Last October, at the the CHIME Fall Forum in San Antonio, Texas, Marc Probst, vice president and CIO at the Salt Lake City-based Intermountain Healthcare, an industry pioneer when it comes to health IT, made a bold declaration regarding the meaningful use program. Probst told Healthcare Informatics that "we should now declare victory and move on."
A little more than five months later, Probst, who has held his senior-level positions at Intermountain for 11 years, has not wavered on that viewpoint despite the fact that several factors have changed, including a proposed Stage 3 rule and proposed modifications aimed to ease the burden of Stage 2. At the 2015 Healthcare Information and Management Systems Society (HIMSS) conference in McCormick Place Convention Center in Chicago, Probst spoke exclusively with HCI Associate Editor Rajiv Leventhal about a myriad of issues, including meaningful use, data security, Intermountain's population health movement, and the overall direction from the federal government relating to IT policy. Below are excerpts from that discussion.
In the fall, you told HCI that it was "time to declare victory and move on" from MU. Five months later, has your stance changed at all?
No, I still believe that. There will be a visceral reaction by the industry to Stage 3, as Stage 2 hasn't even been fully accommodated yet. It's not even the technology—that's the easiest part. It's the doctors' adoption of it and the community's adoption of it. It just takes time. Stage 3 will add fuel on that fire, and make it harder. I still stand by what I said, that it's time to claim victory, hold us to a certain set of standards, and move on.
What do you mean specifically by "visceral reaction?"
You have heard the changes to Stage 2, with the reporting period and patient engagement, and you will hear that same human cry for Stage 3. You'll first hear it from the comment period, which is now, but if it's not dramatically changed, you will hear a lot more human cry. There's not much meaningful use money out there anymore, either.
The Centers for Medicare & Medicaid Services' (CMS) Stage 2 proposed modifications included a drastic reduction in the patient engagement view, download, transmit measure. Did you understand the reasoning behind that?
I don't believe it was an intent to devalue patient engagement, but rather a reflection of the reality of the challenge to achieve the engagement as outlined in Stage 2. For many of my peers, and I'll include myself in this, that has been a difficult thing to do, getting that engagement. The fact that it was relaxed was a recognition of that difficulty. Stage 3 will be another difficult hill to climb, and that 25 percent number probably will get reduced, though I can't see in the future.
So for those who have gone to great lengths to engage patients, you don't think those efforts have gone to waste?
I wouldn't say that, because people will demand it. If they don't, then it's not a meaningful function. If it's a meaningful function, people will build good apps to use that data, and then there will be demand. We weren't at that phase, we were at the Blue Button phase, which was was providing data that you couldn't do anything with. Now, I'm no uber fan of meaningful use and its functions, but it's important to continue to focus on patient engagement and getting patients access to their data. But don't pay attention to those artificial percentages—they are not useful.
Have you been able to successfully engage patients at Intermountain?
Our portal, MyHealth, gets a pretty high percentage of use, and it does allow for secure messaging with clinicians, access to medical records, labs, standard functions like that. That's been our strategy to this point. We know we have to take it to next step. Right now, though we are involved with major Cerner implementation, so you cant do everything.
With MU, there does seem to be a continuous disconnect with what providers want and what the feds mandate. Why is this?
The government has a role in things that are of general interest to our country. Having the government define a series of functions that an electronic medical record (EMR) should do is not the right approach for meaningful use. I remember when Dr. Bill Stead (Vanderbilt University Medical Center) came into a policy meeting years ago having a detailed, well-written testimony around data liquidity. He said, and I paraphrase, "if you move forward with standards and data liquidity, you will be successful with meaningful use. If you don't, you will fail." And now when you look at the lack of interoperability, much of that has to do with not paying attention to what Dr. Stead said. We didn't achieve it, we didn't put the foundation in the right way. Now the government is laying more functionality on top of more functionality, and and thats exasperating the problem.
