If you’ve had enough of my posts from a talk Marc Probst gave, then you’ll be glad to know this is the last one. There’s no hiding my respect for Marc and hearing him in person did nothing but elevate that respect for him. Some of the comments below will feel a bit random, but I thought they were interesting enough to share with you all.

Meaningful Use and Certified EHR Overlap
I asked Marc about the challenge of reconciling the overlap between the certified EHR criteria modeled after the meaningful use matrix and meaningful use itself. It seemed that they were measuring basically the same thing. Marc’s response was, “That’s a battle I lost.” Then, Marc muttered under his breathe something about certifying the software versus the users. Basically, he was in agreement and under the same confusion I’ve had in regards to the value of certifying the software related to MU versus you actually meaningful using your EMR.

Challenge for Hospital Systems
At one point Marc talked about the challenge of a hospital to adopt an EHR if they haven’t started this already. He started listing off things like a data center and encryption. The data center for a hospital is a significant challenge that takes time. I’ve been a part of the design, creation and building of a couple of data centers and infrastructure like this takes time to implement. I still believe it’s premature to purchase an EHR, but I don’t think it’s premature to plan for things like network infrastructure, data centers, etc.

Certification and Procurring the Right EMR
I had to smile when Marc, co-chair of the EHR certification workgroup, said point blank, “EHR certification is not about procuring the right EHR system.” If you’ve read this blog for any length of time you know how I feel about this subject. Glad to hear Marc say it too.

Funding and EHR Adoption
Marc was really honest when he described that IHC had 0 doctors doing CPOE. I was surprised by this since my childhood doctor was from IHC and had an EHR back then. That said, Marc made an interesting point after saying that IHC had 0 doctors doing CPOE. He proceeded to say he didn’t think the reason they hadn’t adopted CPOE yet was because of a lack of funding. It was all the other things that took time to figure out which has delayed adoption.

On my twitter stream I was getting a number of skeptics around my previous post about meaningful use and EHR certification being simplified by CMS (Medicare & Medicaid Services). They seemed a bit surprised that CMS would simplify meaningful EHR use.

Let me add a little more content and context to why Marc Probst thinks the way he does about this subject and why I wholeheartedly agree with him that MU and certified EHR’s final rules will be simpler than they are in their current form.

One of the most compelling reasons Marc gave was when he talked about a meeting he had with David Brailer. In their meeting David Brailler told Marc Probst that “Meaningful use will be a small bump in the road.” Marc then described David Brailler’s reasoning. Basically, the EHR stimulus package is only $20 billion (yes, I rounded to make the math nicer) of spending by the government after you take into account the penalties and other savings they should achieve. If you look at that spending over the number of years it will be given out we’re looking at somewhere in the neighborhood of $3 billion per year (another round number) of spending by the government. Then, the all important question:

Is CMS going to put a bunch of major roadblocks in the way of the government spending $3 billion per year on EHR?

Of course the answer could be discussed, but the point is that $3 billion in the government’s budget is nothing. Yes, I’m cringing while typing that, but it’s true. That’s why David Brailer is dead on when he says that meaningful EHR use will be a small bump in the road.

Personally, I think this is a great thing. I’ve been arguing that the barriers to this money are too high that it would be a mistake for doctors and clinics to focus too much of their energy on getting the EHR stimulus money. Now if those barriers were to lower, we’d not only see the increase in interest in EHR software, but we’d also see a significant and meaningful increase in adoption and purchase of EHR software. Then, the fun really begins.

In my ongoing series of posts from Marc Probst’s visit to Las Vegas (you can see my first post here), these next comments by Marc were really interesting.

Marc said, “The guesses are good that CMS will dilute meaningful use.”

I also asked Marc a question about whether he thought that the HHS certification criteria would be less than what CCHIT submitted as their “meaningful use” EHR certification criteria. He responded that the HHS certification criteria will be designed around the meaningful use requirements (which we already knew) and so it is likely that if the meaningful use criteria are diluted then the HHS certification criteria would be diluted as well.

What do you think of the suggestion that MU will be diluted? Which parts of MU do you think will be diluted or do you wish would be diluted?

