On more than one occasion in recent years, Marc Probst, who has been vice president and CIO at the Salt Lake City-based Intermountain Healthcare for 13 years, has urged federal healthcare decision makers to "declare victory for Meaningful Use [MU] and move on." Certainly, the EHR (electronic health record) incentive program for Medicare and Medicaid physicians has lost some momentum of late once MACRA (the Medicare Access and CHIP Reauthorization Act of 2015) was passed by Congress in April 2015, and within the law, MU was given a new name, Advancing Care Information (ACI).
But for hospitals, Stage 3 of MU would not be affected by the MACRA legislation; those that are eligible must begin the final stage by 2018 to quality for incentive payments and avoid penalties. At HIMSS17, however, in an exclusive interview with Healthcare Informatics, Probst once again expressed his desire to move on from the federal reporting program. Probst also discussed the industry's most pressing issues, momentum around interoperability, and advice for fellow healthcare CIOs. Below are excerpts of that interview from the HIMSS show flow at the Orange County Convention Center in Orlando.
How are you feeling about the current policy moment in health IT? Are you more optimistic or concerned?
I am actually on the optimistic side because of the lack of clarity on the regulatory front. I think Meaningful Use is very unlikely to survive, at all. I have been pushing for MU to be declared and done. For the people that attested to Stage 2, pay out their incentives because you will pay it anyway, and be done with this. If we can stop the regulatory aspects of MU, two years from now all these booths [at HIMSS] will be different because there will be so much innovation going on on healthcare. MACRA is fine and I understand it, but let's stop upping the ante. Let's stop here, not go to Stage 3, and be done.
For you as a CIO, as you go through your job, what's most pressing right now?
The pressing issues [for CIOs] are not changing much. Cybersecurity is always there, and because I think our CISO is taking a nice and logical approach to it, I worry about it, but I think we are taking the right steps to do the best job we can to protect our data. But of course, that doesn't mean we're secure. Right now, trumping security as my top concern is costs. We are implementing Cerner, which is not cheap to maintain and run in the long run, and we need to get those costs as controlled as we can so we can invest in other areas. And that's my third area of focus—everything that's happening with consumerism and digital. I think we have analytics, not completely licked, but like security, it's not [totally] taken care of, but we are doing a good job in analytics, and we have a good program to move it forward even in things like AI [artificial intelligence] and machine learning. We are taking the right steps to advance down that road. Where we need to up our game is thinking about how to engage with the consumer, and how can we do that to modify our overall operations and become a digital healthcare delivery system. We have huge aspirations in that space at Intermountain, and we are confident we can get there.
Are providers and patients ready for this shift?
There will be patients who want to take on more responsibility and even become their own care managers, and leverage the tools we will provide them to give them their data and give them access to good algorithms to help them self-diagnose and provide more self-service care. There will be that subset of the population, whether they are cost conscious or just millennials, who want to go that direction. But I agree, the vast majority of our patients are typical patients, so I don't think we are trying to move them out of the system, but trying to expedite their use of the system. How do we get to clinics who don't have any waiting rooms? That's about changing your operations in your clinic, getting the right tools up front, and gathering the right data up front. If we build those flows, will make a difference for patients. I think it probably makes the physicians' lives for the better, as they will have more regular patients in the process.
When you look at the federal level, and the leadership changes we are seeing, how will this affect health IT?
HHS Secretary [Tom] Price is excellent. That's who I know, from dealing with him since being at CHIME. He has been very helpful and I believe he has a good vision for what IT can do; his desire to take the burden off physicians is spot on. Going back to MU, if you take the regulatory demands out of MU, why don't we let them use these systems in the way they want to, to provide the best care for their patients, versus how the federal government tells them they have to? The current [process] is creating problems for them. Some 99 percent of all physicians want to provide the very best care they can. I'm sure there is the outlier who doesn't know why he or she went into medicine, but for most of them, let's take these tools and morph them to do care the way they think is the best process for them. How they document, how they order, what they document—let them make those decisions. Meaningful Use isn't letting them do that; it's saying these are the boxes you have to check and your life will be miserable. So I think Sec. Price, as he looks at this, and President Trump, whether you like him or not, both do want to get regulation out of the way so some of these things can happen.
Last year at HIMSS, there was this federal "pledge" for better data access and sharing announced. A year later, has this commitment been meaningful?
No, it hasn't. It was a good statement by Dr. DeSalvo in saying that interoperability is important, so sign on. It got attention to interoperability, but that attention was already there. I never thought data blocking existed, and I still don't. What they have done is diluted the definition of data blocking to "it's hard to be interoperable," but that isn't data blocking to me—it's just the technical world we live in. So that pledge didn't have a lot of teeth. But what has really happened with interoperability in 2016 is that FHIR has taken off as a standard. It's not the end all and doesn't solve all of our problems, but it solves some of them. It got a lot of traction last year, as did HSPC, which is advancing that FHIR protocol and interoperability. We still have to take it deeper and get to semantic interoperability where the data can be consumed and used across systems. But the conversation is right and the direction is good.
What advice can you give to CIOs who are struggling?
In 90 percent of what we do at Intermountain, I would consider us fast followers, and I would suggest people consider what a fast follower mentality is. We are seeing things work in organizations and it's happening really fast. We will have way more failures than successes, so being a fast follower is a good idea. Also, partner with us; not financially but showing interest in doing some of the things we are doing and come join us in this journey. If you look at our booth [here at HIMSS], we don't sell anything, but we do think it cultivates a partnership mentality, so if you are a 300-bed facility in Iowa and you want to get involved in innovation, join us, we will happily have you. At Intermountain, we think that's our role.
