Speaking to Healthcare Informatics live on site at HIMSS16 in Las Vegas, notable Intermountain Healthcare vice president and CIO Marc Probst said that the major interoperability pledge that leading vendors and health systems recently signed won't be enough on its own to get healthcare to where it needs to be.
Probst sat down with HCI Managing Editor Rajiv Leventhal at the Salt Lake City, Utah-based Intermountain's booth on the HIMSS exhibit floor. Probst discussed the big news at HIMSS16—the interoperability and open healthcare pledge—as well as other policy hot topics, and what's new at Intermountain regarding IT. Below are excerpts of that discussion.
Intermountain was one of the major healthcare organizations who signed onto this interoperability pledge. What will the health system's role be?
Our role is to continue to act as leaders in the importance of interoperability and not blocking data. How much better care can be if data is more liquid and able to move between organizations? Our role is to continue to do what we have been doing. We have been very engaged on the national front encouraging things like standards and improving interoperability. All of these things are a continuation of what I think we have already been doing. The pledge is our statement to the government that we will continue to do these things.
Do you think the pledge has enough of an accountability factor tied to it?
Our pledge will stick; whether the process the government kicked off in doing the pledges will stick, well, that is to be seen. It's going to take more than a bunch of people pledging that this is important. If you go through the list of the folks, all of them thought that these things were important before the pledge. So [the commitment] is really just a formality. The pledge is not enough, though. It's a good effort by the government to try to get people to rally around this topic and show leadership.
Can you expand on the pledge "not being enough?"
I was meeting with [National Coordinator] Karen DeSalvo [on March 1], and on the side of the conversation we started talking about standards and the importance of them. Interoperability is great, but if you can't use the data you can't make a big difference in healthcare. I know she believes that, but what she doesn't align fully with me is that I believe the government has to enforce a set of standards. And they can empower the private sector to go out and develop those, but they need to do it quickly. At some point we need a government action to say these will be the standards, and in 10 years, everyone will be using them or, you pay for it, or whatever—the or I cannot define right now. I think [Karen] thinks that's difficult to do, but I don't think there's any other way to accomplish it.
Do DeSalvo and other federal health IT leaders engage with and value the provider community's feedback enough?
I think she has been the most engaging National Coordinator that we have had, and really willing to listen. Now, she is in a difficult time, they have run out of money, budgets are tighter, it's harder to keep people focused and interested, but she is doing a great job listening. She is great with CHIME, and I'm the board chair of CHIME this year, so she's been great in working with us and gathering the information we need. Can there be more? Yes there can.
As a CIO, what would you like to see regarding future of meaningful use and MIPS/MACRA?
The government has the opportunity to declare victory in meaningful use. It did succeed in getting the adoption of EHRs [electronic health records], and there is more digitization of data. It even brought some parity because of the way the incentives were paid out to allow smaller hospitals and practices to get engaged in these EHRs. Take that as a victory. I don't think you need to do the math on how it worked, you'll probably get all kinds of opinions. Now let's look at MIPS and MACRA, let's include the hospitals in it, and look at how we are actually going to change and improve care versus a prescriptive set of checking the boxes that we had with meaningful use.
Can meaningful use be changed just like that?
The government can do whatever it likes to do. Seriously, they can. Continuing to push meaningful use and spend the energy on it is not helping to move the ball forward. There has been an underachievement on what it could do. If they would just change the direction and understand that we did achieve a certain amount with meaningful use, but we are done with that. Now, let's move forward with better outcomes, and let's even incentivize better outcomes, and there's ways to do that today now that we have the technology in place.
What's new with Intermountain regarding care management and population health?
We are doing a lot. Some of it is around patient engagement, and that's everything from virtual medicine, telehealth, asynchronous communication with the physician—all of these things will be really important. We are in the 'figuring it out' stage with this, so it's not in bulk yet. It's really exciting and it will make a difference. We have always been strong in analytics, but it's really neat what we're doing more with cognitive [computing] and learning systems. I think that has neat potential—looking at populations, how do you best care for that population, and how do you segment a population? We are headed in the right direction, but it's early in the process.
What are the biggest challenges for Intermountain around engaging patients?
Individuals don't interact much with the healthcare system, just because of our history. You went to get healthcare when you were sick. Maybe if your mom was a strong believer, you'd go to get a physical every year. Of if you needed to go to Boy Scout camp, you would get a physical. It was to solve a problem, a problem that you already had and recognized. The challenge now is to get people to interact with the system on a more regular basis. If we are going to keep people healthy, or help people become healthy, it's going to take a lot more nudging and interaction, and understanding their likes and dislikes. Some people will react well to diets, while some will react well to exercise. Some people will need help with making sure they take their medications, and for some it will just happen. We will have to understand that psyche and how we interact with those different populations. That will be a challenge and something that we haven't proven we're very good at yet.
What's the one thing that concerns you most as CIO?
That would be security. It's just that the bad guys are getting so darn smart, and they're changing things so quickly. It's a lot of money and angst. People ask me what keeps me up at night, and I know it's a trite question, but [security] is what does it. I think we need to deal with it holistically. I don't think we are addressing it as an industry very well, and I don't think we are fully looking at why they're taking our data and how come they are being able to monetize it. If we could look at the back end and say we won't put information out there that allows them to do the things they're trying to do, then they will stop tying to take our data. That will be the most likely way this ends—we just don't have anything of value for them. No one cares if I had a colonoscopy or not, they want to want to go out and get a mortgage.