Probst: Healthcare ready to transition to 'something better'

The U.S. healthcare system is “in a good position to transition to something better” than Meaningful Use (MU), according to Marc Probst, CIO of Intermountain Healthcare. The recent announcement from Centers for Medicare & Medicaid Services Acting Administrator Andy Slavitt about moving away from MU this year “opens up a more national conversation,” Probst told Clinical Innovation + Technology.

And, making the announcement on that stage drove the change into a conversation about what’s working and what could be improved. Although Probst sees the announcement as a good thing, he's not going to get his hopes up. "There’s a lot of logistics associated with unraveling something as big as Meaningful Use.”

Ongoing complaints from providers center around the way MU has continued to up the ante of functionality-based measurement. Shifting the conversation to one that “addresses standards and the nuances of interoperability is really positive,” Probst said.

MU is “a victory in the sense that it got a lot of information systems out there. A lot more people are using EHRs. All of that is really positive. The negative might be how much we paid for it.” But, having the technology out there along with the ability to collect data in a “check-the-box kind of world hasn’t allowed people to figure out how to improve care or lower costs or leverage the systems.”

Stage 2 turned people off, he said, especially since so many people had problems with Stage 1. “The requirements came out quickly for Stage 2 on top of what we were trying to do with Stage 1. We underestimated the level of effort required for Stage 1.” CIOs and health IT leaders were pretty vocal and, as one of the original members of the federal Health IT Policy Committee, Probst heard a lot of the criticism. He agreed that criticism reached a fever pitch about a year ago. Some of that, he said, can be attributed to the departure of some of the leaders responsible for drafting the regulations. “There was probably a little more license to snipe than there was when they were in their roles.”

Moving to more outcomes-based measurement, as Slavitt said, “would be incredibly powerful,” said Probst. “If we’re going to value-based payments, you want better outcomes. This would allow people to start being creative in the use of these systems” rather than just being able to place orders online, for example.

In Probst's view, open APIs like FHIR, the JASON report and other activity focused on interoperability is momentum in the right direction, but it will take time. “Getting to standards is going to take a lot more work than if we could just mandate them.” He has been pushing for such mandates but “gotten a bloody nose from running into brick walls.”

Probst said it’s easy to Monday-morning quarterback on the progress for standards but MU probably should have started with standards. “We may not have gotten all these systems installed as quickly. Clearly, it wouldn’t have been the stimulus activity it was but we would have gotten to standards more quickly.”

Moving forward, Probst said it’s time to get value out of the information systems that have been implemented. That will come from analyzing data, understanding the practices within each organization’s operations whether a hospital or clinic. “We’ve installed a lot of really expensive tools. If people can’t start improving their operations, they’ll never be able to meet the needs of a value-based payment system. It becomes really, really key.”

Probst also noted the need to spend money on IT security. Intermountain is investing tens of millions because “healthcare providers now have all this digitized data that people are trying to steal.” Intermountain built a security operations center almost two years ago which he said has been incredibly successful. They also launched a consortium in November, working with the Leavitt Group to look at the problem of IT security and privacy holistically. “Right now, every health system is building its own moat, walls and turrets. There are a few things we could do to protect us an as industry and take the burden off the industry.”

Intermountain also did a complete security audit and used the results to launch a $40 million remediation exercise “to get us, hopefully, ahead of the game.” The organization hired a chief information security officer six years ago and has gone from three people in its security department to more than 40. “We believe it’s our responsibility.”