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CAMBRIDGE, MASS. -- Meaningful use: a chaotic hodgepodge of misguided, if well-meaning, regulations.
Health IT budgets? Laughably small, but if you're a healthcare CIO, make sure your hospital directors approve funding for new health data staff and security.
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Provocative statements all, but it was just a normal day on the speaking circuit for John Halamka, M.D., CIO of Boston's Beth Israel Medical Center and a health IT thought leader known for his outspokenness and innovative flair.
On Monday morning, Halamka was addressing about 50 healthcare CIOs and health IT professionals at a leadership forum at the Hyatt Regency Hotel staged by the College of Healthcare Information Management Executives (CHIME).
"How do we navigate what is an increasingly rough time with limited resources and products that are really not that good?" Halmaka said. "My budget is 1.9% of our organization's operating budget. Fidelity [Investments] spends 39% on IT. That doesn't seem right."
Halamka: CMS is inconsistent
As for meaningful use, Halamka criticized CMS' incentive program for EHRs for what he said is drastic inconsistency on the key "view, download and transmit" measure, which shows how healthcare providers allow patients to receive their health records electronically and exchange them with another provider.
CMS in March backtracked on meaningful use stage 2 by replacing the requirement that providers use "view, download and transmit" with 5% of their patients. Now, in stage 2, providers only have to do it with one patient.
Yet, in the proposed new stage 3 rule -- which Halamka has criticized in his widely read blog -- providers will have to show that they used the measure with 25% of patients. "Does that make any sense? These thresholds for stage 3 are too high," he said.
On the stage 3 EHR certification side, Halamka called the proposed rule for stage 3 EHRs, or 2015 Edition, "431 pages of the kitchen sink" and said vendors would have to dedicate some 200,000 hours of developers' time to meet it as written now. The deadline for submitting public comment on the sprawling proposal is May 29.
"That rule must be rewritten from scratch. It needs to be wildly slimmed down," Halamka said.
Cheaper to spend on security now
Halamka also warned that health data security audits by HHS' Office of the Inspector General are coming soon and healthcare CIOs should prepare for them. HHS's Office for Civil Rights is also readying its first formal round of HIPAA audits of healthcare organizations and their business associates.
Halamka, whose hospital was fined $100,000 last year for a 2012 data breach involving the theft of about 4,000 patients' health data, acknowledged that incident and declared that such breaches could happen to any organization and should serve as motivation to invest more in security immediately.
"We've all been in the news. You just hope it happens to the other guy, not you," he said. "The world of security is a project that will never be done. It's a whole lot cheaper to hire security people and do security projects than deal with a breach, which can cost millions of dollars."
The emphasis on refreshing health IT organizations with new talent rang true for Robin Lang, associate CIO at CaroMont Health and CaroMont Regional Medical Center in Gastonia, N.C. She attended the CHIME forum at which Halamka spoke.
"I really liked his approach of disrupting the paradigm by bringing in outsiders," Lang said.
National patient ID future debated
On one issue championed by CHIME, a national patient identifier system, Halamka was skeptical.
"Um, not going to happen," he said. "Maybe we can get a voluntary opt-in patient ID system."
After his speech, Halamka said that while a national patient ID system could be beneficial, he thinks Congress, which has long refused to fund such a system, is so opposed to the idea that it is hard to conceive of a change.
However, Russell Branzell, president and CEO of CHIME, told SearchHealthIT that CHIME is making progress in Congress in getting the national patient ID issue back on the political agenda. CHIME is promoting a $1 million challenge campaign in support of a national patient ID.
"At least they're acknowledging that it's an issue," Branzell said of lawmakers.
Speaking about another topic of big interest, Halamka, like many other health IT thought leaders, declared that the future of healthcare reimbursement will be based on medical outcomes rather than fee for service.
And he said wellness apps, personal wearable devices and smartphones will be integral parts of that transition because they can effectively track key body metric indicators, such as glucose levels and heart rate, to care for patients with chronic conditions.
As an example, Halamka cited an app his hospital's IT team developed that allows patients and their families to track patients' conditions and hospital schedules on smartphones.
"You're going to see more things like this, apps sitting on top of EHRs and not waiting for EHRs to provide it," said Halamka, whose hospital system still uses its own "homegrown" EHR.
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