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LIVE FROM AMDIS: ONC’s Reider and Muntz Respond to CMIOs’ Concerns

June 26, 2013
by Mark Hagland
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Senior ONC officials field questions and comments from CMIOs

In a morning presentation to many of the nation’s leading CMIOs, Jacob Reider, M.D. and David Muntz, senior officials from the Office of the National Coordinator for Health Information Technology (ONC) offered their audience an idea of how they view the CMIO role in clinical transformation in the healthcare industry, and fielded a range of questions and comments from CMIOs, as the Physician-Computer Connection Symposium 2013, sponsored by the Association of Medical Directors of Information Systems (AMDIS), got underway at the Ojai Valley Inn and Spa in Ojai, Calif. on June 26.

Reider, ONC’s chief medical officer, and Muntz, the federal agency’s principal deputy national coordinator, first spoke about how they see the CMIO role in patient care organizations in terms of CMIOs being change agents in their organizations and translating broad policy goals into practical results in hospitals, medical groups and health systems across the U.S. At one point, taking a consciously light-hearted approach, Muntz described five stages of CMIO development in humorous terms as proceeding through a series of phases taking the CMIO from the status of “victim” to that of “hero,” to a final stage of “enlightened wonderment,” in which the CMIO thinks to her- or himself, per collaboration with others in the organization and beyond, “We’re great, but so are they.”

David Muntz

More seriously, Reider and Muntz attempted to convey what they cited as the centrality of the CMIO role in transforming healthcare, particularly in terms of helping their organizations achieve next-generation patient safety, care quality, and efficiency.

In that regard, Muntz drew his remarks towards a conclusion by saying, “We talk an awful lot about meaningful use, but what I’d like to talk about is what should precede meaningful use, and what should continue after it. We need to engage in meaningful conversation: why are we doing this? Who’s going to benefit? How are we going to measure success? How do we move people from engagement to active participation, so that both patients and physicians are active participants?” he asked rhetorically.

In addition, Reider noted that the Health and Human Services Health IT Safety Plan that was issued in December 2012 for public comment, will be published in final form relatively soon, though he did not specify a date. With regard to that program, Reider compared the goals for the program to the huge push in the airline industry for passenger safety a few decades ago, resulting in zero airline fatalities in the U.S. in the past 10 years. The FAA [Federal Aviation Administration] has an extraordinary program of airline safety,” he noted, “and we are actually thinking of emulating many of the elements of that program in healthcare, to continuously improve safety.” The three core components in the draft plan, he emphasized, focused on three words: “learn, improve, and lead,” saying, with regard to the “learn” part of that formula, “We need to increase the quantity and quality of data and knowledge about health IT safety. We want to capture the data in all of your facilities to determine what is going on that’s good and what’s bad; that this might be akin to the flight safety recorders in airplanes. We need to know at a much more granular level what’s going on so we can determine the sources of problems.”

Jacob Reider, M.D.

Following the conclusion of the dual presentation, Reider and Muntz fielded a variety of audience questions and comments, which varied in tone and approach from challenging to supportive, with regard to the meaningful use process under the HITECH (Health Information Technology for Economic and Clinical Health) Act. The first audience member, a CMIO from the Northeast, asserted his concern that the meaningful use process has actually negatively impacted him as a practicing physician, as fulfilling the requirements of meaningful use has reduced the amount of time he is able to spend with patients in each patient visit, harming his ability to spend the time needed to diagnose correctly.

“The meaningful use incentive program is in a period of transition; healthcare is in a period of transition from fee-for-service and towards fee-for-value,” Reider responded to the question/comment. “What I hear you concerned about is process… We have these intermediate outcomes represented in the meaningful use program. How do we see past this checkbox? Sometimes, the checkbox may actually not be as important as we thought it was. So how do we leverage the meaningful use program and aim towards the broader goal of better patient care and greater efficiency? I know it’s hard.”

Then a CMIO from the Midwest, who said she was a strong supporter of the meaningful use process, asked Reiter and Muntz how they could exert more pressure on electronic health record (EHR) vendors, as she expressed her extreme dissatisfaction with some of the core capabilities of the current EHR products on the market. What can federal authorities do to pressure EHR vendors to rapidly improve their products? She asked the ONC officials. In responding, Muntz cited the EHR Developer Code of Conduct voluntarily established by the Electronic Health Record Association in May, and whose creation is focused on achieving collaboration and transparency among EHR vendors.

CMIOs See Challenges

Following the session, Colin Banas, M.D., CMIO at VCU Health System in Richmond, Va., said that while he was not at all surprised by the broad range of sentiments expressed by audience members in their questions and comments to ONC’s Muntz and Reider, to the extent that there were challenging comments, “The comments reflect how difficult MU2 is,” and CMIOs’ anxieties over tackling Stage 2 of meaningful use in 2014. “We’re a very advanced organization in terms of CPOE, and everyone thought Stage 1 would be a cakewalk for organizations like ours—and it wasn’t,” he told Healthcare Informatics. “Meanwhile, MU2—the quality reporting requirements are on steroids. And as advanced as we are, MU2 is turning out to be very, very challenging for us.” Still, Banas said, there is a basic acceptance that the meaningful use process is not going away. “It’s all about the process challenges now,” he added.

On a broader level, Christopher Longhurst, M.D., CMIO at Lucile Packard Children’s Hospital at Stanford University, Palo Alto, Calif., commented that “What’s more important than what was said this morning was what was unsaid. The future of ONC is unclear, given that their funding expires, and nobody knows what’s in store beyond meaningful use.”

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