When David Muntz left his position as Principal Deputy National Coordinator for Health IT at the Office of the National Coordinator for Health IT (ONC) last October 5, many in healthcare wondered what his next moves might be. As Muntz said in his first post-ONC industry interview, on Oct. 7,
his transition to the position of senior vice president and chief information officer at GetWellNetwork, an interactive patient engagement solutions provider based in Bethesda, Md.,
truly reflected his desire to continue to follow his journey of service to the healthcare industry, in this case, as a senior executive at a vendor company.
Still, Muntz remains deeply engaged in following recent developments in the healthcare policy sphere, and sat down on Feb. 25, during HIMSS14, the annual conference of the Healthcare Information and Management Systems society, being held at the Orange County Convention Center in Orlando, Fla., with Editor-in-Chief Mark Hagland, to discuss his perspectives on policy and industry trends. Below are excerpts from that interview.
You left federal service in October. How does the world look?
It looks good. It looks more peaceful.
What were your biggest learnings from being in government?
The government is filled with very intelligent, very passionate people, whose intentions are both honorable and broad. And they work for a lot less money and longer hours than most people would work, so the typical comments you hear about government are just not right. On the other hand, what you do see is, to create great policies, you really should have a deep understanding of the industries you’re trying to regulate. And there was an absence of the tools for that [at ONC]. So Farzad [Mostashari, M.D., the former National Coordinator for Health IT] purposely went out and found people, including me, Judy Murphy, [R.N., Deputy National Coordinator for Programs and Policy] and Jacob Reider [M.D., Chief Medical Officer].
And sometimes, even with adjustments like that, things still don’t always hit the mark. And also, as a generalization, with regard to politics, people practicing politics in the private sector usually have an outcome they’re trying to achieve, and there is a product or service they’re trying to create. In the government, the outcome is a policy, and sometimes, we hit the mark perfectly, and sometimes we miss. If it hadn’t been for the government, we would still not have the EHR [electronic health record] penetration we need. So the HITECH [Health Information Technology for Economic and Clinical Health] Act was an absolutely needed thing. On the other hand, I heard the word “lever” used a lot, as in, “Let’s use this policy as a lever to achieve a goal in the industry.” And sometimes, there’s a limit to that.
And the reason I left was to focus on the patient and the family, and tools. Patient engagement in the government is, I’m going to use the Blue Button or look at discharge policies. But the reality is that patient engagement also means the family and the community. The government really hasn’t made that connection yet. So the company I went with intervenes during the episode of care, whether in the hospital, or in the ambulatory setting, or in the home, so you can stop something before it becomes more serious. So that’s why I feel so passionate about what I do now; and I felt that way in the government, but I couldn’t fully effectuate that there.
And as we see the end of meaningful use, we’ll see an ongoing emphasis on IT. And we didn’t take care of behavior health, long-term care, prisons; we didn’t serve a lot of groups that need attention. And the nice thing about where I went is that everybody gets served. And I also hope that the new National Coordinator—who by the way I think is absolutely wonderful—will focus on things inside and outside the government, and will leverage resources to help serve all of HIT, and ultimately benefit what should be one word, patient and family.
What are your thoughts about the letter sent to CMS [the Centers for Medicare & Medicaid Services] and ONC from CHIME and 47 other organizations, yesterday? And what do you think of other such efforts, and options?
I think there is merit to the effort. Are there regulatory and sub-regulatory things that can be done [to make the deadlines more flexible]? I would frankly like to see [the timeframe requirements for Stage 2] be delayed, because a lot of people won’t be ready for Stage 2 completion. I want to see the implementation go well. Putting HIT in is easy; putting in HIT well is extraordinarily difficult. And it is not something that’s going to affect just a portion of the United States; it’s going to affect everyone in the country.
What might regulatory flexibility from the agencies look like in this instance?
