BREAKING NEWS: Russ Branzell Speaks First to Healthcare Informatics about CHIME’s Proposal for a One-Year Extension of Stage 2 of Meaningful Use

You can read that memo and white paper in a lot of different ways. We at CHME believe that the implementation of HI technologies is exactly the right thing to do, which is why HITECH was created in the first place, and was the right thing to do. There are definitely recommendations in that white paper that we agree with, in terms of interoperability, better patient matching, and outcomes realization. But even within those areas, ONC is working on those concerns. And if you look at the three major cycles of meaningful use, stage 1 was intended to push initial implementation. Stage two was always intended to blend further implementation with interoperability. Are we all heading absolutely true north? Not quite. But healthcare IT leaders have given their blood, sweat and tears in the past few years—now, have we seen all the benefits from it yet? Not yet, no. But having lived through those change cycles myself, you have to give kudos to what the field has done.

So obviously, you’re not endorsing the totality of the “reboot” proposal?

We believe there’s some accuracy in their concerns, but we don’t support a fundamental set of changes. We believe we’re heading in the right direction, and that the things we’re doing are fundamentally positive. CHIME does not want to get involved in politics; we want to make sure that this process is optimized.

How did the proposal come about within CHIME?

It’s a proposal we believe the industry needs for some maturation. What happened was that our board of directors did some analysis here to determine what would be a better appropriate amount of time to get stage 2 right, while they’re also doing the ICD-10 transition as well as some other transitions. We don’t want this to be pushed out for a very long period of time, but given the timeframes we’re looking at now, in most cases, when you make a big change, you take about a new year to implement a technology and then you need about a year to optimize that technology. We want to provide an opportunity to see the clinical, safety, process, and financial benefits of this. And this allows organizations that have not even completed Stage 1 to get going; it gives the vendors time to improve their offerings into stage 2 and 3. Most are ready for stage 2 in theory, but we all know that it will require quite a big ramp-up of technology improvement, as it did in Stage 1. And it’s not wrong, it’s just how software development works.

So, in summary, we think it’s the appropriate amount of time to ensure appropriate implementation and appropriate benefits realization.

What do you expect the responses will be from the stakeholders, including ONC oficials, Congress, the senators?

I don’t think anyone’s going to be surprised by this statement; it’s just a formalization of what many have been calling for. What I hope is that this will serve as a catalyst for discussion and debate about whether this will be the appropriate amount of time. Other societies and associations may come out and say, no, we may need less, or more, time.

Might ONC fear this could open a floodgate of demands for further delays beyond a one-year extension?

I don’t think so. I’m still on one of the committees—around stage 3 quality measures. And my work with ONC has been nothing but positive, professional, and extremely rational. And if this serves the purpose we want it to, to ensure that this program will be as successful as it can be. And if all sizes and types of providers are able to come along with us, that’s the way we could ensure that success. And I’ve worked very closely with Dr. Mostashari, David Muntz, and Judy Murphy, for years. I can’t tell you exactly what their public response will be; they don’t even have to technically respond to the “reboot” letter for some time. And we’re not questioning the separation of powers here at all. We just think that the timing is a little bit off now, and we want to make sure there’s time for improvement; and I’d be surprised if they didn’t agree with those basic points.

Now, per the response from the senators, we’ll see this week. We have meetings scheduled with most of those six senators, as well as with the staffs of other congressional leaders. And we’ll reiterate the point that if we were to stop something this fundamental in midstream, you could actually create some damage to institutions operationally as well as clinically. And this isn’t as simple as a reboot; it’s a very complex, nationwide, organization-by-organization implementation, for which slowing down probably enhances success, but stopping altogether probably creates damage.

Is there anything else you’d like to add?

Well, I hope what people take from this is that we believe that the vast majority of work is very positive—right direction, right reason. But like everything we do in life, there are still significant opportunities for improvement. We just have to make sure that we do it right. and with some small corrections and adjustments, we think we have an opportunity to make the meaningful use process a super-success.