Fierce Q&A: Deloitte's Paul Keckley on reform, data-sharing and political wrangling

Meaningful Use, ICD-10 and other health IT initiatives will be integral to healthcare reform, Paul Keckley (pictured), executive director for the Deloitte Center for Health Solutions, told FierceHealthIT.

Following the Supreme Court's decision last week to uphold the Affordable Care Act, many healthcare leaders voiced similar opinions, saying the ruling would have a positive impact on the push for increased use of information technology in healthcare.

"So much of what the law presumes is based on access to information-driven healthcare" Keckley said. "It allows for administrative simplification."

Keckley also talked to FierceHealthIT about anti-reform sentiment and what might have happened had the law not been upheld.

FierceHealthIT: How will last week's Supreme Court ruling on ACA affect health IT?

Keckley: I think if you look at health reform in the broad context of Meaningful Use and ICD-10 as elements of that--and that the Affordable Care Act merely assumes that those are implemented--it doesn't presume that those have been delayed or set aside. I think that's been the missing link. The law writers and the legislative staff knew as the ACA was being written that a year earlier the HITECH Act had put $27 billion in place for Meaningful Use. It presumes that much of the information that we'll share via these federally sponsored websites for, for instance, the exchanges--how the law requires the exchanges to set up and operate their websites--that much of that data is derived from a set of these tools that are already in place.

It really presumes that all of these investments have been made, and that over a decade we'll reach this promised land of the convergence of clinical and administrative data into an elegantly designed, cloud-based technology that is accessible to Joe Six Pack through mobile communication devices, as well as to docs and hospitals and others.

As I look at it, the [message] going forward to doctors and hospitals is that you've got to get on with it. It's reality. You don't have a lot of time to step back.

FHIT: How will politics and anti-reform sentiment affect reform?

Keckley: I know there will be a lot of pushback. I saw recommendations that CMS skip ICD-10 and go to ICD-11; I know there'll be folks that come and say [the money for Meaningful Use] is inadequate and we need more. Those complaints will fall on deaf ears.

There is one thing that's clear out of the Hill, and that's that the investments in information technology are a means to an end, and the end is that we create a more efficient system that allows co-mingling of clinical and administrative data so that we can rid the system of fraud, improve its efficiency and reduce waste, and align payments with evidence. That's what it's about.

There's consensus that you can't move the system to the 21st Century unless it's technology based, and that we have not leveraged technology appropriately. I think that's going to continue. I think that the reality for the doctors and hospitals is going to be that you have to make those investments instead of making other investments.

FHIT: What would have happened had reform not been upheld?

Keckley:  It would have stalled clinical integration and community-based solutions like the health information exchanges. The trajectory of the ACA, in tandem with HITECH and ICD-10, is more systemic, more community-wide. It's not competitor focused deployment of technology.

We've got to be able to share information across systems of care, and we've got to make it available to Joe Six Pack, and we've got to co-mingle administrative and clinical data. You can't create value-based purchasing unless you're considering both cost and clinical appropriateness. I think some policy makers get that, and others are probably sitting outside trying to figure out what the fuss is about.

FHIT: How can we improve healthcare technology in general and data-sharing in particular? 

Keckley:  Employers are the leverage that will force or embarrass health plans or providers into using technology effectively. These are the folks that pay the brunt of the bills. I think there's almost a holy war that employers need to fight to insist on [technology's] implementation, to insist that a hospital CEO or a health plan CEO not make excuses for not sharing data with other plans or with other hospitals. I think if you sit on those boards, that should be part of a strategic plan that's near-term.

This interview has been edited and condensed for clarity.

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