Marc Probst: Meaningful Use Stage 3 a mistake

After serving six years on the federal government's Health IT Policy Committee, Intermountain Healthcare CIO Marc Probst's term ended in June. And while, he said, many smart and passionate people are working to improve the industry, lobbies are just as influential in terms of change.

"The concept and the power of special interests is alive and well, particularly when you're talking about a $35 billion program," Probst said, referring to the Meaningful Use incentive program. "The federal advisory committees tried to filter through that, but I'm not sure that was always accomplished."

In an interview with FierceHealthIT at the recent College of Healthcare Information Management Executives fall forum in Orlando, Probst expanded on his committee efforts. He also talked about Meaningful Use and Intermountain's role in the Department of Defense's electronic health record contract.

FierceHealthIT: You've been outspoken about the focus of Stage 2 of Meaningful Use; how do you feel about Stage 3?

Probst: I can just tell you I'm incredibly disappointed we even have a Stage 3. It's just a mistake. It's just prolonging the program. We should have claimed victory, frankly after Stage 1, but clearly after Stage 2, and stopped the program. There's no real additional benefit.

Do I like the open APIs strategy? Absolutely. I think it's a great idea. It shouldn't be driven by Meaningful Use.

What I said around Stage 2 was, it should only be about interoperability and standards. That's all it should have been about. I'll tell you the same thing for Stage 3. If we have to have it, that's all it should be about. We're not getting to the real root of the problem.

FHIT: Karen DeSalvo has spoken recently and frequently about the need for standards and how it should have been addressed earlier. Is that encouraging?

Probst: Yes, it's encouraging. I'm a huge proponent of Karen DeSalvo; I think she's excellent. She gets it, she really does. She inherited Meaningful Use and she acknowledged that we need these standards. She's struggled with how to implement them and I don't think she's in full agreement with me. I believe they need to be legislated and created as law and forced upon the industry; I think she goes with probably the more realistic view of politics and how it can happen. But this is a national safety issue.

It's costing us money; we're losing lives every year; and even from a defense perspective, our national security is at risk because of all the costs and challenges of healthcare. This is something the government needs to take seriously.

They need to legislate this, and they need to just get it done.

FHIT: Clearly Congress has taken an interest in all of this. Is there hope that such legislation will actually happen?

Probst: The nature of Washington is to politicize things. This isn't popular. It would be really difficult. You're basically going to choose the winners and the losers, and likely, everyone will be a loser when you come up with standards because no one is standard--none of the vendors.

You're talking about a massive infrastructure lift. Like the railroads, it could be expensive, logistically very, very difficult and it's going to slow things down for a number of years. But what happens afterwards, once you've done that, progress is just rampant.

There are people that get it. We spend a lot of time with people in D.C. and they get the issue; I just don't think anyone wants to be as extreme in their language as I am. Of course, I'm not a politician, so I can be more extreme.

FHIT: At this time last year, ONC was going through quite a few changes, with a number of high-profile leaders leaving over a relatively short time period. What's your take on the current state of the agency?

Probst: I think Karen is managing ONC very well. The question is, do they have funding? Do they have the resources that are required to have a big time impact on the industry? I question that. She has tremendous influence because of who she is and the way she approaches it. But the Office; I just don't think it has quite the same panache, because it doesn't have the same kind of funding that it used to have. I hear a lot of people asking, "Are they relevant?" To me, they're relevant because of her, not because of a lot of other things that are happening.

FHIT: Your organization is providing guidance for the Department of Defense's electronic health record effort. Can you detail those efforts?

Probst: We're a subcontractor to Cerner on that contract. Cerner committed to the DoD to provide our build of Cerner. All the content, the care process models, the order sets, all those kinds of things around how we provide care at Intermountain will be the basis for what Leidos and Cerner will leverage with the federal government.

Obviously, DoD is going to make their own decisions, but this becomes the baseline.  

FHIT: What are your biggest takeaway from serving on the Health IT Policy Committee?

Probst: It astounds me how a couple of very well-placed leaders can absolutely sway decisions in D.C. I won't use names, but I think Meaningful Use is really the fruit of a couple of people--built upon, discussed, modified, molded a little bit--but the core of it was coming from a very small number of people; maybe one source. That's kind of amazing when you're talking about this kind of money. That doesn't make it wrong, and it doesn't make Meaningful Use wrong. In fact, the goal of getting electronic health records out to the majority of our country is a very good goal. The approach of dictating functionality and those types of measures we put in place, that was never fully thought through, I don't think. I think we should have focused 100 percent on standards, and if we had done that, we would have had a better outcome.

I think Congress got involved way too late. It was not interesting to them until it turned into a problem. It would have been nice if they had listened a little more upfront to some of the things, not just me, but what a group of people were saying.

Editor's Note: This interview was condensed for content and clarity.

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