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.
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