GUERRA: It seemed that the first iteration of meaningful use was a bit light on specifics. In fact, Blumenthal seemed to send it back for repairs. Do you think it was lacking or was it a good first attempt?

PROBST: I think it was a good first attempt at taking reams of information and trying to distill it down to a direction for meaningful use, so I thought they did a very good job. It does lack in detail, obviously, just given the timeframe. When Paul Tang started speaking to it right out of the gate, he emphasized the importance of CPOE and he’s right. I mean there’s no doubt about it; that’s an important component of what meaningful use is. However it got moved up in importance but not farther out on the timeline, so that goal became unachievable from my perspective. So there were examples like that of things that are important but we’ve got to get some practical components in place to allow them to occur.

GUERRA: So it was just a bit too ambitious on the CPOE measurement, you thought?

PROBST: Well, that one particularly, but there are others that are pretty aggressive in the 2011 timeframe. And then you’ve got issues like the chicken and the egg thing, there isn’t a whole lot of capital out there right now, and if you haven’t purchased a system or selected one, what’s a reasonable? Is it reasonable to suggest you could get that done in 18 months? No, it isn’t. There are some of those pieces that, I think, need to be filled in.

My hope is that they go back and look at it, and take some of the aggressiveness out, or at least make it practically aggressive and call for work that can be achieved.

GUERRA: Is the fact that some items were a bit aggressive indicative of wishful thinking, or just natural for a first attempt?

PROBST: There’s probably some wishful thinking there, but that’s part of being aggressive in putting a plan together. Now there is an opportunity for people to comment on it.  

GUERRA: So it sounds like you are fairly pleased with the process so far. Is that accurate?

PROBST: That’s accurate. The only thing I am – and frustrated is too strong of a word – but it gives me pause, is the pace we have to work at to get these important things done. It’s very fast, and I can only imagine what’s going on at HHS in trying to do all the things they’re doing in the background to support us, but it’s really aggressive if you think about it.

GUERRA: That may shrink the comment periods. Is that one of the negative effects of such aggressive timelines?

PROBST: Well, you’re seeing the impact of that aggressiveness. I think it would have been wonderful for that workgroup to have had more time to work through some of the issues, for them to make it throw it back at the committee and then get more input from the committee members and feedback. If they had more time, perhaps some of the issues that are now arising could have been resolved in a natural process of the workgroup versus immediately being thrust into the public eye. But that time isn’t there; it had to come right out, and so we didn’t have the luxury of time or the luxury of more testimony. I don’t think that group had the opportunity to even have testimony; they basically took what NCVHS just put out and other people had provided, but they didn’t sit down and have testimony from organizations talking through this themselves.

So I think those are some of the things that surface because of the pace. Is it wrong? I’m not in a position to judge that what we’re doing is too fast. It just gives me pause that it’s happening quickly and we have to work quickly, and I think people are going to have to be understanding that because of the pace, they may not be perfect at every step.

GUERRA: It seemed at least half of the last Standards Committee meeting was spent trying to figure out what they were supposed to be doing, rather than doing it. I think a lot of that has to do with the bizarre way the HITECH law was written, so I’m not trying to blame anyone. Are you experiencing any of that on the Policy Committee? Do you think perhaps the Standards Committee is in a different position because they are supposed to take orders from the Policy Committee, and not many have been forthcoming yet?

PROBST: I think that on the Policy Committee we know what we’re doing at this point. The first meeting was kind of, “what does this all mean,” and I thought Dr. Blumenthal and his team did a pretty good job of getting us broken into these workgroups. These workgroups are functional. The group I’m on (Certification), I think it’s pretty functional. We’re not perfect but we are doing real work, we are making assumptions. We started without any definition of meaningful use, and now we have an initial definition of meaningful use, and that has tailored our conversation. My assumption is we have more data that’ll tailor even further around certification and adoption.

So on the policy side, given the pace we’re working at, I do think things are happening. Now you asked me the question, do I think the Standards Committee is in a little bit of a different position and I do think it is. Because if you think about the process — the Policy Committee comes up with policy, this is what meaningful use is going to be, for example. Then, if you take that and hand it to the Standards Committee and say, “Okay, let’s talk about standards that need to be developed in support of that, or not developed to support it,” whatever, how are they to go about it?

So I think it is different. They were purposely designed to take the information from one group and move it to the other. And, yes, I think it would be more challenging right now to be on that committee, than it is in the Policy Committee because I think we have very immediate steps and we know what we need to do.

GUERRA: My gut feeling is that the people on the Standards Committee are so high level and strategic in nature that they are not used to be in the position of waiting to receive orders.

PROBST: Well, I’m not sure I would say they’re just waiting for stuff to come their way, but you are right, they are tremendously bright. But there is a specific process that ONC has put in place, and they do want to get through these steps around meaningful use prior to us giving a whole lot of directions to Standards, but I don’t want to get into their heads. I understand what you’re saying — being on that committee and the way things are structured is probably frustrating to some of those folks. I wouldn’t be surprised if they’re feeling some of that.

Part II