AMDIS: Glaser calls for greater interoperability, accountability in gov't initiatives

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OJAI, Calif.--John P. Glaser, PhD, vice president and CIO of Boston-based Partners HealthCare System, told the AMDIS Physician-Computer Symposium audience last week to expect a bumpy road ahead, but assessed the current meaningful use framework as “something that had to be done and has been started intelligently.”

The federal healthcare strategy behind meaningful use as well as EHR certification represents a huge shift that will have ramifications in the years ahead, said Glaser, who has served as senior special adviser to the Office of the National Coordinator for Health IT (ONC) and group chair of the HIT Policy Committee, and will take the reins as CEO of Siemens Health Services in August.

In addition to EHR adoption, health information exchanges (HIEs) will be one of the most challenging aspect of the federal initiatives, because it’s not clear whether states will be able to support secure, sustainable information exchange, he said. Integrated systems will be critical to HIE as well as the features and functions that will result in meaningful use.

“What will adoption rates be? How much interoperability will really be achieved? We don’t know… we’ve changed an enormous swath of healthcare and it’s impossible to change all that and have it all work perfectly,” Glaser said.

“This will not be a smooth ride into EHR adoption and use. The majority of revenue will now be based on our effective use of this technology. How well we do or do not do [will] depend on implementation. This raises the stakes for healthcare systems and practices too,” he said. “If you think you can duck this and go on your merry way, you can’t.”

Through the rules for meaningful use and EHR certification, the government now has greater control over the evolution of EHRs than it has ever had, according to Glaser. However, as more organizations and practices adopt them, to a certain extent, commoditization will eliminate merely having an EHR and related healthcare IT in place as a differentiator in the marketplace, he said.

“Now we’re going to be connected. Organizations will be interdependent among those who participate in information exchange.” Connected organizations will need to pay closer attention to their integration efforts as well as those of other facilities to ensure that software upgrades and new device implementations don’t harm the exchange.

“A fundamental way to think about this is that [the federal initiatives are] a foundation for what is to come,” he said “For a while, we would strut our competitive stuff by saying ‘we have CPOE [and] those guys don’t.’ That day, when our possession of IT distinguishes us, will be gone.”

When that happens, organizations and practitioners will distinguish themselves by “doing things we should have been doing all along,” such as using technology to engage clinicians and involve patients in their care, as well as leveraging data for all kinds of purposes, he said.

The meaningful use definition and EHR criteria "set the bar high. We know it’s high, but if you set the bar low, nobody's going to [aim] high. It's good management to go high, get reaction, then settle," said Glaser.