CAMBRIDGE, MASS. -- At a private roundtable discussion convened by security vendor Imprivata the day after its HealthCon 2012 user conference ended, CIOs, physicians and other leaders weighed in on how the re-election of President Barack Obama will influence the future of health IT.
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While the participants represented views of various political stripes, they basically agreed on one thing: continued policy implementation methods by the Office of the National Coordinator for Health IT (ONC) probably will be more productive at this point in the evolution of the U.S. health care system's quest for patient data interoperability among providers.
Considering initiatives around regional extension centers (RECs) and health information exchange (HIE), the continued meaningful use incentives will enable adoption of accountable care organizations (ACOs), said Micky Tripathi, CEO of the Massachusetts eHealth Collaborative. That will help align the health care industry's overall payment model.
"There was a certain secular trend I think was already there, in regard to where health care was headed, toward value-based purchasing. Health IT was enabling that. In respect to meaningful use, whether or not it was going to accomplish all the goals that were set out, it without question has increased penetration of [electronic health record] systems much faster than it would have happened," Tripathi said, addressing how he believes ONC policy will help stabilize the health care market:
Meaningful use…without question has increased penetration of [electronic health record] systems much faster than it would have happened.
Micky Tripathi, CEO, Massachusetts eHealth Collaborative
"[Obama's re-election] has removed the confusion as to whether ACOs were going to survive or not. I feared we would have this period of great uncertainty where you have the private sector really headed toward value-based purchasing but Medicare and Medicaid stuck as the rocks in the fee-for-service world and not able to move forward. The ACO allows them to move forward and gives them incentives to do that."
Hospital IT leaders on the roundtable echoed that sentiment. They expressed relief that meaningful use in combination with ACOs commissioned via the Affordable Care Act would remain in place so they could finish what they've started under the first four years.
"I think it is hard enough for hospitals to re-jigger their preparations for health care reform, but to not be sure that that's fully going to take effect and to operate under a period of uncertainty...you need to optimize for one or the other," said Sean Kelly, M.D., Beth Israel Deaconess Medical Center ER physician and Imprivata CMO.
Meaningful use still a work in progress, but doing the job
None of the panelists claimed that meaningful use was perfect as implemented by ONC, but it does provide the roadmap to interoperability. "From the hospital perspective, it's probably going to be a much easier transition [than if Romney had won]," said Ed Ricks, CIO of the 197-bed Beaufort [S.C.] Memorial Hospital. "It's better to continue on the path, even if the path isn't exactly right."
Ray Campbell, the outgoing executive director of the Massachusetts Health Data Consortium, concurred. "The meaningful use program has been effective," he said, giving kudos to ONC leadership for quickly turning around a very complicated Congressional legislative mandate. "The national coordinator deserves a lot of credit for having taken a sketchy statutory framework. [He] really made an impressive set of rules and policies, and provided a lot of support."
Imprivata CEO Omar Hussain shared observations from his company's international customers, watching from afar the sometimes painful process of U.S. health care collectively digitizing its medical records.
"We're so close to it that we don't recognize the value of meaningful use," Hussain said. "When I talk to CIOs in the U.K. or the Nordics, they often say that they feel we're so lucky that we have meaningful use, because it's taking a population that is reluctant to change and use technology and it forces them to do it...if you don't use a technology, it's not going to have value."
Beware the fiscal cliff
Whether Romney or Obama had won, however, the financial future of the U.S. health care system would have remained in doubt. An Obama win didn't fix that problem overnight. Jeffrey Brown, CIO at the 189-bed Lawrence (Mass.) General Hospital, said the looming fiscal cliff and 2% across-the-board Medicare "sequestration" budget cuts could cost his facility millions if Congress and the president can't agree on measures to ease them.
"That's a huge variable...it will have a big dent in our [overall hospital] budget and the IT capabilities we can budget for," Brown said. "There are a lot of implications for medium-sized hospitals."
Frank Fear, CIO of Memorial Healthcare, a 150-bed community hospital in Owosso, Mich., said his facility has long been planning for cuts from Medicare and Medicaid, which comprise 60% of its revenue. Health IT could be a way to navigate narrow financial straits.
"We want to leverage technology like other industries, to be more efficient and increase revenue," Fear said. "So meaningful use comes along and accelerates all those things."
Editor’s note: Sean Kelly’s title has been updated to reflect he is the CMO of Imprivata, not CMIO.