LIVE FROM THE CHIME/HIMSS FORUM: CHIME’s Path Forward: CHIME’s Board Chairman Speaks

What’s necessary is for your vendor to automatically send the update to the med rec information to your electronic health record [EHR]. We may also ping the Surescripts database with the software enabled in an EHR, in a new upgraded version, by the way—and the physician is writing orders at that same time. And that same process should also occur at discharge, so that that database is pinged to make sure we know what you’re walking out the door with. Well, that was a new requirement in the EHR under meaningful use. And for some reason, the ambulatory EHR community got around that issue a while ago, and most of their solutions already incorporated that medication reconciliation “ping” with Surescripts into their solutions, so no upgrade was required. But now, on the inpatient side, we now have a new per-transaction fee that’s built into the process that we must pay.

I shared that with Claudia as an example of some of the issues we have to deal with, where not only will an MU requirement create a new mandate that will impose a new transaction fee on us for a process change, it will also require investment in upgraded software. So while the meaningful use measures are about the right kinds of things, and the benefits case for them is right, we don’t always understand the cost-side consequences of putting those measures into place.

Another clear example is around quality reporting [of outcomes and process measures]. You build a database with certain reporting metrics in it; well, to accommodate the database, you have to extend out your reporting model. So it’s the same kind of thing: all the vendors had a new development cost associated with the new reporting requirements around quality metrics, and so we’ve all had upgrade costs.

And you do think ONC understands that?

What I find is that when you sit and explain those things to ONC, that they understand.

From your standpoint, is the pace of required changes under MU about right? Or is it too demanding?

I remember a scene from the movie “City Slickers,” in which Billy Crystal’s character is all totally frazzled by all the things he has to deal with, and the guy who ran the dude ranch says, ‘You’ve got to remember the one thing.’ But there isn’t a ‘one thing’ for us in healthcare IT; instead, we’re trying to cope with Stage 2 of MU; trying to predict what will happen with Stage 3; and we’ve got a whole bunch of things coming out of healthcare reform at us, probably in 2014. And we’re struggling with bundled payments and ACOs; and all that requires good data; and we’ve got to get through the ICD-10 challenge. And many of us also have individual things coming at us back home, including ways to fund and support our research organizations. So the challenge is obviously one of keeping all the plates spinning. So that’s what I’m challenged about. The pace isn’t about just meaningful use—if it were only that, it would be fine. I do see some sensitivity with regard to the pace of that. And I understand politically the need to keep things moving forward at ONC.

And in terms of the demographics-driven changes to healthcare costs, I can’t imagine that the policy- and reimbursement-related pressure will slacken, correct?

I can’t imagine it either. Think about the biomedical device tax that was embedded into the ACA [a provision that imposes a 2.3-percent excise tax on the sale of medical devices under the Affordable Care Act]. It’s that sort of stuff that adds the additional pressure on us. It’s a pressure that you can’t anticipate—you just know that it will be one more thing that you’re going to have to manage on the margin.

Let’s talk about the process that led up to CHIME’s selecting Russ Branzell as its incoming CEO.

The conversation about upping the ante for CHIME’s leadership has been open for at least a few years now. The understanding has been that CHIME is continuing to grow, and the question that the board needed to work through and give itself some time to do, was, what did we need to do to allow the organization to continue to grow? And it might be in ways beyond what we know the organization to be like today. I said to my fellow board members, we need to diversify our portfolio—we needed to move down many paths to support our missions. And Rich [Rich Correll, who has been CHIME’s CEO and who is moving to the COO position on April 5 when Branzell comes into the CEO position] has been incredible in helping us to build this organization and move it along and really produce good results for over 20 years now. And when I introduced Jim Turnbull this morning to acknowledge his John E. Gall CIO of the Year Award, Jim mentioned having a conversation 27 years ago who introduced the term CIO to him and described what that role might be. And he said that conversation made all the difference to him; and that individual was Rich Correll. So I’m delighted that Rich will stick around and continue to run things, while we also bring a new face of leadership to the industry, and it’s someone who knows all the leaders in the industry, while we continue to run the operations of the organization. So Rich will continue to do that while Russ brings back new case studies to help us think of new possibilities.