Editor's note: This is the second in a two-part series featuring HIMSS CEO Harold "Hal" Wolf III. Here, he discusses the federal government's role in fostering innovation and the expanding responsibilities of healthcare CIOs. In part 1, Wolf explained how health technology relieves new financial pressures on the industry.
According to HIMSS CEO Hal Wolf, there are two executive branches in any organization that get a peek at just about everything that passes through the company: finance and IT.
Perhaps more than ever, the CIO is the healthcare system’s utility player. Although the roller coaster of healthcare reform has made the biggest impact on the insurance market, there are widespread indirect implications for IT. From facilitating value-based reimbursement to reporting data to federal agencies, CIOs have a hand in just about every regulatory change, Wolf said.
In the second installment of a wide-ranging interview with FierceHealthcare, Wolf explains how hospitals are changing the way they invest in new technology to disseminate information to providers and streamline care, and why he’s concerned about changes to the Office of the National Coordinator for Health IT’s (ONC) EHR certification process.
FierceHealthcare: You were the chief operating officer of Kaiser’s Permanente Federation from 2008-2013, which spanned the first several years of the HITECH Act and Meaningful Use. What did you learn from that experience?
Hal Wolf: Wow. How many hours do we have?
The Kaiser system worked very hard to support innovation. There were investments made in developing and supporting innovation on all levels of the organization, whether it was the health plan, the clinician or the workforce.
Today, if you try and take away those enablers and those support capabilities, you would literally have to pry it from the physicians' hands.
Why? It’s insightful. It utilizes knowledge management. I saw physician leaders go from, “This is interesting,” to “This is imperative,” to “I wish it could do this.”
People began to recognize that health and information could come together, and they became inspired and began thinking outside the box of the current care delivery. That sparks innovation and it feeds upon itself.
My takeaway from Kaiser was that if you produce meaningful conversation around the use of information and wrap it around a spirit of innovation, you can create a new dialogue about the way we deliver care that is patient oriented.
There is also the recognition that not everyone is the same; you cannot have one-size-fits-all. And that lends itself to segmentation of care, and communities of care. That impacts how you develop applications, how you work with individuals and their extended ecosystems. All of these things are enabled by information and technology.
We made a change recently via the board of directors to our mission statement from “better health through IT” to “better health through information and technology.” We felt it was really important to recognize it’s not just about IT. IT is extraordinarily important to members and to the platform, but it's about using both the technology and the information. That really gets to the heart of what I’m so excited about with HIMSS.
FH: Where does the federal government fit into that? How can the Department of Health and Human Services and ONC help drive innovation and interoperability?
HW: We’ve made a huge investment in the United States in developing a technology platform. We’re having a good debate right now about usability and Meaningful Use and how far we go to build a prescriptive model for using data and information. We’re looking to create connectivity and we’re trying to create the use of technology as an enabler at a level we haven’t had before.
I think it’s fair for the administration to say, as do many health providers, “Let’s not get overly prescriptive here. Lets really maximize what we have and focus on the innovation of individual systems and also see how it accelerates itself.” And I think that’s fine.
What we don’t want to do is suddenly back away from it and say, "OK, everything back to the way it was—let’s not keep pushing the industry forward" because we’re going to run into the trap we talked about earlier in terms of the economics of our care environment in the United States.
It’s a balancing act. I’m not discouraged and I'm not overly encouraged that everything is hunky-dory. But, at the same time I think we’re making some practical decisions.
FH: What are your thoughts on the changes ONC recently made to its EHR certification process to allow EHR vendors to self-attest to 30 certification criteria?
HW: I’m always concerned about self-reporting because standards are extremely important. I think checking against standards is always important—it’s a part of basic scientific method. You always want to come back and do peer review and challenge the assertions. So, I would be cautious. For other systems around the globe, self-reporting hasn't always delivered the greatest benefits.
I think we just need to monitor the outcomes, but at some point we need to do some peer review to make sure whatever is being self-reported remains as accurate as possible.
FH: There is a lot happening—to put it lightly—in healthcare right now with efforts to repeal and replace the ACA. How does the uncertainty that payers and providers face trickle down to the CIO?
HW: First off, we’re looking at potentially shifting reimbursements. That has an impact on how we track and report information as well as reimbursement capabilities and coding—all of those things are inevitably going to get impacted.
That impacts the CIO from an IT standpoint. It all touches the CIO.
There are two places in any organization and almost any industry where you see everything end-to-end. It’s the finance department and it’s the IT department. It’s pretty hard not to touch something in a healthcare system that one way or another doesn’t cross the footpath of the CIO in that organization.
So as these changes take place and we think about shifts into or out of value-based care, and when we think about reporting—all of those things will have an impact.
FH: Do these changes raise concerns about how much money CIOs have to spend on new technology?
HW: If there’s going to be an impact on reimbursement levels, there’s going to be an impact on investment.
Let’s also watch and see what that means because it could be an acceleration in investment in the short term so you have less operating costs moving forward. IT leaders are looking at analytical packages to help them get to more efficient care models. And that may be absolutely necessary because of reduced reimbursements.
Sometimes you spend money to make money and sometimes you spend money to save money. It's part of that maturity cycle where we've seen, moving from an investment in heavy technology platforms to more of an investment in the analytical and use of information to both diagnose and improve care, as well as find administrative and operational savings.
FH: There are so many health apps, and with the FDA signaling changes to the way it regulates digital health technology that trend is likely to continue. But a lot of apps aren’t well-tested. How do providers navigate that?
HW: If you look at the applications on the consumer side and health model side, people are engaged and then they lapse. But a lot of the information and some of the data can be useful to the medical model from an integration standpoint.
I think what the FDA is trying got do is find a balance between critical information that needs to be protected and that impacts care delivery directly or decision points—which has always been the goal—versus information that can help guide and direct what a person does.
I think when you look at the development and speed at which innovation is coming it got pretty binary for a little bit. We’re learning there are some nuances here and it's allowing a little bit of flexibility that requires open discussion. It doesn’t mean you open the floodgates and walk away—it’s just nuance that allows us to have a conversation, which is first and foremost, protect the information of the patient. Secondly, make sure the information being used isn’t used in such a way that it creates harm. And third, do all you can to create the flexibility of innovation.
All of those three things are going to rub against each other for all the right reasons, but we need to be very vigilant.
Editor's note: This interview has been edited for length and clarity.