On May 6, the Ann Arbor, Mich.-based College of Healthcare Information Management Executives (CHIME) issued a formal response to a critique by six Republican U.S. senators of the meaningful use process under the Health Information Technology for Economic and Clinical Health (HITECH) Act. CHIME’s leaders called for a one-year extension of Stage 2 under meaningful use, arguing that such a move would “maximize the opportunity of program success.”
In responding to the April 15 release of a white paper by six Republican senators (John Thune, S.D.; Lamar Alexander, Tenn.; Pat Roberts, Kan.; Richard Burr, N.C.; Tom Coburn, Okla.; and Mike Enzi, Wyo.) calling for what those senators had said was a needed “reboot” of the meaningful use process under the HITECH Act and asserting that the program itself was fundamentally flawed, CHIME’s leaders, wrote a letter to those senators, signed by Russell P. Branzell, CHIME’s president and CEO, and George T. “Buddy” Hickman, CHIME’s board chair. In the letter, CHIME’s leaders said, “While we share some of your concerns with the current state of interoperability, we strongly believe that EHR [electronic health record] incentive payments under the policy of meaningful use have been essential in moving the nation’s healthcare system into the 21st century. One of the goals behind meaningful use is to eliminate inconsistency and variability long-since built into healthcare information technology systems.” CHIME’s leaders strongly defended the core foundations of the program against the accusations launched by the six senators, while asserting that a one-year extension of Stage 2 of meaningful use was called for.
The release of the letter coincides with an immediate policy push: on Tuesday, May 7, CHIME will hold its first-ever CHIME Public Policy Symposium in Washington, D.C., emceed by Russ Branzell, in which healthcare CIOs will share their experiences and perspectives on meaningful use with an intended audience of congressional staff, federal agency staff, and healthcare IT vendor executives. Among the CHIME leader CIOs who will participate will be Randy McCleese, Chuck Christian, Albert Oriol, Pamela Aurora, Neal Ganguly, and Susan Heichert (CIOs of St. Clair Regional Medical Center, St. Francis Hospital, Rady Children’s Hospital of San Diego, Children’s Medical Center of Dallas, CentraState Health System, and Allina Hospitals and Clinics, respectively). Then on Wednesday, May 8, Branzell will lead a delegation of CHIME leaders to meet with staffs of several of the six Republican senators behind the “reboot” proposal, as well as with staffs of a number of other members of Congress.
Branzell will also be participating in the Healthcare Informatics Executive Summit, to be held may 15-17, in San Francisco. He will be the opening keynote speaker on May 16, when he will speak on the topic, "Charting a New Course in Healthcare: How Organized IT Leadership Can Actively Shape Healthcare's Future."
Upon the announcement by the CHIME organization on Monday morning, Russ Branzell gave HCI’s Editor-in-Chief Mark Hagland the industry’s first interview on this subject. Below are excerpts from that interview.
Would you describe this set of activities this week as an unprecedented policy push on the part of CHIME?
I’m not sure it’s unprecedented. This is a public policy position and HIT industry request in answer to, one, the senatorial reboot white paper; and two, a reaction to HHS and CMS [the federal Department of Health and Human Services, and the Office of the National Coordinator for Health IT], relative to where we are relative to the state of the industry. And obviously, part of this will be our proposal for a one-year an extension to Stage 2.
Russell P. Branzell
How do you view the “reboot” letter and white paper? Do you see it as a fundamentally political response to the White House’s efforts around HITECH?
Actually, the way I see it is that those senators are duly responsible elected officials, and as agents of the people have full right and authority to question how federal money is spent; I think it’s their duty to do so.
Still, the “reboot” white paper is a pretty severe indictment of the HITECH program at a fundamental level, isn’t it?
You can read that memo and white paper in a lot of different ways. We at CHME believe that the implementation of HI technologies is exactly the right thing to do, which is why HITECH was created in the first place, and was the right thing to do. There are definitely recommendations in that white paper that we agree with, in terms of interoperability, better patient matching, and outcomes realization. But even within those areas, ONC is working on those concerns. And if you look at the three major cycles of meaningful use, stage 1 was intended to push initial implementation. Stage two was always intended to blend further implementation with interoperability. Are we all heading absolutely true north? Not quite. But healthcare IT leaders have given their blood, sweat and tears in the past few years—now, have we seen all the benefits from it yet? Not yet, no. But having lived through those change cycles myself, you have to give kudos to what the field has done.
So obviously, you’re not endorsing the totality of the “reboot” proposal?
We believe there’s some accuracy in their concerns, but we don’t support a fundamental set of changes. We believe we’re heading in the right direction, and that the things we’re doing are fundamentally positive. CHIME does not want to get involved in politics; we want to make sure that this process is optimized.
How did the proposal come about within CHIME?
It’s a proposal we believe the industry needs for some maturation. What happened was that our board of directors did some analysis here to determine what would be a better appropriate amount of time to get stage 2 right, while they’re also doing the ICD-10 transition as well as some other transitions. We don’t want this to be pushed out for a very long period of time, but given the timeframes we’re looking at now, in most cases, when you make a big change, you take about a new year to implement a technology and then you need about a year to optimize that technology. We want to provide an opportunity to see the clinical, safety, process, and financial benefits of this. And this allows organizations that have not even completed Stage 1 to get going; it gives the vendors time to improve their offerings into stage 2 and 3. Most are ready for stage 2 in theory, but we all know that it will require quite a big ramp-up of technology improvement, as it did in Stage 1. And it’s not wrong, it’s just how software development works.
So, in summary, we think it’s the appropriate amount of time to ensure appropriate implementation and appropriate benefits realization.
What do you expect the responses will be from the stakeholders, including ONC oficials, Congress, the senators?
I don’t think anyone’s going to be surprised by this statement; it’s just a formalization of what many have been calling for. What I hope is that this will serve as a catalyst for discussion and debate about whether this will be the appropriate amount of time. Other societies and associations may come out and say, no, we may need less, or more, time.
Might ONC fear this could open a floodgate of demands for further delays beyond a one-year extension?
I don’t think so. I’m still on one of the committees—around stage 3 quality measures. And my work with ONC has been nothing but positive, professional, and extremely rational. And if this serves the purpose we want it to, to ensure that this program will be as successful as it can be. And if all sizes and types of providers are able to come along with us, that’s the way we could ensure that success. And I’ve worked very closely with Dr. Mostashari, David Muntz, and Judy Murphy, for years. I can’t tell you exactly what their public response will be; they don’t even have to technically respond to the “reboot” letter for some time. And we’re not questioning the separation of powers here at all. We just think that the timing is a little bit off now, and we want to make sure there’s time for improvement; and I’d be surprised if they didn’t agree with those basic points.
Now, per the response from the senators, we’ll see this week. We have meetings scheduled with most of those six senators, as well as with the staffs of other congressional leaders. And we’ll reiterate the point that if we were to stop something this fundamental in midstream, you could actually create some damage to institutions operationally as well as clinically. And this isn’t as simple as a reboot; it’s a very complex, nationwide, organization-by-organization implementation, for which slowing down probably enhances success, but stopping altogether probably creates damage.
Is there anything else you’d like to add?
Well, I hope what people take from this is that we believe that the vast majority of work is very positive—right direction, right reason. But like everything we do in life, there are still significant opportunities for improvement. We just have to make sure that we do it right. and with some small corrections and adjustments, we think we have an opportunity to make the meaningful use process a super-success.