It's really too much abut the technology, the process, the functions. Years ago, Dr. Paul Tang (Palo Alto Medical Foundation) said during a policy committee meeting, "What are we trying to do? We're trying to save lives and lower the cost of care. Wouldn't that be meaningful use?" Regardless of the data entry or anything like that, that's the idea. Pretty much the whole committee was behind that at the time. We painted ourselves in a dysfunctional corner with Stage 1, and it's been very difficult to see our way out of it.
So do you have confidence in the government's direction moving forward?
I have tremendous confidence in Karen DeSalvo. Whether she can maintain that (not my trust, she'll always have that) and continue to do the things she's doing at the Office of the National Coordinator for Health Information Technology (ONC), such as rallying the troops, is yet to be seen. She's an excellent federal leader for all the right reasons. But when she moves on, who knows what will happen? ONC turnover has been a problem, and our legislators need to take a more serious look at the problems, and begin to legislate some of the solutions.
Let's talk about Intermountain. What's new in terms of population health initiatives?
Well, when accountable care organizations (ACOs) came out, we did not sign up, and that was deliberate. We didn't think there was enough emphasis on the patient at first, and on patient responsibility in healthcare. So we created our own strategies around sharing between patients and healthcare organizations. We have been doing a lot of work around how the finances will work, how we will do captivated care, and how we are going to contract with clinicians in the future. Much of that work has been going on for a good five years now.
How will we lower costs? We are actively driving costs down through information systems, which is near and dear to me, and also things like supply chain management. We have taken $250 million a year out of our operations just through better supply chain practices. Our goal has been CPI+1, consumer price index plus 1 percent, and grow at that rate in the future—2016 is the goal for that. So we have had a lot of strategy, process change and cost cutting to get prepared for population health.
On the technology side around analytics, we are understanding our populations better, doing better chronic disease management, and we continue to be focused around best practices of care, how we can do that in the most effective way. What's interesting around population health is that healthcare has looked at things as episodes of care, and now we're looking at things as longitudinal care for everything someone is doing in their life. We have Healthe Intent from Cerner, and underlying population health analytics tools to know what registries to put in place to support the care we're providing.
We are really focusing now on portals and mobile as well, bringing the clinician and patient closer together. I wouldn't say we're a leader or follower there, though I think we will be a leader eventually because we will invest appropriately in it. This is new to us, though. You don't want to be the first at everything, you want to learn from mistakes too. But we know we have to do it.
You recently blogged for HCI about taking a more holistic approach to data security, focusing less on penalties and audits. Do you see this coming to fruition?
Why are people trying to take healthcare data? Some of it is to do fraudulent transactions to banks and those types of things, but also to fraudulently bill insurance companies, and get paid for that. Look at the reasons why people are taking data and start protecting against that occurring—by definition, that would stop them from stealing our very private healthcare data. We need CMS, provider organizations insurance companies, and security experts getting in the room and solving the problems together holistically. Today, I'm spending tens of millions of dollars trying to protect it, and others are too. We're all attacking the symptoms, and now we need to cure the problem. It will take leadership that's been missing, and that's the job of the federal government. It's way better than threatening me with more penalties and wasting so much time in responding to potential breaches or violations of Health Insurance Portability and Accountability Act (HIPAA) policies. That time could be used to cure the problem, and yes, I do think it's possible.
Lastly, as an industry leader, what advice could you give to fellow CIOs?
First, as CIOs and leaders in healthcare, we cannot compete on patient data. It is ubiquitous, and we need to facilitate that sharing. Also, stop chasing bright and shiny objects. Just walk around here, they're all over the place. Work together, stop inventing it for just ourselves, but really work together to create solutions in healthcare. We are starting to coalesce around a smaller subset of major vendors, and we should start leveraging those relationships to solve the problem once for many people. We have to have ability to truly interoperate, whether it's CommonWell or Epic, or whoever. We will get to interoperability, but the challenge is will we get there in enough time to save as many lives as we could possibly save? We aren't right now, it's going too slow. And that's where the federal government needs to step in and provide leadership.
