Prior to his speaking to an audience of physician group leaders at the Denver-based Medical Group Management Association's annual conference, held in October at the Ernest N. Morial Convention Center in New Orleans, David Blumenthal, M.D., spoke with HCI Editor-in-Chief Mark Hagland regarding the latest developments around meaningful use under the American Reinvestment and Recovery Act/Health Information Technology for Economic and Clinical Health Act (ARRA-HITECH). Below are excerpts from this exclusive interview.
Healthcare Informatics: What kinds of feedback have you been receiving from CIOs, CMIOs, medical group and hospital leaders, and others, since mid-July? What's your assessment of the ‘temperature’ of the industry right now?
OVERWHELMINGLY, THE MAJOR ORGANIZATIONS THAT REPRESENT PROVIDERS OF CARE ARE SUPPORTIVE OF WHAT WE WANT TO DO. THEY SEE THIS IS NECESSARY, DESIRABLE, INEVITABLE. THEY JUST WANT TO MAKE SURE THIS GETS DONE RIGHT.
David Blumenthal, M.D.: First of all, overwhelmingly, the major organizations that represent providers of care are supportive of what we want to do. They see this is necessary, desirable, inevitable. They just want to make sure this gets done right. I don't think they feel we've given them everything they want; but I feel we've given them enough in the way of flexibility so that it's doable. The latest survey of CHIME members [members of the Ann Arbor, Mich.-based College of Healthcare Information Management Executives) seemed optimistic. Some of the folks who had been expressing skepticism to me privately during the run-up to the final rule have said, we think this is doable. And there are no guarantees; this is a voluntary program, not a mandate.
HCI: But of course, there are penalties after 2015.
Blumenthal: Yes, though it remains an open question as to whether the prospect of such penalties will motivate providers in this area.
HCI: I spoke recently with the CEO of a major medical group in Northern California, who told me that he was deeply disappointed that medical groups are not recognized as formal entities under meaningful use. In other words, individual ‘eligible providers,’ including physicians are, but the groups, which could provide so much support, can't receive any incentives directly. Your reaction?
Blumenthal: First of all, the law pretty much specifies who's eligible for incentives. The law is the law, and we're implementing it. But I also had dinner last night with an old friend of mine who runs a 3,000-person network, and they're going like gangbusters to help their physicians. I do understand that there's no specific return to the medical group as opposed to individual providers, but I think there still is a large incentive to the groups.
HCI: Is there anything specific that might address medical groups’ participation, in Stages 2 or 3?
Blumenthal: I'd rather not address that specifically, but if we were authorized under the statute to do something in that regard that would help patients, we'd do it.
HCI: If there's a single area we've been hearing about that CIOs and other healthcare IT leaders believe will be the most difficult to succeed in under meaningful use, it's the area of quality data reporting. I spoke recently with Jane Metzger, principal researcher in the Emerging Practices division at [the Falls Church, Va.-based] CSC. She and her colleagues found in their analysis of the data reporting requirements that even reporting out ostensibly ‘simple’ items like VTE prophylaxis will actually involve gathering data from across numerous clinical information systems, most of which are not now interoperable in hospital-based organizations. If you were to acknowledge one area of particular concern among healthcare IT leaders regarding the core requirements, would this be it?
CMS IS GOING TO HAVE SOME VERY SPECIFIC REQUIREMENTS FOR REPORTING. ON THE ONE HAND, THE INITIAL IMPLEMENTATION MAY BE A CHALLENGE; ON THE OTHER HAND, FOR THE FUTURE OF QUALITY REPORTING, THIS IS A VERY IMPORTANT STEP.
Blumenthal: I don't know where the rub is going to come; we'll be watching closely to see where it is. CMS is going to have some very specific requirements for reporting. On the one hand, the initial implementation may be a challenge; on the other hand, for the future of quality reporting, this is a very important step. So I hope this will be a hard area, because it's an area of great importance [to achieve].
HCI: If you could summarize briefly your message to CIOs at this moment in time, what would it be?
Blumenthal: Have courage, keep going.
Healthcare Informatics 2011 January;28(1):40-44