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David Muntz: People are Tired of Meaningful Use

February 25, 2014
by Mark Hagland
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Now in the private sector, Muntz shares with HCI his perspectives on policy and industry developments

When David Muntz left his position as Principal Deputy National Coordinator for Health IT at the Office of the National Coordinator for Health IT (ONC) last October 5, many in healthcare wondered what his next moves might be. As Muntz said in his first post-ONC industry interview, on Oct. 7,

his transition to the position of senior vice president and chief information officer at GetWellNetwork, an interactive patient engagement solutions provider based in Bethesda, Md.,

truly reflected his desire to continue to follow his journey of service to the healthcare industry, in this case, as a senior executive at a vendor company.

Still, Muntz remains deeply engaged in following recent developments in the healthcare policy sphere, and sat down on Feb. 25, during HIMSS14, the annual conference of the Healthcare Information and Management Systems society, being held at the Orange County Convention Center in Orlando, Fla., with Editor-in-Chief Mark Hagland, to discuss his perspectives on policy and industry trends. Below are excerpts from that interview.

You left federal service in October. How does the world look?

It looks good. It looks more peaceful.

What were your biggest learnings from being in government?

The government is filled with very intelligent, very passionate people, whose intentions are both honorable and broad. And they work for a lot less money and longer hours than most people would work, so the typical comments you hear about government are just not right. On the other hand, what you do see is, to create great policies, you really should have a deep understanding of the industries you’re trying to regulate. And there was an absence of the tools for that [at ONC]. So Farzad [Mostashari, M.D., the former National Coordinator for Health IT] purposely went out and found people, including me, Judy Murphy, [R.N., Deputy National Coordinator for Programs and Policy] and Jacob Reider [M.D., Chief Medical Officer].

And sometimes, even with adjustments like that, things still don’t always hit the mark. And also, as a generalization, with regard to politics, people practicing politics in the private sector usually have an outcome they’re trying to achieve, and there is a product or service they’re trying to create. In the government, the outcome is a policy, and sometimes, we hit the mark perfectly, and sometimes we miss. If it hadn’t been for the government, we would still not have the EHR [electronic health record] penetration we need. So the HITECH [Health Information Technology for Economic and Clinical Health] Act was an absolutely needed thing. On the other hand, I heard the word “lever” used a lot, as in, “Let’s use this policy as a lever to achieve a goal in the industry.” And sometimes, there’s a limit to that.

And the reason I left was to focus on the patient and the family, and tools. Patient engagement in the government is, I’m going to use the Blue Button or look at discharge policies. But the reality is that patient engagement also means the family and the community. The government really hasn’t made that connection yet. So the company I went with intervenes during the episode of care, whether in the hospital, or in the ambulatory setting, or in the home, so you can stop something before it becomes more serious. So that’s why I feel so passionate about what I do now; and I felt that way in the government, but I couldn’t fully effectuate that there.

And as we see the end of meaningful use, we’ll see an ongoing emphasis on IT. And we didn’t take care of behavior health, long-term care, prisons; we didn’t serve a lot of groups that need attention. And the nice thing about where I went is that everybody gets served. And I also hope that the new National Coordinator—who by the way I think is absolutely wonderful—will focus on things inside and outside the government, and will leverage resources to help serve all of HIT, and ultimately benefit what should be one word, patient and family.

What are your thoughts about the letter sent to CMS [the Centers for Medicare & Medicaid Services] and ONC from CHIME and 47 other organizations, yesterday? And what do you think of other such efforts, and options?

I think there is merit to the effort. Are there regulatory and sub-regulatory things that can be done [to make the deadlines more flexible]? I would frankly like to see [the timeframe requirements for Stage 2] be delayed, because a lot of people won’t be ready for Stage 2 completion. I want to see the implementation go well. Putting HIT in is easy; putting in HIT well is extraordinarily difficult. And it is not something that’s going to affect just a portion of the United States; it’s going to affect everyone in the country.

What might regulatory flexibility from the agencies look like in this instance?

Yes, you could establish a threshold above which people who exceeded a threshold are excluded from penalties, potentially. And so  being relieved of penalties would be good. So why not continue or expand the REC [Regional Extension Center] program to cover not only physicians, but hospitals, and particularly eligible professionals. There are things that could be done just through funding. Why not consider some of those things? The agricultural extension program is decades old; and why couldn’t you extend the REC program? And including into behavioral health and long-term care is something additional that should be done.