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Taking the Wheel

September 25, 2008
by Kate Huvane
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CIOs are lending their time and expertise to ensure that legislation being passed reflects the needs of today's health systems

The role of the evolved CIO is multi-faceted, to say the least. One of the most important aspects of a CIO's job is being able to anticipate problems that may arise down the road, and crafting effective strategies for managing them.

As a growing number of CIOs are finding out, this responsibility isn't confined to issues that occur within the four walls of the hospital; rather, it extends far beyond to the laws impacting every patient in the United States. CIOs are also discovering that part of their responsibility includes keeping a close watch on legislative issues affecting health IT adoption, and doing their part to ensure that appropriate bills are being passed to push health IT forward. And as more proposals involving EMR and e-prescribing adoption progress into laws, CIOs are finding that being politically involved and educated isn't merely beneficial from an altruistic standpoint; it can directly impact how their health systems operate.

John Glaser

John Glaser

Bill Stead, M.D., associate vice chancellor for strategy/transformation and CIO at Vanderbilt University Medical Center (Nashville), is an active member of the Tennessee eHealth Advisory Council. Stead views that part of his life as public service, and feels that in the current health IT climate, it's simply too important not to be involved. And he isn't alone; in fact, this type of thinking is increasingly common among CIOs, many of whom now consider influencing legislation as another of their many duties.

Rich Correll

Rich Correll

“I think that CIOs need to be at the table, and they need to take the time to work on problems that go beyond their boundaries,” says Stead. “You aren't going to see a quick return on investment, but you will see it, and the CIO community needs to be part of that discussion.”

The way John Glaser sees it, health IT is going to keep surging ahead regardless. Therefore, the onus is on CIOs to steer legislation in the right direction and leverage their own experience to ensure that the bills being passed reflect the needs of the health IT industry, says Glaser, CIO at Partners HealthCare in Boston.

“You have to be mindful, as a CIO, that lawmakers want to do something, and if we don't help them, we run the risk that they don't do the right thing,” he says. “It's really important that people who live it — the experience of being in the trenches and in the reality of inpatient and outpatient care — that we bring that experience to the table and say, ‘Here's what would help, and here's what won't help.’”

Many now believe that the more CIOs make themselves available to provide testimony or lend an opinion, the less likely it is that legislation will go awry. For those still unsure of the potential impact of participation, Rich Correll, president and CEO of the College of Healthcare Information Management Executives (CHIME, Ann Arbor, Mich.) offers this piece of evidence: HIPAA.

When the Health Insurance Portability and Accountability Act was passed, he says, “All of a sudden it was law, and (healthcare professionals) had many, many challenging issues as a result of having to comply with it, some of which they might have felt did not made a lot of sense. This is an opportunity now to get ahead of legislation that's being passed, and to influence it and to hopefully educate those who are creating legislation.”

Being politically active, says Correll, offers CIOs a chance to influence what will happen, “rather than having to react, as in the case of HIPAA, to legislation that is created, sometimes without full knowledge of the impact of what is being passed into law.”

Taking a proactive approach is critical, according to John Halamka, M.D., who stresses that even if CIOs dedicate just a few days out of the year to the cause, it can make a significant difference. Halamka, who holds CIO positions at Boston's Beth Israel Deaconess Medical Center, Harvard Medical School, and Harvard Clinical Research Institute, was present during National Health IT Week, held in Washington, D.C. in June. At the marathon event, he served on the Honorary Steering Committee along with such health IT proponents as Senators John Kerry (D-Mass.) and Sheldon Whitehouse (D-R.I.), and Representatives Patrick Kennedy (D-R.I.), Tim Murphy (R-Pa.), Allyson Schwartz (D-Pa.), Phil Gingrey (R-Ga.) and Dennis Moore (D-Kan.), among others.

John Halamka, M.D.

John Halamka, M.D.

The experience, says Halamka, was well worth his time, as he was able to meet with several key players, including Sen. Kerry. He urges his colleagues to pitch in whenever possible, even if it means just giving a statement about a technology that was recently deployed.

“We need CIOs to testify about their own experiences with EMRs and CCRs, and to provide information so that we can establish best practices,” he says. “It's imperative that CIOs are involved in legislative activity. By getting involved, it's going to make your job easier in the long run.”