I had the privilege to hear Marc Probst speak on Friday and he was everything I hoped he’d be. I’ll be writing a number of posts from things I heard from Marc Probst over the next couple days, but I wanted to start with one thing Marc Probst said that was very interesting.

Marc said that he was afraid that the EMR stimulus money is going to make the rich richer.

Reminded me a little of my Big Winners from the ARRA EHR Stimulus Money post. I’m afraid like Marc that this is very accurate. The EMR stimulus money is going to end up in the rich clinics pockets.

A relatively new reader of EMR and HIPAA, Michael Archuleta, sent me his notes from the Utah Medical Group Managers Association 6/25/09 where the keynote speaker was Marc Probst. For those that don’t know, Marc Probst is the CIO of Intermountain Healthcare (IHC). IHC is huge in Utah and I think it does pretty well in a number of surrounding states as well. Plus, Marc Probst is also a member of the HIT Policy Committee. You may remember that I’ve talked about Marc Probst on EMR and HIPAA a few times before.

Anyway, I found some of the points that Michael captured interesting. I guess in the end I was interested to hear what Marc Probst was telling people. Michael Archuleta’s notes are as follows (published with permission and the emphasis added was mine to highlight some interesting parts):

Mark Probst – Intermountain Health Care – government wants to invest 42 billion in IT healthcare. IHC has 500,000 enrollees, 28,000 employees. 600 physicians. They are a unique integrated health care organization. Feels Obama framed the problem (related to health care, in previous nights TV pitch) well, and wants his plan in by Oct 09. Referred to how IHC is the lowest cost per capita.

Probst has met with 3 congressman and 20 government staffers. Using Mayo Clinic as a benchmark, could save 30 pct in chronic illnesses. There are 300,000 uninsured Utahns.

Four stages of an EMR. Third stage was commercial products. Stage four will have broad adoption of solutions. Second increased knowledge. Third is introduction of clinical decision support. A stage 3 EMR could save a 300 bed hosp at least 11M.

At LDS hospital there were 581 adverse drug events in 1990 and in 2004 there are only 270 . Their stats showed that waiting to 39 weeks (for OB delivery) was best for infants and reduced neonatal admissions. The docs said they knew this already and didn’t induce unnecessarily. But when showing them the data, they were in fact inducing. The same stats showed improved outcome with acute respiratory stress.

150 people are working on a new EMR system (for IHC) with GE and people from India. A complete clinical information system has automation (taking common tasks and automating it like voice, scanning, bar codes. Helps you with inventory management and pricing. Provides automated data entry with hot texting.), connectivity (using a network. Allows doctors to see and share information and this brings more specialists into the picture.), decision support (prompts and alerts for obvious things. Advanced decision support like glucose management and need to push the human mind.), data mining (using historical data to identify patterns and to test hypotheses).

Commercial systems were good at automation and connectivity but were weak on decision support. IHC was good in that area so they decided to build their own hybrid.

Rather than rip and replace, they aggregate, view, analyze, alert and then gradually replace existing systems.

The government HIT policy committee: Meaningful use says that to get money you need a certified system and have meaningful use. There must be a certification and an adoption. Must have the ability to do health information exchange. Time frames are aggressive: They originally thought they had until October to define requirements and then were told by the Obama administration that it was moved up to July 16. It will move from policy to a standards committee.

The intent and commitment of the people involved on the HIT committee is to do the right thing.

Questions from the floor: Doesn’t HIPAA preclude the ability to share information? In his opinion it allows for protection.

How do we get our voices heard? Have to get involved with AMA.

What is meaningful use? Capture discreet data like BMI, weight. Then there is an adoption process.

How will costs go down? If other things are in place, then we will minimize duplications. We may be connected but we can’t talk.

What about CCHIT? It is unclear what their role will be. IHC, for instance, is a hybrid of best of systems. Who would certify us?

Now that the HIT Policy committee has marginalized CCHIT EHR certification and proposed that HHS define the EHR certification criteria, it only seems reasonable to ask whether HHS will do a much better job than CCHIT did at defining “certified EHR.”

