The Future in Present Tense: One Industry Luminary’s Take on the Current Landscape of Healthcare

Now, in terms of the other issues—calls for the extension of Stage 2 or the delay of Stage 3—you’re seeing a lot of industry groups asking for relief in some way. And I’m very sympathetic to those calls because of all of the various things hitting the providers and industry at the same time. If we were just talking about meaningful use, I would say we should all just say, let’s just keep the pedal to the metal and keep going forward. And given the way the payment structure is, the more you extend it, the more it dilutes the outcomes. But ICD-10 is coming now, and that’s a big lift. We’re creating a statewide testing platform here in Massachusetts with the Massachusetts Health Data Consortium, with over 150 organizations. And rather than every health plan having to test with every provider on a paired basis, which is unbelievably inefficient, is there maybe a better way? Why wouldn’t you all pool your resources for this? Just think about Blue Cross having to test with every provider organization in the state and then Harvard Pilgrim and Tufts doing the same thing. But my point is, that’s a huge lift. And now you’ve got accountable care and value-based purchasing now changing the fundamental paradigms of how healthcare is being paid.

So meaningful use is sort of coming at the same time as everything else; and I think it would make sense to create some accommodations.

So what would your recommendation be, around that?

I don’t have a specific recommendation, and I haven’t looked, frankly, at what the impact would be of specific proposals like extending Stage 2 or delaying Stage 3. But I am very sympathetic to the need to perhaps consider that, because of these other factors. Perhaps we could extend Stage 2, keeping things moving forward while giving people a little bit more time in Stage 2, while keeping the Stage 3 timeline as it is, so that those who are ready can keep going.

Looking at the shift to the new healthcare, what are your thoughts? In your view, how are things moving forward right now?

I’m actually amazed at how fast things are moving. I would love to say that this is just how I predicted it three years ago, but in fact, it’s gone so much faster than I’d ever envisioned. I’m just amazed at how deeply the concepts of accountable care and value-based purchasing have already seeped into the industry. And so even leaders of community hospitals that aren’t actually yet in the pertinent risk-based contracts know what’s coming. That’s pretty amazing. And it’s also pretty amazing in that it’s hard to find a provider who doesn’t know where they are on the spectrum of EHR [electronic health record] development. Everyone has thought about it, and organizations either already have one of those, or are about to implement one.  And that’s somewhat true of HIE, too. And in terms of HIE, I’ve been amazed… I’m hard-pressed to think of a conversation I’ve had with any hospital where they weren’t thinking about HIE, whether they’re funding something or working towards it. If they don’t have a strategy, they’re in a high degree of angst about it.

So how far accountable care and patient-centered medical home concepts have penetrated into the industry, and how far the awareness of the need for EHR and HIE have come, those are all amazing. And HIE is happening faster than I would have thought, even a few years ago. There was this sense that it was swimming upstream, that it was a fight against the market. Now, both the good and bad news are that HIE is demand-driven and responding to the market. The problem is that the technologies are all so different. Just yesterday, I was looking at DocBookMD, they’re promoting an app to all the medical societies in the country. I’m not promoting them at all, but someone told me that 200 members of one medical society have signed up for this. And it involves taking a picture of an image. And you could do a screen shot of a problem list, so hey, wow.

My only point is that it’s now incredibly decentralized, and because technology is advancing so rapidly and putting more and more power into the hands of the individual, health information exchange is happening all over the map, but it’s a little bit chaotic. So the benefit of it is that it’s organically driven, and people really want it; the bad thing is that it’s quite chaotic The older conception of health information exchange was that it should be a bit more organized and you could get public health surveillance out of it. If you use DocBookMD and then you don’t want to participate in a formal HIE, you’re not going to get public health surveillance out of it.

And look at this: the first iPad come out in March or April of 2010, version 1; and now we’re just a little over three years into that era.

Do you think that physicians now understand that this shift is taking place towards the new healthcare?