Tripathi talks: The MU timing debate, EHR dissatisfaction

While some have dubbed 2013 the year of EHR dissatisfaction, Micky Tripathi, says that’s not the case. In an exclusive interview with Clinical Innovation + Technology, the president and CEO of the Massachusetts eHealth Collaborative and chair of the federal Health IT Policy Committee’s Information Exchange Workgroup, discussed the Meaningful Use (MU) program, the next ONC chief and more.

Regarding EHRs, he said that some dissatisfaction “is just a regular part of the transition to and adoption of a new technology.”

All industries go through a shakeout during which standards are settled and business consolidates around a few of the bigger players. “That trend is starting to take hold” in healthcare, Tripathi said.

Tripathi also addressed MU Stage 2: “Very real progression is happening.” The whole program is a learning process for everyone, he said. “People started to dig down into the details and realize this stuff doesn’t happen overnight. The most complex industry in the world isn’t going to turn the corner overnight.”

The progression of the MU program always planned to move the industry forward in increments. For example, Stage 1 was designed “to get people using the systems and taking little tiny steps toward using the information the systems provide.” With Stage 2, “we now have the ability to push information electronically to the patient or to the next providers. In Stage 3, we are setting up the ability to query for information which is much more complex.”

MU has been “very deliberately staged.” When asked about the various criticism the program has faced in recent months, Tripathi said, “I agree that it may be that more time is needed for the industry to sort of gather its winnings and then move to the next level. But, Stage 2 is too close to talk about delaying the start. Vendors are certifying their products so we can’t change that now. Perhaps we can talk about extending on the back end how long providers have to accomplish Stage 2 and, by extension, when Stage 2 would start.”

A big issue, he said, is MU in addition to all the other changes impacting healthcare, such as ICD-10 and accountable care which represents “a fundamental change in the way 15 percent of the economy gets paid.” Laying MU on top of these other efforts adds up to a lot of work for providers.

In response to the six Republican senators who called for a reboot of the MU program, Tripathi said, “I appreciate the concern and some of the issues that they raised are valid. Overall, I think that they’re wrong. I respectfully disagree.” The federal government is spending a tremendous amount of money, he conceded, but “look at what has been accomplished.” In less than four years, upwards of 60 percent of physicians are using certified EHR systems. “You can’t look at another part of the economy that has had that kind of transition in that short of a time. We’ve had unbelievable progress that stands up very well to any other industry.”

Tripathi said the MU program is similar to investments other industries make all the time. “In terms of the money, if you think about this as a business problem and leave aside the fact that government is providing some of these funds, you start to see that this is very much like what happens in other industries as well. This is not just a giveaway--this is the government as a business. Medicare and Medicaid are businesses and the government is doing what Toyota and GM and Chrysler and Walmart do every day, which is invest in their supply chain—the  physician network that provides the services they pay for.”

Walmart, for example, will help their suppliers pay for certain technologies, such as RFID, that the suppliers wouldn’t make on their own and that benefit Walmart. “It’s short-sighted to look at the expenditures and expect to see immediate payback and think those dollars are wasted. [MU] is a long-term investment. To me, that’s a very shrewd business practice and is keeping with what private sector does every single day.”

In response to Farzad Mostashari’s, MD, ScM, announcement that he will step down as national coordinator for health IT, Tripathi said “he’s been tremendous.” The next ONC chief has the groundwork already laid for them, he said. “The direction is very clear. The real question is how aggressive do you want to be in Stage 3 and how much consideration do you want to give to the other things going on in the market. There is a lot of institutional momentum built into the process.”

And who might fill Mostashari’s shoes? Tripathi said, given that there are only two years left in the Obama administration, the next leader easily could be “an insider who has been very involved in [the MU process] in some capacity from the beginning.”