Intermountain CMIO: MU wasn't worth it

CHICAGO—Knowing what we know now, the $29 billion spent on Meaningful Use wasn’t worth it, said Stanley Huff, MD, CMIO of Intermountain Healthcare, delivering the closing keynote at the Physicians IT Symposium during the 2015 HIMSS Annual Conference & Exhibition.

The incentive program drove IT adoption but introduced numerous unexpected consequences, he said. For example, the immunization interface for getting data from EHRs to public health agencies specifies the HL7 standard. However, Huff said Intermountain already had an integrated database with the state health department. After an immunization event, the information writes directly to the state-shared database. “When we saw this criteria, we said the intent is data-sharing between the state and healthcare organizations and what we’re doing is a better architecture than HL7 because it involves one common sources as opposed to copies that have to be managed to ensure they’re synchronized.”  

Huff said they were told too bad resulting in no value and costs to do the work. “That is a typical story for a lot of different things.”

MU has shown no evidence of improving care quality, he said. “If we hadn’t taken the incentive money I think our patients would be receiving better care and our clinicians would be happier. That’s a dark assessment but I think there’s a recognition of problems.”

Development of truly interoperable data exchange standards is needed, he said, because “everything we need does not exist today.”

Huff also expressed concern with MU’s mandates that lock in certain technologies. For example, if the government requires barcode medication administration, “as soon as something better comes along, we’re stuck.”

MU also doesn’t allow for solutions other than information systems, he noted. “We’ve seen incredible improvements in quality by hiring a person to follow up as opposed to having a computer do everything. Let people create the systems that make that possible and allow us to innovate and be creative. Take into account the community and other activities important to achieving outcomes.”

There are three problems with care delivery, Huff said: the lack of evidence-based medicine, providers paid for volume and patients who are not engaged. In the move to value-based reimbursement, “it’s essential that payment strategies align in order for us to achieve the triple aim.”

Intermountain has begun a beta project to understand how incentives might influence physicians. Huff said physicians’ base pay is about 15 percent less than what they would normally be paid. That 15 percent is the at-risk salary that is based on quality, total cost of care and the productivity of the clinician. The organization’s enterprise data warehouse generates a series of reports and performance can be broken down by hospital location and even by provider. They can view graphs of how a particular quality measure is changing over time as well as a dashboard for overall quality.

Citing his facility’s colon surgery numbers, Intermountain uses a set of evidence-based interventions which were implemented as protocol. That resulted in equal or better patient scores, decreased length of stay while maintaining or improving clinical quality and $1.2 million in annual savings. “It was a win all around,” Huff said. “In most cases, when you provide better healthcare you actually decrease costs.