What has been the most challenging piece of work on the Healthcare IT Standards Committee?
The sheer size of the undertaking is challenging. And, what complicates that even more so is the number of moving parts. WE have the policy committee establishing the definition of meaningful use, and we have the standards committee that is establishing the standards, which will support the definition of meaningful use. Then we obviously have a lot of regulatory activity that’s happened on the HHS side with respect to how the dollars will be doled out to physicians and hospitals and HIEs and Beacon Communities. And, a lot of the work that we’re doing at the standards committee level is Not only to support meaningful use, but also to support the technical requirements for how interoperability will occur as it relates to the grant dollars associated with the Beacon Communities and health information exchanges and Regional Extension centers. If I had to put it into two categories as to what has been the biggest challenge, it’s the sheer size of the undertaking in combination with the speed of which the expectations are that this work will be done. It’s a monumental task, especially when everyone on the panel has a day job.
What is the most pressing thing before the panel right now?
The deadlines. Not only the deadlines of what needs to be done by 2010, 2011, 2013, and those kind of deadlines. But we have to get those decisions made, and we’re a recommendation body to ONC, and then obviously, they’re the final arbiter of standards and will make the decisions on which standards they will adopt and which ones they won’t. But, we have to get those recommendations in timeline for them to make those decisions in timeline for the vendors to have ample amount of time to build those capabilities into their products to be in compliance with these reimbursement guidelines where physicians, to earn their money, must be doing this in a certain way to get money back on meaningful use. So it really is the deadlines, which some people think are way out there in 2011 and 2012, but the reality is, it takes these vendor solutions quite a bit of time to implement these standards, so we have to get the work done well in advance.
What unique perspective do you bring to panel?
I think what I try to bring to the table is real-world experiences in not only the difficulty in implementing these standards, but how they impact an end-user’s workflow. In building Surescripts, we were using the NCDP script standard, and that’s only one standard. We’re talking about dozens of standards now that would need to be implemented and I think in reminding the committee about the interpretation that vendors can have in looking at a standard and saying I can implement the standard in this way … there needs to be clear guidance. At Surescripts we created these implementation guides, where we laid out exactly here’s is how you have to implement the NCDP standard. Some people agreed with our interpretation. Some didn’t agree with our interpretation of how it should be implemented, but at the end of the day, if you want to get certified on that network, then you have to implement it in this way. In this world, we’re trying to be prescriptive, but at the same time we don’t want to harm innovation. I think what I bring to the group is simply a real world balance of what it takes to implement these kinds of standards into the workflow of these physician practices or hospital groups.
How has the standards panel work informed you?
I did not realize up until this work that we’re doing on the standards committee level how really competitive these standards groups are with one another. They have a lot of, not only overlap in capabilities of work that they’ve done in various different workgroups, but also they’re very competitive with one another. It’s not necessarily that they talk ill will of each other, but they do present a ‘let me tell you why I’m better than this standards-setting group.’ It’s very difficult sometimes to be in the middle of that.
Did you expect Prematics to be at the stage it’s reached now?
Strategically – right on target. I brought a very strong management team together to solve a very different problem. One of the things I noticed while building Surescripts is the gravitation vendors have to large physician groups. There was really a large underserved population in these small practices. We wanted to do something a bit different – take an e-prescribing workflow tool, focus on small and medium-size practices, which is where high prescribers exist, and just focus on them in any given region. Layer on top of that the ability to communicate with health plans. I think health reform set us back a bit. I was hoping we’d be further along with the number of health plans we’re working with. I’d expected at this point we’d have more health plans on the network or service.
What in your view is the top barrier of physician uptake of e-prescribing?
It’s the expectations that physicians have about e-prescribing that appears to be the top barrier to it because physicians automatically think that as soon as they sign up for an e-prescribing service that somehow magically all of the faxes from pharmacies will stop. And, they don’t. There’s a reason for that. Pharmacies have to go through their records and make sure that every one of those physician records and those databases are flagged that this physician is now electronic. Until all of those records are flagged, frome time to time when a patient calls a pharmacy for a refill, they’re going to send a faxed refill request to that physician who is e-prescribing because that particular record in their database was not flagged as electronically enabled. Those filter out over time. If they’re still getting faxes, they think it’s broken.
What are you reading?
Paper Kills 2.0, which is Newt Gringrich’s and David Merritt’s book. I think it’s fascinating. It’s very, very interesting to hear those perspectives on the status of where we are right now and where we will be a year to two years from now.