State-level success

One of the avenues that many politically active CIOs choose is involvement in state-level initiatives. Just recently, Halamka testified and gave statements for a bill signed into law by Massachusetts Gov. Deval Patrick (D) that will provide $25 million to promote the use of electronic records. The legislation, he says, will require hospitals and community health centers to adopt CPOE systems by 2012 and EHR systems by 2015.

Having a voice in state-level initiatives is key for Halamka — who serves on the board of directors for Massachusetts SHARE (Simplifying Healthcare Among Regional Entities), a regional collaborative operated by the Massachusetts Health Data Consortium (Waltham, Mass.). He is also chair of the New England Healthcare Electronic Data Interchange Network, a consortium of five of the largest payers in Massachusetts. Halamka is happy to lend his time, not only because he has a vested interest as a CIO, but also because legislation tends to advance at a more accelerated rate at the state level, especially in Massachusetts.

“We have a culture of total collaboration in Massachusetts,” he says. “IT initiatives aren't focused on competition, but instead on achieving the means to enhance quality for all patients.”

According to Glaser, Massachusetts owes its success to healthcare professionals who have made health IT a priority. “The CIOs and CMIOs have largely been the drivers,” says Glaser, who serves on the boards for both MA-SHARE and the Massachusetts eHealth Collaborative. He is also one of the incorporators of the upcoming American Health Information Community 2.0, an advisory body aimed at providing recommendations to Mike Leavitt, secretary of the U.S. Department of Health and Human Services (HHS, Washington, D.C.), on how to accelerate the development and adoption of health IT.

Stead concurs, adding that a key benefit of state-based programs is that “they're closer to the ground level,” which makes it easier to measure their success. Plus, he adds, “State projects have the great advantage that they tend to be based on real demonstration work.”

Stead speaks from experience. In 2004, Tennessee was awarded one of five grants from the Agency for Healthcare Research and Quality (Rockville, Md.) for $25 million over a period of five years to fund IT initiatives. According to Stead, the Tennessee eHealth Advisory Council developed the architecture for the plan, which involved establishing regional patient data sharing in the three counties that surround Memphis in southwest Tennessee.

The data exchange system is now up and running; however, it didn't happen without a great deal of collaboration about which technical approaches to use, and how governance would be established. “We're now almost four years into that work, and hopefully, as we come out of it, there will be some generalized takeaways,” says Stead. “Tennessee, I believe, is one of the larger states where we have people regularly at the table from all the regions. That's what the eHealth Council does, and I believe that gives us an opportunity to succeed.”

Among the other key initiatives brewing in Tennessee is the MidSouth eHealth Alliance, a project that involves aggregating full clinical data from all competing hospitals and safety-net clinics in a three-county region in southwest Tennessee; and the Vanderbilt Center for Better Health, a program created in 2002 by Stead and Harry Jacobson, M.D., vice chancellor for medical affairs at Vanderbilt University. The Center was established “to accelerate change in healthcare by taking people out of silos to work together and explore alternatives,” says Stead. To facilitate this goal, the Center collaborates with the Reagan Institute in Indianapolis, the New York-based Markle Foundation and New York-Presbyterian Hospital/Columbia University Medical Center.

“There is a professional family that's working in this space; it's not all isolated, as I'm sure most people would suspect,” says Stead.

Massachusetts and Tennessee are just two examples of states earning high marks in health IT; several others have made significant strides, including New York, Rhode Island, Pennsylvania, Minnesota, Arizona and California, among others (for more information on state-level activity, read “50 Little Labs,” page 54).

So the burning question is, if states can achieve success with health IT initiatives, why haven't federal efforts yielded the same progress? There is, unfortunately, no simple answer. While some pinpoint a lack of standards or interoperability, others say the process needs reforming.

“One mistake the federal government is making is letting the marketplace decide,” says Halamka. “That's not the way to do things. You need regulations and mandates in order to achieve the pace of change that we're seeing in some states.”

