This appeared in my e-mail today. It’s an ad for some article that was supposed to prompt us to think about IT from a different perspective. Should IT be delivered from a clinician-centric approach? How is that new? I suppose it’s better than a “CFO-centered approach,” but we deserve even better. As an industry, we've lost focus on our priorities. The needs of the individual are getting lost in a maze of fee-for-service motivated check-boxes and auto-generated drivel. What's the foundation of IT that's best for a patient? THAT’s what should be delivered.
The AMA and 33 other organizations sent a letter to National Coordinator Karen DeSalvo last week. The letter has seven requests of ONC:
- Decouple EHR certification from the Meaningful Use program;
- Re-consider alternative software testing methods;
- Establish greater transparency and uniformity on UCD testing and process results;
- Incorporate exception handling into EHR certification;
- Develop C-CDA guidance and tests to support exchange;
- Seek further stakeholder feedback; and
- Increase education on EHR implementation.
Let’s take them one-by-one …
Decoupling EHR certification from the EHR incentive programs. One could argue that this is already happening, and we can expect it to continue to happen. Check.
Re-consider alternative software testing methods. I’m not sure that “re-consider” is what’s in order here. The letter asks ONC to re-consider the stance on scenario based testing. But ONC’s stance is (and always has been) that scenario based testing is a great idea. Is the goal of the letter to express enthusiasm for this model? ONC will share the enthusiasm. The harder part will be to create a framework that builds and maintains scenario-based test procedures. This is a shared responsibility. Shared by government (ONC and NIST) and industry (health IT developers) and – yes – the AMA and the 33 other organizations who sent the letter. ONC has invited everyone to participate (here’s the open test development site). So far – I don’t see much (any?) engagement from the AMA or the others who signed the letter. It’s relatively easy to write a letter saying someone else is responsible for solving problems. Time to step up to the plate and participate in the solutions, folks!
Establish greater transparency on UCD testing. Yep. I agree. ACBs need to enforce this, and ONC needs to get serious with those who don’t comply. UCD testing results not posted on the CHPL? Give them 60 days warning (more than enough!) and de-list the product.
Incorporate exception handling & C-CDA guidance and tests. These requests expresses AMA’s ambition for ONC (and NIST?) to do full interoperability testing. But as defined by congress in ONC’s authority – the certification program does conformance testing. That means the products conform to the standards. It doesn’t mean they have been tested with full end-to-end interoperability tests. If we want ONC and NIST to do that – there will need to be an expansion of ONC’s authority and budget. Asking ONC to do this is barking up the wrong tree. AMA should lobby Congress on this one, not ONC. Yes – there is some low-hanging fruit here with the C-CDA. ONC could offer more explicit guidance to limit some of the optionality that exists in the HL7 standards. I agree on this point.
Seek stakeholder feedback. I think they do a pretty good job with this. ONC’s FACAs are open to the public, transcribed, and always invite public comments.
Increase EHR implementation eductaion. Well, ARRA funds are depleted. While I agree that there is work to continue here – but ONC and the RECs and the developer community – I’m not sure that this can be increased in context of the current fiscal situation.
I’ll enable comments on this post - as I’m interested in how others view this letter.
Or maybe I should call it "Reider's block?" ..
Despite 15 years of blogging – this time, I've written and re-written a post so many times I can't count them. So here's one to get me started.
I had dinner last night with a former colleague who has had a long track record of success in government, health care, and education. He’s getting close to retirement, and we talked about what has driven him – what he sees in himself as a leader, and why some people seem to find success so consistently, while others do not.
His goal after retirement is to teach in community colleges. A community college grad himself – he reflected that these schools are special places that help others succeed. Period. The faculty are not arm-wrestling for status or grandeur. Students often have had other careers, or had less-than-stellar high school performance.
He is a noble guy – with altruistic goals – and I think that this demeanor is what’s helped him succeed throughout is career. I observed that his interest in teaching community college students aligns perfectly with how he’s approached every other job: to help others succeed. It’s not about himself or his own personal achievements.
This demeanor is uncommon. But it’s certainly aligned with how I’ve tried to be throughout my career as well. Success as a physician wasn’t ever measured by my income, or the number of patients I saw in a day – it was measured by my patients' success. I served them. Period. To help them reach their own personal goals of health and happiness.
And then – at some point fairly late in my career – I realized that this approach – helping others succeed without judgment – without invoking MY agenda – was the same set of attributes that would align with success in other domains.
Fast forward to January 2015. My dad has been in the hospital and I’ve once again witnessed the dysfunction of our care delivery system from the other side of the stethoscope. It’s a sobering reminder. The culture of health care that I witnessed in Boston (at the “best “ hospital in the world) remains disconnected, distracted, and aligned on the wrong incentives:
- Revenue. Fee-for-service models push care providers to maximize charges rather than care quality, patient experience, or best outcomes.
- Recognition. Smart, assertive heroes who do more, and write more papers and get more national or international recognition are perceived to be "better" physicians than folks who listen, share decisions with patients, and really focus on the right stuff.
Despite many efforts to change the way we pay for care, educate our physicians, or create stage 4 cultures - so far, it's not working.
But we can't stop trying.
And so my next chapter will be focused on a few guiding principles:
- Work with great people who want to do what's best for others – to really add value to the world in a way that will empower others to find health and happiness.
- Facilitate new cultural norms in health care that focus on shared decisions, collaboration, transparency, and compassion.
- Avoid people and organizations who want to be "rock stars" and succeed for the sake of success – either in status or revenue or power.