Live from the CHIME Fall Forum: Intermountain’s Probst Says It's Time to Declare MU Victory and Move On

Marc Probst, who has been vice president and CIO at the Salt Lake City-based Intermountain Healthcare for 11 years, encompasses 23 hospitals, over 250 clinics, and 36,000 staff, in Utah. On the first day of the CHIME Fall Forum, being held at the J.W. Marriott Resort in San Antonio, Tex., Probst, a member of the board of CHIME (the Ann Arbor, Mich.-based College of Healthcare Information Management Executives) sat down with HCI Editor-in-Chief Mark Hagland to talk about recent developments at Intermountain Healthcare and to discuss his perspectives on the meaningful use process and on recent developments at the Office of the National Coordinator (ONC), as a member of federal IT Policy Committee. Below are excerpts from that interview.

What’s the latest for you and your team at Intermountain?

We’re implementing the Cerner electronic health record (EHR). We contracted with them last Thanksgiving, and we’re madly configuring now in order to go live in the first quarter of 2015.

As many in healthcare know, Intermountain was a true industry pioneer, when your organization was one of the very first to build its own EHR decades ago. What made you decide to abandon that system and go with a commercial solution?

Well, we built our system in the mid-1970s because there were no clinical information systems back then. And we had to build our own EHR, and it served us pretty well. But when we looked at all the requirements under meaningful use, certifying our own system—we looked at the requirements for self-certification, and the decision [to abandon it] was easy. We were going to build a new system that GE Healthcare would then vend. And we went about six years down the road on that development work, and GE chose to create Caradigm instead; so we asked  ourselves whether we should keep going or buy one, and we decided on this approach, and chose Cerner.

So what is meaningful use for you, as an IT pioneer?

Well, it’s a pain in the neck! We believe we were already some of the most meaningful users, in the broader sense of the term, in healthcare IT, prior to the meaningful use program.  But meaningful use has imposed rigid functions that you have to do, and I don’t think it’s added any additional value to what our clinicians do, but only to add tasks. So it hasn’t been all that helpful. I sit on the [federal] IT Policy Committee, so I have a little to do with meaningful use, but nonetheless, it hasn’t been [satisfying].

What is your overall critique of meaningful use as a process? It has, at the very least, compelled hospitals and physicians to implement EHRs, correct?

I agree, meaningful use has put technology much more broadly into healthcare, and raised the discussion, and that’s good, and I think that raising the technology level is good. I honestly think we should now declare victory and move on. I’m not a fan at all of how we’ve defined meaningful use, in terms of checklists and such. I believe we’re in healthcare because we’re there for a reason and to care for people, and that putting technology in the hands of able clinicians and informaticists—we didn’t need to prescribe how to use it, only to make sure people are using it.

And I would describe meaningful use Stage 2 as a meager success, if that; and so 2015 is going to be a very bad year for meaningful use, and the odds are slim that organizations are going to meet the requirements, now that October 1 has passed. I also believe that if meaningful use Stage 3 is not completely focused on interoperability, that the industry is just going to say, you guys are out of your minds, you know? It’ll be interesting, for sure.

Are you concerned about all the recent departures of senior officials at ONC?

Yeah, I think it is a bad time. I’m a big-time Karen DeSalvo fan [Karen DeSalvo, M.D., National Coordinator for Health IT]. Her intentions were terrific, her approach was very good, and she was figuring it out. We were making some progress on interoperability, at least from a discussion perspective, that we hadn’t been having previously. And having her attention be bifurcated at best now [since Dr. DeSalvo will be taking on a position within the Department of Health and Human Services focused on the Ebola crisis], will not be a good thing. And the best thing about ONC, from my perspective, has been the staff. So losing the staff hasn’t been good, and right now it doesn’t feel like a winning team, and who wants to play for a losing team?

For many in the industry, the departure this fall of Judy Murphy, R.N., seemed like an exceptional loss, given her industry knowledge, profile, and credibility.

Judy was a big loss; Jacob [Reider, M.D., Deputy National Coordinator] was a big loss. There’s been a lot of turnover. David Muntz [former Deputy National Coordinator] was a big loss. Judy was terrific.

What would you like to see happen on the Policy Committee and in your dealings with ONC in the next year, and what do you think will actually happen?

I’d like the Policy Committee to focus on interoperability, and to put all the emphasis on interoperability in Stage 3. The vision, the framework, that’s been laid out is terrific. I’d like to see some teeth put into it. I’d like to see serious focus on standards that would allow for interoperability.

Do you think that will happen?

I think we’ll continue to talk about interoperability; I think meaningful use Stage 3 will be about something different from just interoperability, and that will be very frustrating for the market. I also worry about whether meaningful use can withstand this transition. And that’s not just because of Karen’s partial departure and situation. It feels as though Washington just won’t listen. It’s not just CHIME; it’s AHA, AMA [the American Hospital Association and American Medical Association], everyone—everyone has asked for a 90-day attestation period for Stage 2, and it’s just been ignored.

Why do you think those requests have been ignored?

I don’t know, but it feels as though they don’t trust the people who are doing this [CIOs and other healthcare IT leaders and managers], and that’s a shame.

What should CIOs be doing right now, in terms of meaningful use, and more broadly?

I think CIOs are doing everything they can to fulfill the requirements of meaningful use. Vendors are having a really hard time getting their products together; and I’m a big supporter of vendors. They get these lists around functionality, like you have to do smoking status, so they build it into the registration process the best they can, but they get demands, so they stick them in, and so we have to work with sub-optimal functionality, and it creates frustration. I do think CIOs are doing everything they can. They’re working really hard, and they want [meaningful use] to be successful.

But I think that a fair number are going to say, look, if I haven’t done it this year, I’ll get the penalties anyway if I haven’t yet attested to Stage 2. I think many will focus instead on ICD-10 and data security, because meaningful use is so frustrating and they don’t control the variables; and security, they can control some of the variables. And the penalties are much harsher for breaches than for meaningful use failure. That’s going to take work and something we have to focus on. There’s no lack of things for CIOs to do; we’re not bored.

What nuggets of wisdom based on your experience would you like to share with fellow CIOs?

All I can say is, it’s an honor to be a CIO in healthcare. The men and women who do what we do are doing it for the right reasons. I was a consultant for 23 years before I came to Intermountain, all in healthcare. And guess what, it’s “10x”—ten times harder than being a consultant—sorry, consultants! And it requires character. I’m shocked that we can’t get some of the foundational elements in place, like standards. Standards is kind of my thing. And I’m shocked we can’t get them in place; HL7 has been at it for 30 years now. The data, transport, terminology, and decision support standards to facilitate interoperability. I believe that we could save tens of thousands of lies every year and hundreds of billions of dollars a year. So tell your congressman to work on those. I spend a lot of time lobbying for standards; standards are very important to me.