Evan Steele: Dealing with government health IT regulations is 'like playing chess'

For Evan Steele, CEO of electronic health record vendor SRSsoft and author of the blog EMR Straight Talk, the uncertainty surrounding healthcare IT regulations is a big deterrent from what he deems the most important aspect of his business--customer service. 

"It used to be you just had to focus on what the doctors needed," Steele told FierceHealthIT in an exclusive interview at last week's Healthcare Information and Management Systems Society's annual conference in Las Vegas. "Now there's all this noise, especially coming from the government, that you've got to think about, and how that is going to affect your business. It's like playing chess."

Steele, whom I talked with just prior to the Meaningful Use Stage 2 announcement, discussed his thoughts on CMS' announcement it will delay the ICD-10 implementation deadline, as well as why he thinks specialists (his primary client base) aren't getting enough love in the whole Meaningful Use process. Below is a portion of that interview.

FierceHealthIT: You discuss the importance of customer service in a recent blog post. Why do you see that as being so vital in this industry?

Evan Steele: It's everything. I like to say with great service comes a great product. If you have great service and a mediocre product, your clients will be far better off than if they had an awesome product with poor service--that's how important service is. Especially as you go through all the complex Meaningful Use requirements; clients have no clue what's going on, doctors especially. They're busy 60 and 70 hours a week dealing with their patients. So they really need the vendors to come through and provide excellent service, answer questions, have great training programs for Meaningful Use. Not just say, 'here's the software, good luck, and here's a little manual.' You've got to hold their hands. It's a complicated process.

We spent--between going to Washington, D.C., listening in on CMS phone calls and attending webinars--two years learning the system. You've got to be able to propagate that to your client base. Otherwise, the best product in the world is not going to get the doctor where they need to be.

FHIT: In the wake of all the big-splash headlines of late (Meaningful Use Stage 2 and the ICD-10 deadline delay), is there anything that's been forgotten about that deserves attention?

ES: The specialists. This is a primary care program. The regional extension centers focus on funding for the primary care doctors. There are some specialties where not one quality measure applies to them. There are lots of Meaningful Use measures out there that are very primary care focused. The specialists are really being forgotten about and I think that they shouldn't be. They should try to craft regulations that will apply and help the specialists, instead of the specialists sitting there, scratching their heads trying to figure out whether or not the rules apply to them. There's no clarity for them.

At the HIT Policy Committee meetings, specialists will come up and talk about it a little bit, but then someone almost inevitably always says "we don't have time to talk about it." They get short shrift.

FHIT: Why do you think that is?

ES: A handful of diseases--diabetes, hypertension, coronary artery disease--they're basic primary care issues. Those problems and diseases make up the lion's share of the costs in the health system, so naturally the government should focus on that--I don't disagree with that.

But if they're going to come up with a program that's based on primary care, why are they scaring the specialists that they're going to penalize in a few years if they don't get EHRs. Most EHRs out there are primary care related.

Primary care is just one specialty, really. There's pediatrics, there's other primary care types, but primary care is half the market. So having a program with one set of regulations that focuses on half the market is tremendous. But then you get into the disparate specialists, and it's really hard to tackle those because each specialty has their own special needs. It's almost too big to handle with one set of regulations.

Maybe they'll attack it over the years and eventually get to the specialists, but I think it's going to be a long time.

FHIT: Any thoughts on CMS' announcement it might extend the ICD-10 deadline?

ES: I think the delay is a good move, actually. I know we've had a while to plan for this, but if you think about it, it's coming right in the middle of Stage 2 and Stage 3 of Meaningful Use. There are so many things for the providers to worry about. Then there's the accountable care organizations that are being set up; it's almost too much.

I think what's happened is that people are just so busy with other things that they're falling behind in their ICD-10 planning, although a lot of planning has been done, that I guess what [the government] is trying to do is avert a little bit of a disaster.

If there were no Meaningful Use, I think ICD-10 should have stayed October 2013. But with Meaningful Use and the stages and the ACOs and everything else that's going on with healthcare, it's not a good time to implement something brand new like that.

Editor's note: This interview has been edited for length and for clarity.

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