those registered, but everyone in the industry and in the country and public space — the opportunity to provide comment, to provide critique.
And we did get a lot. We got a lot of different feedback, a lot of questions, a lot of ‘you haven’t thought of this,’ ‘you have thought of this but we don’t necessarily agree with this.’ But what we did receive from a vast majority was positive feedback from that crowdsourcing. Very little criticism to the point of, ‘you shouldn’t be doing this,’ even to the point of what we thought would have been some natural pushback from the privacy community was, ‘thank you for including privacy in the criteria.’ And that’s what we believe, if you have to do something or I guess you have to make sure it has great security and great privacy, which is why we actually encourage people like that to participate in the process.
Gamble: Yeah, and it also just really generates a lot of discussion; I know it did at HIMSS. It’s a good way to get people talking about it and keep people talking about this topic, too.
Branzell: Absolutely. There are lots of different people working on different things, whether it’s a technically-based patient matching algorithm, and we want them to keep working on those things. This isn’t going to be the wherewithal of all solutions; it’s still going to take other technologies to be all brought together under an umbrella called a patient identification system. But we still need everybody else in the industry continuing to advance their areas of specialty, whether it’s biometrics or patient matching algorithms or anything of that nature. We’ve received very strong support from all those organizations working on those type of things that this could hopefully be kind of an umbrella solution that brings all those things in, so we have an identification system that works across a health system, not within isolated silos.
Chapter 2 Coming Soon…