EHR regulations, interoperability top patient record concerns
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SearchHealthIT and the College of Healthcare Information Management Executives (CHIME) collaborated to bring you a series of interviews with CHIME fellows, as a preview to National Health IT Week in Washington, D.C., Sept. 16-20. The series will also offer thoughts on the legacy of outgoing federal HIT coordinator Farzad Mostashari, M.D. This interview features CHIME fellow Indranil (Neal) Ganguly, vice president and CIO of CentraState Healthcare System of Freehold Township, N.J.
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What in your mind was Dr. Mostashari's most significant contribution to health IT during his ONC tenure?
Neal Ganguly: One of the things I loved about Farzad was his willingness to listen. More than any other national coordinator, he has really reached out to the front lines and engaged his entire organization in active feedback. I think that's been critical in shaping the meaningful use regulations to be much more attainable.
Would you agree that he took a lot of items from advisory committee meetings to heart, and hardwired it into meaningful use?
Ganguly: He did, and I also think [ONC as an organization] spent a lot of time really looking at the things from the comment period, processing that active comment work coming in from community and industry, as well as reaching out to organizations like HIMSS and CHIME, coming to the events and spending one-on-one time with the people in the trenches.
Do we need an M.D. or a CIO for Dr. Mostashari's successor? He had attributes of both.
Ganguly: He was a combination of a really dynamic cheerleader with somebody who had clinical knowledge, combined with somebody who understood the IT mechanics as well, a really unique combination. I think that it is a good mix of skills to bring into that role, although I feel it is very difficult to find somebody with all three of those. If I had to gauge in order of importance the skills I'd like to see the next coordinator have, I'd probably weigh pretty heavily on the side of somebody who has been in the shoes of those doing the work, who really understand the current state of health IT in this country -- somebody who understands the capabilities and limitations that we as an industry have to [deal with when it’s time to] deploy some of these things.
Right now, as I look some of the challenges rolling up with ICD-10, with the regulatory mandates that are flowing from value-based purchasing and accountable care organizations, those things that are really going to drive a lot of IT activity, I'm struggling with where my resources are going to come from to get this all done. Meaningful use feeds and supports all that, but it’s not always as well-integrated as we like. So it's so helpful to have someone with the on-the-ground understanding. If it can't be someone like Farzad with the M.D. and the IT credentials and dynamic leadership, I'd like to see someone with CIO credentials and real experience with rolling these things out -- [someone] who can act as the voice between the rule-makers and the industry to help make sure we're charting a realistic path.
How will IT support quality-based payment initiatives over the next five years, whether it's bundled payments, value-based initiatives, accountable care organizations or some new amalgam of them all that wins out?
Most providers haven't been in the payer game, so they don't have the tools from a human resource skill-set standpoint and a software standpoint to play in that arena.
vice president and CIO, CentraState Healthcare System
Ganguly: One, very simplistically, [by improving and streamlining] the communication between the players: The physicians, patients and the payers for these services. A lot of us feel that health information exchanges are the tool by which that [support] should be happening, and philosophically I agree with that. I don't think that the tools are yet at the maturity stage where they are enabling that kind of real communication and streamlining it to happen in a meaningful way. But that's where they're headed.
Two, from a provider standpoint I think there need to be tools to help providers evaluate risk better. These models are going to involve far more risk-taking on behalf of providers, and they need to understand how to run a business that way. Most providers haven't been in the payer game, so they don't have the tools from a human resource/skill-set standpoint and a software standpoint to play in that arena. I think that's got to change. We need to bring those tools to the table that will allow us to effectively understand what it really costs us to care for a certain population, and what are the triggers we can pull to reduce that cost if we more appropriately manage the patient?
Ganguly: I think the lack of a strong standard has caused tremendous problems from a technical standpoint as we try to ensure the accurate flow of information between these systems. Vendors have historically had no incentive to follow strict standards, and many of them have huge investments in the legacy products. Driving towards a very strict standard is probably time-consuming and expensive for them, and they'd like to leave things as-is if at all possible. But a lot of time is being wasted with [a lack of data standards], and frankly we're running up against walls when it comes to delivering information to patients in a meaningful way.
People right now in the health information exchange world are celebrating when they can move a CCD [continuity of care document]. That's a great first step, but it's the pure foundational level of what needs to happen. We need to move information that is discrete and able to be analyzed by these systems to allow us to manage populations, manage individual health. A CCD really isn't doing that for you. We are at the very early stages of information sharing. Without strong standards to lubricate that flow I just see [it taking] much longer for us to get to meaningful exchange. Right now we're working on technical exchange, not meaningful exchange.
Where's the return on investment for you in attending National Health IT Week?
Ganguly: A key value proposition is awareness building. I think our legislators have really begun to understand that IT really can play a role in improving healthcare, but the true complexity of it is still not [always] clear to them. Most people who are using technology are probably using iPads or PCs, and these are computer technologies that are relatively easy to understand.
But the complexity of these systems that we are deploying right now in hospitals, in provider offices to support the electronic collection of information and delivery of intelligence to allow healthcare to happen is of an order of magnitude beyond their scope of understanding. I think National Health IT week helps build that level of understanding up a little each year. The lack of strong [patient data] standards is costing us time and, more importantly, money. I think that message has to resonate with them so they can make intelligent decisions as they look at legislation or rulemaking around healthcare IT.
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