HIT Voices: The Policy Challenges Facing Health IT Leaders (Part 1)

Aug. 16, 2013
Anita Samarth, President of Clinovations, a Washington, D.C.-based consulting firm that works with the government, providers, and other health IT stakeholders, talks about the scope of different policy issues facing industry leaders in 2013 and beyond. This is part 1 of a three-part series.

Never have IT leaders at hospitals and healthcare systems been tasked with as many policy mandates as they are being asked to manage currently. In the upcoming September issue of Healthcare Informatics,Associate Editor Gabriel Perna talked to several industry leaders on the scope of different policy issues facing healthcare IT leaders in 2013 and beyond.

Leading up to the release of that feature, over the next week or two, he will be publishing additional, extensive interviews of what was said by a few of these experts. Much of this has been left on the “cutting room floor.” Part 1 of this series is with Anita Samarth, President of Clinovations, a Washington, D.C.-based consulting firm that works with the government, providers, and other health IT stakeholders.

Below are excerpts from that interview.

What are some of the major policy issues facing healthcare IT leaders for the rest of 2013?

The biggest challenges, for those of us who live in it, we understand it, and I think most CMOs, CIOs were planning an EHR [electronic health record] journey for a long time. They were hoping meaningful use would fit into what they were doing already. But when you look at the more cursory requirements, if you are in the more progressive half, or even the progressive three-quarters of the nation, then you usually don’t balk at the requirements. But most organizations are finding through Stage 1 efforts is that the devil really is in the details. Many organizations haven’t put together a specific staff to manage meaningful use achievement, audits, adaption, etc. At a recent usability hearing, one of the CIOs said, “We went through the audit, certification, and products needed to meet the capability to support the organization in achieving meaningful use, but there are not requirements that align with requiring the EHRs to have the documentation needed in the event. I use that example because that’s indicative of the issues facing CIOs in 2013-14.

I think at a high level [the requirements] makes sense, but all of these executives are faced with the operational burden of them because they don’t have the IT for that because they are getting squeezed on the financial side.

How are other regulatory policies, i.e. ICD-10, payment reform, playing into how healthcare organizations are looking at Meaningful Use?

I can tell you, with our health systems, without naming them—we have health systems that had originally planned to not meet the requirements of Stage 1 of meaningful use.  That’s the most significant chunk of money. But they said, ‘We have other priorities.” They are much more bogged down by other things that are imminent. [Most executives] are focused on the larger initiatives. What’s really interesting is that some of these other initiatives that tie back to reimbursement have some specific measures. Meaningful Use is supposed to get you some of that infrastructure, but there is a gap in supporting meaningful use metrics and measures that support reimbursement. Same with ICD-10. That’s a different initiative, meaningful use isn’t driving that. So you start working towards these in parallel, and the ones the effect your bottom line are somewhat supported by meaningful use, but not directly. But they are completely maxed out. 

Some are arguing that Stage 2 should be extended or delayed, and others are calling for a temporary suspension. Can we expect anything to come of this?

Well, I’m admittedly split. Obviously there is a portion of my day job that supports policy the CMS [Centers for Medicare & Medicaid Services] and ONC [Office for the National Coordinator of Health IT] is putting into place, and there is a portion of my job that supports the organizations that are implementing it. I sit here feeling the tug of both. I feel comfortable that if the government is going to get engaged, they have to do a bit of a hard push and a gentle pull along. With Stage 1, the hardest part was the administrative and process burden of it. Not what was required for installation. Now with Stage 2, there are more significant exchanges of information. It’s sort of forcing [your] hand to ensure exchange. There is interest in the administration to say, there keeps being this call for what have we achieved. The big value has to be Stage 2. If we push that off, we can have the story being out there and we’ve done a heavy lift. I feel that. But I also feel the fact that it’s one thing to allow incentives to raise the bar, it’s another thing to penalize those that are moving as fast as possible. You do have to acknowledge the burden this has placed on the industry. We haven’t had the time nor made an effort to study what this has meant for quality care delivery.

I think with this tension, history has told us they will delay. If I had to bet, it will probably happen, but it will be tough. I would be disappointed with a delay, even though I think it’s inevitable. I agree with the Stage 3 delay stuff, but Stage 2, we’ve got to start putting some of this in place, so we can see what we can do with it.

How should CIOs proceed with Meaningful Use with all of this going on?

They should go full-scale ahead. At the end of the day, there is always going to be something else. You know what you know now, so you should plan for it. They must proceed. The harder parts will be the policies they have to put in place, so if they don’t start working now, they won’t be comfortable with those policies. And we’ll have the same noise we have now, which is I just record my measures; I don’t do anything about it. Stage 2 triggers a lot of change in thinking and operations and policies, so if we don’t get that done, all we’ve done is put in technology.

How top-of-mind is the transition to the ICD-10 code-set for hospitals and healthcare CIOs? Is the Oct. 1, 2014, realistic?

I think it’s a tough stretch. It’s going to be tough. If you look at the readiness of organizations, certainly there are technology solutions that CIOs have been working on. But there is still a lot of variation. What we’re going to find is people are going to choose the level of specificity that they can handle. I think we’re absolutely in the not ready, but I do believe in setting a date and starting the effective date. You can start to see what’s happening.

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