AG: I completely agree about John (Glaser’s positive influence on defining “meaningful use”) and I’ve written as much. You may not know the answer to this, but there is also a Standards Committee that has yet to be formed. And there have been a lot of questions about what the differentiation might be between the Standards Committee and HITSP, John Halamka’s group. Do you have any information about the Standards Committee makeup, how it’s going to interact with the Policy Committee and the relationship of the Standards Committee to HITSP?
MP: I don’t know any of that, no.
AG: But they're good questions.
MP: They are really good questions. Blumenthal has just gotten in and HHS still needs to finish their appointments, I think it’s just all very preliminary. Congress basically set down the dates for GAO to have to have the first 13 in place. But I don’t know if there are those same triggers out there for the other committee or the other seven on the Policy Committee. I think GAO has just met the timeline that they had to meet.
AG: We’re all just working our way through this, right?
MP: The best thing about standards is that there are so many of them, right? I hope the Standards Committee can become a brokering point to say, ‘Whether or not they're the perfect standards, these are what we’re going to follow.’ Where does HITSP fit in this? Where does HL7 fit in this? I don’t know. We may only be 85 percent right in terms of agreement, but boy, it would be nice to have a target to go after.
AG: Let’s not forget CCHIT.
MP: Do we have to talk about CCHIT?
AG: We can never leave any acronyms out as far as I’m concerned.
MP: CCHIT in my book is really good; I’m just concerned about a blanket rule that every system has to be CCHIT-certified, boy, that’s got a lot of challenges in that statement, and I’d be careful.
AG: There are so many questions and so few answers. As you said, Blumenthal has got to settle in and then he’s going to bring John in. Sibelius has to settle in. But Blumenthal has been saying that we need to really take this slow.
MP: Yes, and I don’t know Blumenthal – I’m assuming I’ll have the chance to meet him. And Glaser is pretty thoughtful in his approach. Some of this has to happen pretty quickly if we’re going to get the incentives out in 2011 and have anybody receive them for good purpose. I personally believe — and I guess everybody is going to walk into this thing with their own perspectives — I think a lot of work has been done on standards. Our challenge right now is to pick the ones we’re going to go after, like I said, and get a target to go after. I think we need to look at what value we want to get out of this system, versus just a bunch of functionality. I don’t think everything has to take five years; I think things can be done relatively quickly to get us at least pointed in the right direction and doing things that will be of real value to healthcare.
AG: When we’re talking about standards, are you thinking of standards in terms of the CCD, the HL7-endorsed CCD, or are we thinking of more granular-type standards for actual fields within a document? Am I even thinking about this correctly?
MP: Yes. I think you are thinking about it correctly, and I think it needs to be quite granular. Standards in terminology, that’s obvious, but when I speak of sharing knowledge, I’m talking about protocols, workflows. They are the kinds of things that people will end up spending huge amounts of money and effort replicating, so you’ve got to get down to the data level. You can't assume, ‘Okay, great, by 2011, we’re all going to be on the standards,’ — that won’t happen. But again, I think we have to have a target that we can work toward. Even if we can’t reach it for 10 or 15 years, we’d have a huge impact on healthcare.
AG: If, for certification purposes, we define EMRs and PHRs very narrowly, will there be room left for competition? Do we need to have them defined so specifically that the competition is gone?
MP: Kind of. If I were to picture it, what you want out there, in a very simplistic way, is the iPhone for healthcare. The iPhone has defined a lot of the infrastructure over which their applications, their phone systems, everything, resides, but you’ve got lots and lots of people writing competing applications to work on that infrastructure – whether it’s your stock prices or your sports scores or GPS or whatever it might be. I think we have to get standard on the iPhone type of technology. So you’ve got the databases, you’ve got the terminologies, you’ve got the whole service-oriented technology with security – all those things which aren’t all that competitive.
The competition is around what's the best application, what's the best protocol for providing pneumonia, or what's the best interface for a physician and a nurse. The communication components to get those data available to them in a format they’ll use quickly – that’s where you should be competing, or ultimately should be competing, if you can get that infrastructure to be standard. That would be my view.
MP: No. I don’t think so. I mean it’s sure nice for Epic or Cerner or Eclipsys to tell their clientele that if they want to add new functions, you’ve got to go through them. So my guess is standards are somewhat threatening to them. Do we want 15 different gauges of railroad going around the United States or half the country driving on the left and half on the right? I mean you’ve got to have some standards if you want to get some of the benefits out of the systems.
AG: I really like your railroad analogy. I think that makes great sense.
MP: The government has got to get involved, right, if you want that.
AG: Yes. Your committee, as far as I can tell, is not going to be the committee that defines meaningful use. Is that going to be out of Blumenthal and Glaser’s side to define meaningful use, to set people up to qualify for the incentives or not qualify?
MP: I don’t know. The reading I've done, I've come to the same conclusion you did. I hope they ask us. I’d be surprised if they didn’t, but I do think that’s more on Blumenthal. Glaser’s role really isn't a government appointee, is it? It’s more that Blumenthal wants him in there.
AG: It sounded to me like it was semi-official advisory-type role, personally, to Blumenthal.
MP: Again, not knowing Blumenthal, but knowing Glaser, Glaser will ask a lot of people.
AG: The interesting thing is that Blumenthal was one of the authors of the Harvard report that came out about a month ago, which had such abysmal figures for adoption of healthcare IT in the hospitals around the country. At least you know that there is someone in there that knows how bad things really may be at this point.
MP: I’m actually very hopeful. I thought Kolodner was a good national coordinator. I thought he, again, was pretty well grounded. He didn’t get a lot of movement, I don’t know if that’s because of him or if that’s just the political process that didn’t allow it to happen. I thought he was pretty good. I think Blumenthal will be good, and the fact that he is leaning so heavily on Glaser gives me a lot of hope.