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One-on-One with ONC Standards Committee Member & Cerner VP of Medical Informatics David McCallie

May 14, 2009
by Anthony Guerra
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Despite tight deadlines, an undefined process and a massive mandate, McCallie is optimistic that the Standards Committee can rise to its challenge.

As ONC’s Policy and Standards Committees get off the ground, there is little time for pleasantries and much work to do. Under such circumstances, HCI will endeavor to interview as many individuals involved in the process as possible. In the past, we have spoken with Epic’s Judy Faulkner and InterMountain’s Marc Probst (Policy Committee); along with Harvard Medical School’s John Halamka, M.D.; Cleveland Clinic’s C. Martin Harris and Gartner’s Wes Rishel (Standards Committee). In this interview, HCI Editor-in-Chief Anthony Guerra talks with Standards Committee Member and Cerner VP David McCallie about how the industry moves forward from here.

AG: What do you expect to come from the meeting on Friday (the 15th)?

DC: We simply haven’t met yet and our formal charter is rather sparse. I don’t have specific expectations, so it’ll be a little bit of wait and see. What I would expect to happen, maybe not in the first meeting, but over a relatively short period of time, is identification of the steps that we can participate in – we the Standards Committee – to help define what a certified EHR is so that meaningful use can get defined and we can get moving with all of this. That’s pretty much what our charter is. I am pleased with the makeup of the Standards Committee, of the folks that I know, and I know half of them probably, they strike me as pragmatic people who have a strong interest in seeing this move forward, and so I think we should be able to get a lot done.

AG: You listened to the Policy Committee meeting, which took place on Monday. Tell me your impressions.

DC: I was only able to listen to the last half, so unfortunately, I missed Dr. Blumenthal’s initial challenge. I think the meeting was a little disorganized because it wasn’t clear what the committee assignments were, it wasn’t clear what the subcommittees were. That took longer than maybe one would like to see to those get formulated, but I believe they settled on some good choices. And the issues are so cross cutting, everyone is going to have to deal with everything anyway.

What’s unclear to me, and that meeting didn’t necessarily help clarify it, is what the role of the Policy Committee is as compared to the recommendations from NCVHS as compared to what Dr. Blumenthal himself will do. It remains to be seen how these various inputs will coalesce to a specific set of recommendations to the secretary.

AG: It should be fascinating, to say the least.

DC: Well, it will be Byzantine perhaps.

AG: I think that’s a fantastic word to describe what I’ve observed so far. From what I understand, the Standards Committee meeting was scheduled for the 15th basically to be in compliance with the requirement that it meet by a certain date. And then essentially the Policy Committee saw that date, realized that they had to give you direction and just scheduled their meeting a few days before. Is that your impression?

DC: I don’t really know how the timetable was set. I know that there is a great sense of urgency in all of these processes because the deadlines for producing the recommendations are short, and given that it takes the vendors a long time to respond to anything that would be a change, and a long time for physicians to purchase and implement these systems, and we have only a short period of time before the first year of measured reimbursement kicks in, everybody is feeling very pressured to move quickly. So some of the chaotic start may just be due to the intense time pressure.

AG: Whatever is ultimately formulated still has to be put out for formal comment, unless I’m incorrect, and you would imagine that would have to be a minimum of 30 days, which would have to be followed by a period of time when those comments would be examined and possibly the guidelines revised based on those comments, so there’s some major steps here.

DC: Yes. I think the interim final is due by the end of the year. I’m not an expert on government policymaking, but my impression is that the interim final can be treated as a final even though it’s still open for downstream revision. So they have a little bit of an out that would allow them to satisfy the law and move forward, yet come back and tweak it later.

AG: The goal, I believe, of the Policy Committee holding their meeting on Monday was to give you direction. Have you received any direction yet from the Policy Committee? Do you expect to get anything before Friday, and, if so, do you have any idea how that would come to you?

DC: A carrier pigeon, I think. Maybe Twitter. No, I think that the Policy Committee will provide direction. I don’t think all of that direction has to be provided between their first meeting and our first meeting. So I anticipate that direction will emerge from the Policy Committee’s subsequent deliberations and will guide the Standards Committee. It will happen quickly, but it won’t all happen in the first week.

AG: Does it make sense to you to have two separate committees, one focused on policy and one on standards? If you were setting it up, is that how you would have done it, or would it have made more sense to have people together because these things are so intertwined?