Crossing the Threshold Into a New Healthcare Policy Era: CHIME’s Jeff Smith Looks Forward

April 2, 2015
Jeff Smith, vice president of public policy at CHIME, is helping the healthcare IT executive leaders’ national association to make major waves on Capitol Hill and at federal agencies these days

Jeff Smith, vice president of public policy at the Ann Arbor, Mich.-based College of Healthcare Information Management Executives (CHIME), is helping the healthcare IT executive leaders’ national association to make major waves on Capitol Hill and at federal agencies these days. The Washington, D.C.-based Smith sees the present moment as a time of great opportunity for CHIME and other healthcare professional associations to have a real impact on federal policymakers in Congress, the administration, and federal agencies, as healthcare IT becomes ever more critical to healthcare system reform efforts.

Last week, Smith sat down with HCI Editor-in-Chief Mark Hagland at the CHIME Washington, D.C. offices, to converse about some of the policy and political currents that CHIME and the other healthcare professional associations are working through these days. Below are excerpts from their interview.

When you look at the legislative and regulatory landscape in Washington, D.C. right now, how would you characterize that landscape overall?

To use a maturity analogy, over the past five years, we’ve gained enough experience with health IT policy to know that there are areas for improvement [with regard to policy development]. And I think when you look at the legislative and regulatory landscape, you see a lot of people in Congress and in the federal agencies who want to help. And when multiple parties want to help, multiple parties have different solutions. So for those of us who work in health IT policy, the real challenge is understanding which policies will jibe together, and which will be detrimental. So whether you’re talking about the Ellmers bill that would shorten the meaningful use reporting period to 90 days [the Flexibility in Health IT Reporting Act of 2015, or “Flex-IT Act,” introduced in mid-January by Rep. Renee Ellmers (R-N.C.)], or the SOFTWARE [Sensible Oversight for Technology which Advances Regulatory Efficiency] Act, which would essentially prohibit the FDA [Food and Drug Administration] from regulating health IT in the same way that agency regulates medical devices; what you see is people trying to be helpful.

Jeff Smith

The challenge for us is trying to figure out which bills are going to be helpful, which bills are going to be a complement to what the federal agencies are doing, and which bills are going to be the opposite. Health IT is now very much on the policy radar in the last year and a half. And for the most part, that’s a very positive development, because it means that people are paying attention; but it also means they could mess things up. So it’s a very busy space, a very active time for health IT policymaking.

Do you think there’s a level of understanding now on the Hill regarding what’s actually going on in the healthcare industry?

Yes, I would say that the degree of understanding on the Hill is actually higher than it was five years ago. But there’s a constant turnover of members and staffers; so there’s always going to be a need to educate, and to help to flatten the learning curve.

What are the biggest issues for you right now as an association, with regard to policy initiatives on the Hill?

In comparison to other years, the SOFTWARE Act, trans-industry cybersecurity legislation that might affect healthcare as one of other industries, as well as other pieces of legislation, are all out there and in play on the Hill. Meanwhile, meaningful use is still a very big deal for us. We are trying to make that program sustainable, trying to figure out if there is a gap between what the federal agencies want to do with meaningful use, and what’s going to make it most pragmatic for those who have to implement it.

So right now, that’s where there’s a lot of focus for us. And having the Stage 3 rule proposed now will help, as we’ll be able to see where the federal agencies are at mentally; so we can go back and see where they’re on track and where they need help. I would be surprised if there were additional pieces of legislation coming out this year relative to meaningful use, depending on how the industry internalize the proposed rules, and depending on how HHS [the Department of Health and Human Services] articulates final rules, you could see legislation being devised. But a lot of it goes back to macro-dynamics. And by that, I mean is, are more than 50 percent of physicians being successful with meaningful use? I think if that number gets closer to 75 percent, policymakers will be put more at ease. If hospital participation remains at the level it is now, they’ll be OK. But if Stage 3 is seen as a problem, then we’ll have to figure out what to do.

Tell me more about CHIME’s initiative around the national patient identifier issue?

With regard to our efforts around the concept of a national patient identifier, essentially, CHIME, through a host of partner organizations, decided that we needed to take steps in the private sector to really raise the profile of the safety and cost implications of misidentification. And we were lucky enough to have a well-timed meeting with Peter Diamandis, CEO of the XPrize Foundation. And essentially, we were able to convince him that accurate patient identification is a national imperative. We do not currently have the cultural, political, social, cultural, or technical climate to achieve 100-percent accuracy on patient identification through legislation or regulation; but we believe that it is time that the private sector take bold steps in this area.

We’re still very much in the scoping phase, and are looking at a relatively length process; this is not going to happen in the next few months. But we’re hoping that after we scope out the criteria and open up the challenge to anybody and everybody who think they have the solution, we can develop something that sits in the public trust, is not a for-profit or proprietary solution, but which will lead to positive identification, and is scalable across the industry. And we’ve already got some buy-in from some vendors and other organizations. We’ve got some important players on board. You’ll be hearing a lot more about it in the coming weeks.

What’s different about this is it’s not going to e a governmental solution. We think there’s plenty of opportunity for a non-governmental actor to be the honest broker. We think there’s a lot of room for a non-profit organization to come in to be the organization that could be that honest broker and broker solutions. And honestly, Russ [CHIME president and CEO Russell P. Branzell] is much closer to this than I am, but he and others have had conversations with some of the folks who have pushed back on this in the past, and they’re not pushing back on this idea; they want to make sure it’s private and that it’s secure. There will always be a contingent of tinfoil-hat people. But we’re hoping that if we can get the commonsensical people and even some people who haven’t been that commonsensical, to partner with us, those on the fringe will remain on the fringe, and those 25 people who are crazy and loud will stay on the fringe, and we’ll say, OK, we acknowledge you’re out of 300 million people.

What should CIOs be thinking now, with regard to the current waves of healthcare policy trends, and what could happen in the next few years?

In their minds, they should be dispelling any rumor that things are ever going to be the way they used to be. We’ve crossed the threshold into a new era where the government is involved in health IT, and healthcare IT leaders need to know that we have to start acting like partners to healthcare policy leaders in Washington.

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