Yes, you could establish a threshold above which people who exceeded a threshold are excluded from penalties, potentially. And so being relieved of penalties would be good. So why not continue or expand the REC [Regional Extension Center] program to cover not only physicians, but hospitals, and particularly eligible professionals. There are things that could be done just through funding. Why not consider some of those things? The agricultural extension program is decades old; and why couldn’t you extend the REC program? And including into behavioral health and long-term care is something additional that should be done.
Wouldn’t extending Stage 2 potentially abut into the timeframe for Stage 3?
Well—you might end up with a pattern of three years, two years, and three years. But because Stage 3 hasn’t been defined yet, why not make the thresholds lower in Stage 3, and stop doing meaningful use and focus on HIT certifications instead, and using the market in that way as a competitive advantage? We’ve reached critical mass; we’ve got almost full adoption. You’re going to have to use HIT if you want to practice medicine.
The fact is that we should concentrate on how you’re using IT, as a vendor, a provider organization, even an individual healthcare professional. So you could certify programs, you could certify people, you could certify technology. And why wouldn’t you think of certifying that? And by the way, those certifications wouldn’t necessarily have to come from the government. You could do it the way that CHIME [the Ann Arbor, Mich.-based College of Healthcare Information Management Executives] certifies CIOs, with competency certifications, usage certifications; and you could set a regulation that said, the patient-matching algorithm must yield a 99.9-percent match. And in two years, it’s going to 99.999 percent, and so on. And there’s a way you could get the industry to move forward outside meaningful use. To be honest, people are tired [of meaningful use], and that phrase is tired.
You realize that’s going to be in a headline, right? So you’re saying, let’s move beyond MU and find other ways to make things happen, then, right?
Absolutely. And the National Coordinator has a huge role to play in that. And the agencies and departments of the federal government, along, they’re strong, together, they’re powerful. And there’s that Kenyan proverb, if you want to travel fast, travel alone; if you want to be powerful, travel together; and the government should think of that. Karen DeSalvo is wonderful, and is uniquely qualified to do that.
Providers are frustrated by vendors—they’re asking me all the time now, why can’t we get them to be truly innovative?
And one of the things I pushed for that didn’t happen [while I was at ONC] was, I wanted ONC to put out outcomes that would deem features and functions through quality outcomes, so that rather than saying, this is the data you need to be collected, but rather, specify only the outcome. For example, I want you to get to 99.99 percent patient-matching capability. And so you’re going to produce an algorithm that produces that outcome, so certification is no longer based on features and functions, but rather than on the outcomes created.
Wouldn’t that require a lot of auditing?
No, because you’d be collecting those quality measures. The point is to focus on what you’re trying to accomplish, and focus on the measures you’d want to collect. I thought that was a simple approach, and it eliminates the checking of boxes. It’s demonstrating outcomes that show the quality outcomes.
Are you at all concerned about EHR vendor consolidation going on right now? Have we reached some kind of tipping point?
I can tell you that I am a strong believer in the free-market system, and that if a strong, agile vendor comes into the marketplace, they’ll capture market share. And the reason is because of the incredible onus that these vendors have, to give real-time, all-time access to their support and product. Being a CIO is one of the hardest jobs in the world—and to the extent that you can move to products based on a commodity or utility basis—monoliths are not known for being able to do that. So if you can come up with a more agile product and system, that will solve it.
So that isn’t a policy worry?
No, because the more monolithic a company becomes, the more vulnerable they become. What I am concerned about is that we achieve true interoperability.
And is proprietary interoperability real interoperability?
Well, many proprietary systems became de facto standards.
How do you feel about healthcare and healthcare IT professionals moving forward in the next few years? Are you optimistic, pessimistic?
Well, there is an awful lot of pressure on healthcare IT professionals, and I’m concerned with their being able to find the talent they need, and people who share the passion they have, to continue to do the important work they’re engaged in. But they’re all so dedicated. I’m very proud to be a health IT professional.