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Desperately Seeking Clarification

March 8, 2011
by Mark Hagland
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David Muntz speaks exclusively to HCI about an urgent MU issue

During the HIMSS Conference, held Feb. 20-23 in Orlando, a number of pressing issues came to the fore, as national healthcare IT leaders met with officials from the federal Office of the National Coordinator for Health Information Technology (ONC), including David Blumenthal, M.D., the national coordinator for health information technology, and Farzad Mostashari, M.D., deputy national coordinator for programs and policy at ONC, as well as Kathleen Sibelius, secretary of Health and Human Services (HHS).

HIMSS Conference attendees, representing hospitals, medical groups, health systems, and healthcare associations, were able to ask questions of those federal officials and get some face-time with them. Unfortunately, as numerous CIOs and other healthcare IT leaders who are national figures told HCI Editor-in-Chief Mark Hagland, some very important areas of confusion and concern remained, even after those face-to-face meetings.

As Hagland reported on Feb. 23, one of the biggest areas of concern that continues to cast its shadow over the entire enterprise of meaningful use effort under the HITECH (Health Information Technology for Economic and Clinical Health) Act remains a complicated set of questions around attestation for meaningful use in stage 1 and implementation with certified vendor products. What happens if a patient care organization chooses to retain its use of a niche vendor for, say, its emergency department (ED) system, while also seeking attestation for the use of a core clinical vendor? What kinds of certification must be obtained?

As David Muntz, senior vice president and CIO at Baylor Health Care System in Dallas, told Hagland at HIMSS, in his meetings with Dr. Blumenthal and Ms. Sibelius, he and his colleagues, including several who with him are policy committee representatives for CHIME (the Ann Arbor, Mich.-based College of Healthcare Information Management Executives, failed to get satisfactory, or even clear, answers to their questions around the vendor issue from the ONC and HHS officials with whom they met. In fact, Muntz told me today, he and his fellow CHIME leaders are this week sending a letter to ONC asking for clarification on the vendor question, as well as others.

In May, Muntz will be part of our "Meaningful Use-Core Infrastructure and Systems Challenges for CIOs: What are the Core Systems Implementation Hurdles?" at the Healthcare Informatics Executive Summit to be held May 11-13 in San Francisco. Below, please find excerpts from Mark Hagland’s interview today with David Muntz on these issues.

Healthcare Informatics: There remains a great deal of confusion around the vendor certification and attestation issue right now.

David Muntz: Yes. The thing that I see is that there is still grave confusion in the marketplace. And the thing that concerns me the most, and I’ve expressed this in a variety of forums, is that when you make a mistake in some contexts, such as Medicare billing, it’s considered fraud. So I’m pushing for clarification so that well-intentioned people can do the right thing. And when they set up the ATCBs, the temporary certification bodies—they described the process for repeal. And even in the HIPAA regulations, they talk about the difference between negligence, willful intent, and mistakes. So absence guidance in this area, I’m very concerned, particularly for hospitals that don’t have the staff we do, or physicians, who have no staffs, and their potentially making mistakes, which might be called fraud.

So what we’re doing at CHIME is putting together a set of questions to send to ONC, very soon. And one of the questions we’ve raised is for a clarification on vendors. And here’s the example we used: you buy a complete, certified EHR from vendor A; but you don’t install their ED system. You buy an ED system from vendor B, and install it, a certified EHR module. And you use those in combination, do you have to do self-certification? My answer would be, no, we shouldn’t have to; otherwise, we’ll all have to do it. Now, Eclipsys [Baylor’s core EHR vendor] has done a modular certification of their ED system, as well as their comprehensive system. So you can do it with the ED, or without the ED. So if you only bought the Eclipsys package without the ED, and you buy someone else’s certified ED, is that then a complete system. Of course, the big challenge is, how do you handle data that you have to derive out of those diverse systems? And how do you handle interface engines, and does that affect my certification?

HCI: I think people are realizing, including ONC, that this is far more complex than anyone realized. Is there anything else at that level of confusion and magnitude as an issue?

Muntz: I think that’s the thorniest set of issues, but the other has to do with just the timing, as the state and federal certification processes are not in sync, as some of the states are behind.

HCI: What would you advise people to do while we await clarification?

Muntz: Go to your professional organizations, and read as much material as possible. The press and professional organizations are trying to put clarifications out. The problem is, how do you deal with conflicting information? So I would suggest that you read the regs first; then go to the ONC and CMS websites, because they’ve done a pretty good job of explaining the rationale and preambles, and the FAQs are very helpful. So I’d start with ONC and CMS, then go to the professional organizations, then to the press.

To emphasize, it’s important to actually read the regs; and the preamble, I’ve found, is the most interesting piece of information, because it’s the explication of the thought process. And I know this is a lot of reading, but this doesn’t happen often to us. You really have a responsibility as a CIO to do that.


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