What has me a little concerned is the process the work they’ve done in creating the meaningful use guidelines. They are too complicated and I believe will leave us with a lot of unhappy doctors. It makes me wonder if the same will happen with defining the EHR certification criteria. A few things do give me hope.

First, the HIT policy committee’s suggestion is for the EHR certification to remain focused on just those things which are applicable to the EHR stimulus money. This should provide HHS with an advantage over CCHIT since it should mean a much more simplified list of EHR certification requirements.

Second, I’m a big fan of Marc Probst who was one of the chairs of the committees that put together the EHR certification recommendations for the HIT Policy Committee. I’m not sure how much involvement he’ll have going forward, but hopefully he’ll have a good part in it.

I guess at the end of the day, I don’t think that HHS could do any worse and probably will be quite a bit better. I’m sure there will be some issues with what they create. The question is just whether they’ll be minor annoyances which can be dealt with or whether they’ll be major issues which will cause doctors to not adopt an EHR even with the $44k hanging over their head.

Marc Probst, CIO at Intermountain Healthcare and member of the new Health Information Technology Policy Committee, gave a really interesting interview to Healthcare Informatics. I really don’t know Marc Probst other than what I read in this interview, but I do know something about Intermountain Healthcare (or IHC as it’s known in Utah). When I was in high school I actually worked for IHC spending one hour a day cleaning a local doctors office. I’m glad those days are over and I don’t think I did a very good job at it either.

However, from that experience and also my high school friend’s dad being the CEO of IHC I got to know the company pretty well. I was really impressed with how the company was run. From the above interview I think that Marc Probst probably has quite a bit to do with that. Let me give a few examples of things he said that I liked:

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.

Call me crazy, but I like I guy that’s not afraid to say that he doesn’t know. Makes me trust someone a lot more when they don’t try to fake something.

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.

My understanding is that IHC built most of their EHR systems in house. This may be why Probst is not so happy with the blanket statement of CCHIT, but he realizes he has to be politically correct enough to not bash it (something I haven’t learned).

Let’s just say that I’m quite happy to see Marc Probst on the Health Information Technology Policy Committee. I’m adding him to my list of really smart and thoughtful people in healthcare.

One of my loyal readers and colleagues in the EHR field recently sent me a link (pdf) to the list of members that were announced on the Health Information Technology (HIT) Committee. Take a look at the list of members on the HIT Policy Committee:

• Christine Bechtel, vice president, National Partnership for Woman and Families
• Arthur Davidson, director, Public Health Informatics, Denver Public Health Department; director, Denver Center for Public Health Preparedness; medical epidemiologist; director, HIV/AIDS Surveillance, City and County of Denver
• Adam Clark, research and policy director, Lance Armstrong Foundation
• Marc Probst, chief information officer, Intermountain Healthcare
• Paul Tang, vice president and chief medical information officer, Palo Alto Medical Foundation
• Scott White, assistant director, technology project director, 1199 SEIU Training and Employment Fund
• LaTanya Sweeney, director, Data Privacy Lab, Carnegie Mellon University
• Neil Calman, president and chief executive officer, Institute for Family Health
• Connie Delaney, dean, University of Minnesota School of Nursing
• Charles Kennedy, vice president, Health Information Technology, Wellpoint
• Judith Faulkner, founder, CEO, president and chairman of board, Epic Systems
• David Lansky, president and CEO, Pacific Business Group on Health
• David Bates, medical director for clinical and quality analysis, Partners HealthCare/Brigham and Women’s Hospital

I think the person that sent it to me was surprised that someone from Epic, a private vendor, was on the committee. What was more interesting to me was that there wasn’t one representative on the HIT policy committee from a small doctor’s office. There was plenty of hospital representation and public health but no one to speak for the small doctors offices. Sad part is that small doctors offices make up the major part of the US healthcare system and should be the ones who really need to access the HITECH Act EHR stimulus money.

Looks like my list of HITECH Act EHR stimulus winners is becoming more true every day. My list didn’t include small doctors’ offices and neither did their committee.