Marc Probst: It feels like Washington isn't listening to us

Intermountain Healthcare CIO Marc Probst is never one to mince words. As a member of the Office of the National Coordinator for Health IT's policy committee, for instance, Probst has been an outspoken advocate for the implementation of standards to drive interoperability in health IT.

"We're still not dealing with the root foundational issues [for interoperability]--the standards," Probst said at the College of Healthcare Information Management Executives' annual fall forum in San Antonio, Texas, this week. "We talked about it in the last policy committee meeting and at the joint meeting, and I think, again, people are starting to get the concept that we need to do it, but we're taking way too much time and going about. It needs to be directed and it needs really strong leadership, but right now that's a little hard to see--based on what's happened at ONC over the past few weeks--that that leadership exists."

In part 1 of an exclusive interview with FierceHealthIT, Probst talks about the ONC's ongoing leadership trials and tribulations, as well as the Meaningful Use program.

FierceHealthIT: What do you think of ONC's handling of Karen DeSalvo's situation, as well as the recent leadership losses suffered by the agency?

Marc Probst: One of the really positive things about ONC and the work they've been doing over the last few years has been their staff. They've had a pretty darn good staff. Jacob's just incredibly knowledgeable and well-intentioned; he's a good guy.

I thought Karen was heading in the right directions, with the vision for interoperability and the pulling the standard and the policy committee together to have that discussion around interoperability, it just felt like we were starting to get some good momentum and de-emphasizing some of this functional list for Meaningful Use stuff. Just a lot of the conversation felt good and appropriate and it felt like a lot of the wind just got sucked out of the sails. Karen was busy as National Coordinator, so I don't think she'll be any less busy splitting her duties between two agencies. I do like her leadership style, though. I think she's really talented.

FHIT: What impact do you think this could have on Meaningful Use?

Probst: Meaningful Use is in a precarious situation. The 2014 numbers aren't looking all that grand, particularly for Stage 2. If indeed nothing changes on the attestation period for this year, I think the failure rates are going to be massive and very difficult for people to recoup from when they start looking at penalties down the road.

It's a tough time for Meaningful Use. We haven't seen what Stage 3 is going to look like; I'm worried about that because I think the industry is just getting tired. There's only so much we can do and it feels like Washington isn't listening to us. As a voice--whether it's been CHIME or AHA or HIMSS or any number of organizations--the message has been consistent: too much, too fast, here are things you can do about it. When the response back from ONC and CMS is 'tough,' that might not be exactly be what they're saying, but that's what it feels like. You worry about it. It'll be interesting to see what happens in the coming year.

FHIT: I've heard rumblings that morale is down at ONC. Considering the recent leadership turnover, would that surprise you?

Probst: Everyone wants to play for a winning team, right? It's harder to recruit people to a losing team. It might not be a perfect analogy, but Meaningful Use was all the rage and a positive topic when it first came out. At first it was 'looking at what we're going to do for this industry.' Then you'd go to HIMSS and say 'wow, look at all these creative people,' because there was an influx of billions of dollars into this economy. It was exciting.

Now, it's penalties, it's organizations very unsure of their ability to do it. Attestation is hard and we're not doing anything to make it better. It's not like we shouldn't be raising the bar all the time, but when it's impossible, you kind of just go 'eh, I've got a gazillion problems, this one isn't necessarily going to make it to the top of my list.'

I'd be demoralized if I were there.

FHIT: What would happen if the penalties were dropped from Meaningful Use?

Probst: I think people would continue to try and implement these electronic medical record systems and do great things with them. I know the people in that room. They're not here because they're looking for the easiest path; they're looking for the best way to provide healthcare to the people in their communities.

If Meaningful Use did anything, it opened up a whole bunch of opportunity for us to get technology into our organizations so that we can do things with it. I don't think people would relax, if that's the concern. I think people would try to get the value out of it--and maybe more value when they're trying to just check boxes, but actually do some really cool things.

FHIT: Do you believe that the penalties are simply a way for government to recoup the money the poured into the program in the first place?

Probst: The cynic in me would say yes, there's some of that thinking. I think there's real partisanship in the conversation, too. The Democrats primarily drove Meaningful Use. They want to keep going down that road because it's the program they set up. The Republicans on the other side are saying 'we're not getting anything for our money.' I don't think either of them are right.

The program definitely had its positives. We should claim victory for the good things we did do, and the Republicans need to look at it and say 'well look at what got accomplished.' I really think it would be great if they would just back off and let us just be successful with these products. I think they'd be shocked at how productive we could be.

That's not likely.

Editor's Note: This interview has been condensed for clarity and content. Read part 2 of this exclusive interview in Friday's FierceHealthIT.