In an industry full of incredibly busy executives, Chuck Podesta must surely count as one of the busiest. Podesta has for years been senior vice president and CIO of Fletcher Allen Health, a Burlington, Vermont-based health system encompassing one academic medical center and numerous ambulatory sites and physician practices. But there’s so much more to it than that. To begin with, in January 2012, Fletcher Allen created a corporate umbrella, Fletcher Allen Partners, which brought into the network Elizabethtown Hospital, a critical-access hospital in Elizabethtown, New York; and then in January 2013, Central Vermont Medical Center, a 100-bed community hospital in Berlin, Vermont, and 250-bed Champlain Valley Physicians Hospital in Plattsburgh, New York.
In part 1 of this two-part interview, Podesta described for HCI Editor-in-Chief Mark Hagland a number of the areas of activity that he and his colleagues have been involved in around accountable care organization development, health information exchange development, and data analytics work.
In this second and final part of the interview, he discusses some of the current issues around fulfilling the requirements for meaningful use under the HITECH (Health Information Technology for Economic and Clinical Health) Act, and his perspectives around those issues. Below are excerpts from that discussion.
In the first part of this interview, you described the work that you and your colleagues have been engaged in around ACO and HIE development, analytics work, and work in other areas. When it comes to meaningful use, it seems like that those organizations working to create more accountable, transparent, coordinated healthcare delivery, will end up meeting the Stage 2 requirements in any case, correct? So you are on record as being against timetable extensions for Stage 2, then?
Yes, I agree. But in terms of what a hardship case is, as defined by federal officials [from the Centers for Medicare and Medicaid Services, or CMS] with regard to the requests for timetable extensions under Stage 2, you can almost see it in what Intermountain is asking for, per Cerner [referring to the request for a hardship extension by the Salt Lake-City based Intermountain Healthcare, as it implements an electronic health record solution from the Kansas City-based Cerner Corporation, after years of using its own self-developed EHR]. And I don’t want to be too controversial, but I will be! And one of the things that Intermountain is saying is that they’re giving up on Stage 2, and they’re going to give up on the incentives, but their timeframe for getting Cerner in is collapsed, and because of that, that could be a patient safety issue.
And so what they’re saying to CMS is that, for us to meet some kind of semblance of Stage 2, you’re forcing us to adhere to very tight deadlines; but if you give us longer to implement Cerner, we’ll be able to implement Cerner better. But Intermountain has to take some responsibility for not making the decision to go to Cerner until late in the game.
And take any of these other organizations with self-developed systems. And those were hardships, too, when others made big vendor product shifts. I don’t want to preach from on high because we happened to implement our EHR in 2009. But you saw the dates: they’ve been there for a long time. And we’ve got to get past this idea that the government will keep moving dates. And look at ICD-10. I mean, the CMS testing could still blow up, and that could change things. But still… And the security thing with Microsoft XP being sunsetted on April 8, with no more new updates—the hackers can’t wait until April 9, because any PC with an unsupported version, they’ll go after.
So as CIOs, we should be preparing for the worst and hoping for the best. But people hope against hope for extensions all the time, and it drives me crazy. And a lot of large organizations are on government panels and have much more exposure to decision-makers than we do. And I think it would really send a wrong message to the industry if Intermountain got a hardship exemption. That’s just how I feel. I mean, what are you telling the little guys? What are you telling the CIOs of 100-bed hospitals who are killing themselves to meet the Stage 2 requirements?
Do you have any explicit advice for CIOs, around all the demands they’re facing in the current policy, regulatory, and operational environment?