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HIT Voices: The Policy Challenges Facing Healthcare IT Leaders (Part 2)

August 22, 2013
by Gabriel Perna
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Edward Marx, senior vice president and CIO of Texas Health Resources

Never have IT leaders at hospitals and healthcare systems been tasked with as many policy mandates as they are being asked to manage currently. In the upcoming September issue of Healthcare Informatics,Associate Editor Gabriel Perna talked to several industry leaders on the scope of different policy issues facing healthcare IT leaders in 2013 and beyond.

Leading up to the release of that feature, over the next week or two, he will be publishing additional, extensive interviews of what was said by a few of these experts. Much of this has been left on the “cutting room floor.” Part 2 of this series is with Edward Marx, senior vice president and CIO of Texas Health Resources, a large multiple hospital system based in the Dallas area.

Below are excerpts from that interview.

What are some of the major policy issues facing CIOs for the rest of 2013?

I think you can break it down into three or four groups. One is all of the payment reform. The one that is most visible in that regard is accountable care organizations (ACOs), which Texas Health is involved in a couple and is pulling out of the Pioneer program [from the Centers for Medicare & Medicare Services]. And then you have value-based purchasing and pay for performance. That is one big area, [we’re focusing on] how to enable that.

The second big area is meaningful use—[and the question of whether or not] to delay or not to delay? The third thing is ICD-10 and [the question of whether or not] is everyone ready for that?  The final thing, and what I’m most interested in, is consumer engagement. Because to make all of these things work, you have to engage the consumers. And I’m not sure we’re doing that from a policy level.

How, if at all, has the delay of the publication of the Stage 3 preliminary rule impacted the work being done by healthcare CIOs such as yourself?

We are very fortunate to have forward-thinking leaders, from our CEO to our board of directors. We implemented an electronic health record [EHR], health information exchange, and patient portal technology, a while ago. We have what it takes to go with meaningful use Stage 3. But we recognize as an industry, we’re not there yet.  Whether, we’re talking about vendors or peer organizations, I think it’s good, they’re taking a look, pausing, and letting everyone catch up. It’s good for the industry. 

It’s an old story, but unfortunately it’s still true, it’s a lack of standards. We have some standards, but we yet can’t think to operate easily. I think the vendors are trying to play catch up. If you look at some of the most wired data that recently came out…I think related to even meaningful use Stage 2, and early Stage 3, with patient engagement and HIE measures, even the most wired hospitals I think were only 40-50 percent on certain measures. The rest were around 20 percent. You can see there is a lot of growth that needs to happen.

Would that same theory, delaying to give providers time to execute, then apply to changing the timelines of Stage 2, as has been discussed and debated by numerous stakeholders

That is the discussion. I don’t think it would be wise to delay Stage 2, because of the momentum question. There is a lot of pressure out there, pushing vendors, payers, providers, and everyone in the right direction. We’ve known about this for a long time. I think we’re past the tipping point on Stage 2. Stage 3 is still a ways out, and I think it would be appropriate for people to catch up on Stage 2, give them a pause to execute, and then hit Stage 3.

Will anything come of this?

I know there is a lot of pressure from associations and things of that nature, but I don’t think we’ll see a delay. People understand the need to keep the pressure on and keep the momentum going. Otherwise, people will get use to the fact that the government comes out with regulation, whether it’s HIPAA [the Health Insurance Portability and Accountability Act of 1996], ICD-10, and then there is delay after delay after delay, so they don’t worry about it. I think that would send the wrong message if you did that with Stage 2.

Why did your organization out pull out of the Pioneer ACO program?

I think I’ll just skip to our talking point on this one. [Texas Health issued a statement saying that it was on pace to save $10 million annually, but it was going to be liable for a penalty between $6 million and $9 million at the end of 2013 through the program]

Is this a longer-term issue for you and your colleagues at THR?

No, I think it’s definitely top five. We’re pursuing other accountable care arrangements. I think it is the future. What’s missing is that patient engagement element. Some of these Pioneer ACOs, the patients don’t even know they are in an ACO. Some of them. There is no personal responsibility. Until we incentivize consumers, we’re going to struggle in accountable care and new payment models.