While the industry waits with baited breath to learn what meaningful use will mean, a few insiders are at the epicenter of that discussion. One of them is Intermountain Healthcare CIO Marc Probst, who sits on the HIT Policy Committee formed to help ONC Director David Blumenthal, M.D., lead HHS and CMS in the right policy direction. Recently, HCI Editor-in-Chief Anthony Guerra had a chance to chat with Probst about what the process is like, and where things are going.
Part I

GUERRA: Recently, Blumenthal told the Standards Committee not to be overly concerned about whether or not a standard could be quickly implementable, remarking that, “Things like this may move faster in the HITECH era.” Does that sound overly ambitious to you?

PROBST: Well, I don’t know the context of Dr. Blumenthal saying that; I respect him a lot. I don’t see him coming up with statements that are frivolous. It is a HITECH world, and things can certainly happen faster than they ever have before. There are the practical realities of people, though. Systems don’t implement themselves, and we tend to be the folks that slow it down, being a CIO (laughing).

GUERRA: Also in that meeting, someone had remarked it was important that what ONC puts out can be mapped to a CIO’s strategic three or five year plan. Does that make sense?

PROBST: Certainly, there has to be a realistic series of steps to get to where we’re going. It would be interesting to see where (that committee) goes with standards. You can certainly see some interoperability, and there’s a lot of standards out there. It would be wonderful if it can get to the point where they can just narrow it down out of the whole group of standards that are out there. I think you’ve got the smart minds on that committee to help do that, and with ONC behind it, maybe we can get there.

GUERRA: Let’s talk a little bit about your progress on the Certification Workgroup of the Policy Committee. What have been the most sensitive issues you’ve had to grapple with?

PROBST: Well, there’s a lot of tricky points. I mean, where does CCHIT play in this? Where does NIST play in this? How can you reasonably assure that either every product or every organization is certified in time for 2011? This is kind of an ongoing theme – just how quickly 2011 will get here. That’s a big challenge.

Another big challenge comes around self developed products or people that use a more best-of-breed approach. How do you certify that it’s a certified medical record when it’s not a single Epic or Cerner implementation, for example? Those are some big challenges we’re talking about right now. Certification, relative to security and privacy; that’s becoming more of a conversation.

CCHIT – they’ve done a great job, there’s no doubt about it. I think Levitt and his cohorts have done a really good job, but can you conceivably get everyone through that process? Can everyone even afford to get through that process between now and 2011?

I’m not trying to put an opinion out there; I’m just simply saying those are some of the tougher questions we’re trying to address. How often do you certify, how do you remain certified? Those are some of the bigger things that are out there.

GUERRA: Have you seen CCHIT’s new three-prong approach?

PROBST: I did. I saw that and I thought it was pretty creative, I thought that was pretty good thinking. We haven’t debated it at all, and I certainly haven’t gotten the details. In fact, I’m talking to Mark Levitt, I think, in a week.

GUERRA: During a Town Hall meeting, Levitt said there was no formal endorsement, but he put that new plan out to HHS or ONC and received a “favorable reaction.”

PROBST: I didn’t even get it through official channels; I got it from someone like yourself who sat in on it. I looked at it. I think they’re getting at some important issues and it was really helpful.

GUERRA: It seems to me that some of the proposals for 2011, 2013 and 2015 are forgetting the adoption step and moving straight to things like meaningful use and extracting clinical information for quality measures. Do you see that as well?

PROBST: Well, yes, and the AHA also has. That was really their big emphasis. One the one hand, they said that everything is too aggressive, which being part of a hospital organization that is a member of AHA, I can empathize with. But they really were strong in stating that you need this adoption period before you can expect meaningful use of it, and I thought it was very well put together.

There’s a lot of groups, there’s a coalition that’s headed by Abdul Bengali from Mayo, and there are a lot of participants in that. I talked to him yesterday, and he was explaining what their approach is and it’s very similar to that. So I think, thematically, from what I’m hearing from a lot of people, that whole adoption piece, we see it built in.

GUERRA: You have a major partnership with GE, correct?

PROBST: We do.

GUERRA: A few days ago, I interviewed GE CEO and President Vishal Wanchoo. That company is offering a no money down, no interest financing EMR package with repayment tied to HITECH. They are also guaranteeing customers that the product will meet whatever certification is deemed necessary. Sounds interesting, no?

PROBST: I think it’s a really interesting offer. In fact, I was debating with one of my internal folks. We talk about GE a lot, obviously, because they’re our partner. It’s kind of like talking about your wife I guess. J We were just brainstorming and wondering — if we were GE and knowing what we know about the economy, and knowing what we know about this ARRA and HITECH, what would we do? I didn’t realize GE had put that package together but that’s close to what we came up with. I think that’s pretty interesting.

GUERRA: One of the questions I asked Vishal was how many vendors, he thought, could offer something like this. GE Capital is putting aside $100 million for these loans.

PROBST: It’s not every vendor that could just write a check like that.

GUERRA: It may be attractive to some people who don’t have the money.

PROBST: Yes, and good for GE which has had a hard time getting real traction in the market. It could work for both the market and them very well.

GUERRA: Just one last question — You’re right in the thick of things, so what is your best advice for your CIO colleagues?

PROBST: I hesitate giving anyone advice because I’m not that smart. I think if you’re a practical CIO, it’s obvious advice; you need to be getting your plans in place for an electronic medical record. You have to have it. Now, that’s practical advice. If you’re asking me for philosophical advice or a comment – at some point we all need to step back and look at what’s right for our country. I will get comments from people that have fully deployed CPOE and those kind of things and they’ll suggest that 2011 is perfect, that’s a great deadline.

And to me, you’re not stepping back and looking at the whole picture here. If you’re a hospital in the middle of Iowa, the most automation you have is HBO Star from 20 years ago because, frankly, that’s all the capital you’ve had to deal with. And, frankly, you can handle your job on that, given your volumes and the problems that you had to face. If that is your situation, you have got such a tremendously difficult path from here to meaningful use or using a certified medical record, that we have to give these guys a break. And everyone isn’t on an equal playing field right now.

My philosophical advice is to make sure everyone is looking at this from the perspective of the country and not just their individual needs. You have to do that. You have to have the plans, you have to know where you’re going to go, you have to know what you’re going to install, but you also have to understand the endgame and appreciate that there’s a lot of participants.