Glaser, meanwhile, feels that although national initiatives have been impaired somewhat by partisanship, perhaps the biggest roadblock is in trying to work through 50 individual sets of privacy laws. Correll agrees, adding, “As if the challenge wasn't hard enough to move the ball forward with e-prescribing, now you've got all these state laws with various requirements pertaining to controlled substances, so it's very difficult to enact national legislation that's going to encompass all those rules. Hopefully federal legislation can be modeled after what states have done, but it's tough.”

For Stead, the key to being able to translate state-level success to the national level can be found in interoperability. “What we really need to do at the federal level is to work out the standards,” he says. “I think that the federal government could accelerate that.” Stead believes the government is already expediting the process by mandating that all federal agencies must be standardized. This has been extremely helpful, he says, as it has helped convert “de facto standards” into national standards in terms of the penetration of various federal agencies and the amount of healthcare that they provide. “Each year, we do make progress,” he says. “But the gap between where we are and what I think we all feel we need to have the proper kind of healthcare, is very large.”

There are ways to narrow the gap, says Glaser, who adds he would like to see more funding allocated to the Office of the National Coordinator for Health Information Technology, and for HHs' Leavitt to be granted “as much breathing room and latitude as he should have.” He does, however, feel that the federal government has made progress. But if things are going to accelerate in that direction, CIOs need to accept more responsibility in steering health IT legislation, he says.

“We want the laws to have power. But we also aren't recognizing that those who write the laws really do want the guidance,” says Glaser. “It's our job to meet them halfway, and at least give them our two cents worth about what ought to happen.”

CIOs at the table

The last thing most CIOs need is another time-consuming role. Fortunately, there are many ways they can have some bearing on legislative activity without having to clone themselves.

“It takes lots of different forms,” says Glaser, adding that participation can entail testifying, writing letters, sitting in congressional hearings or participating in advocacy days, during which CIOs have the opportunity to meet with representatives and staff members. These meetings, he says, are critical, as oftentimes staff members play a pivotal role in drafting legislation. “You can meet with them and explain, ‘Here's what's going on and here's what we think needs to be done,’” he says.

Both Glaser and Halamka encourage CIOs to leverage memberships with organizations like CHIME, HIMSS (Chicago) and the Washington, D.C.-based American Hospital Association, all of which have government affairs or advocacy components, to become more involved (see sidebar).

For instance, members of CHIME can join the organization's Advocacy Leadership Team, a group of CIOs that “provide counsel regarding legislative and regulatory initiatives, advise CHIME, testify, and advocate on behalf of the organization,” suggests Sharon Canner, the organization's director of advocacy programs.

Through these activities, Correll says, CHIME hopes to “leverage the involvement of CIOs in these legislative developments. We'll have a CIO educate a group of Senate or Congress staff members all at once, for example. This is where our partnerships with HIMSS and the American Hospital Association come into play,” he says.

Indeed, the CIOs who were in attendance at National Health IT Week (for which CHIME is a partner) were able to meet with their state constituencies and explain their positions on certain bills. It was time well spent, says Canner. “We took a position on the electronic prescribing bill; we supported it, and that was passed and signed by Congress and the president, and put into place. As we know, what Medicare does, the private sector follows. So it's a major health IT advancement, we believe.”

However, it may not always be possible for CIOs to escape the everyday responsibilities of the job. In those cases, according to Halamka, the best thing to do is to simply stay abreast of what is happening.

“The two most important things are knowledge and education,” he says. “CIOs have to be plugged in. Go to news sites, read blogs — know what's going on. The CIO is an extremely busy person, but this is too important not to be involved.”

Looking ahead

Of course, the work of a politically active CIO, like any CIO, is never really done. While the political climate in the nation will most likely cool after the election, hospital executives need to stay active in the cause long past November, says Glaser. CIOs need to continue to work with staff members on a regular basis and “help them understand the issues and the challenges,” he says. “There will be new leadership in place, and so you might have educated staff people two months ago, but you'll have new people to deal with in a few months.”

The goal, he stresses, is that when Congress convenes next month, both at the state and federal level, it will be in a position to act fast.

“We're in an interesting time, and have been for a couple years now in which the country is wrestling with a variety of healthcare challenges,” says Glaser. “There's growing understanding on the part of the federal government, both the executive and the legislative branch, as well as state governments, that IT can be a very important and potent tool in reducing costs and making care safer.”

Healthcare Informatics 2008 October;25(10):42-48

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