HIT Leaders Want Flexibility, Transparency from Next HHS Chief

"The timelines and the pressures we're putting on the industry need some flexibility and sequencing so that people can be successful," says the CEO of CHIME. He and others are hopeful that Kathleen Sebelius's successor will listen to and understand the needs of the field.

Burdened by requirements to implement initiatives such as ICD-10 and meaningful use while hospitals face declining revenues, the healthcare CIO community holds hope that the next HHS secretary will have more sympathetic ears.

"I think this entire implementation of all these major initiatives has been on such an aggressive and tight timeline and maybe an inappropriate timeline, that the possibility of more collaboration from the field might have made things a little bit more successful," says Russ Branzell, CHIME president and CEO.

"We're trying to move an industry that is so wrought with error right now that everything we do to try to change it is going to result in some pain and discomfort," Branzell says.

"We truly have said the timelines and the pressures we're putting on the industry need some flexibility and sequencing so that people can be successful, and they've suffered from their own aggressive timelines," Branzell says.

Coming on the heels of the surprise Congressional delay of ICD-10 implementation until at least October 2015, as well as the earlier bumpy rollout of Healthcare.gov, HHS Secretary Kathleen Sebelius's unexpected resignation last week is casting fresh doubt on CMS' ability to execute its own hefty agenda in a timely way, Branzell says.

"You have to wonder if CMS was even ready for ICD-10 themselves, because they were just looking for exchange partners to start testing with, so it's not just the field that feels the pressure of this, but the government entities that have to implement them too," Branzell says.

"So much of what occurs now in Washington is us going there trying to create great relationships and try to foster trust, so we can help influence this process, rather than the opposite of that," Branzell says.

HHS in general and CMS in particular needs to "really reach out to organizations and try to understand what the needs are of the field to be able to be successful in these initiatives. Depending on the person or the leader, some are very good at that.

Former HHS Office of the National Coordinator head Farzad Mostashari "was very good at reaching out to people like myself and other organizational leaders and finding out what can be done to try to improve things," Branzell says. "There were several others. That has just not always been the case."

For now, "we have timelines that are legislated and so we'll continue to march down those legislated timeframes," Branzell says. "If anything, it gives us less of an option at this point, probably, to see any flexibility in that, because they're going to be focused on getting the new secretary nominee through that [nomination] process, so we're probably under more pressure now to get things done in the timeframes that are there."

"In some ways, those of us in IT kind of cringe when we think about the rollout of Healthcare.gov, because it was a great opportunity and it was just completely mismanaged," says David Miller, vice chancellor for IT & CIO at the University of Arkansas for Medical Sciences.

"The person [Sylvia Mathews Burwell] that they've got up for the potential nomination looks really good as well," Miller says. "I think this was probably just a whole lot tougher than people thought it would be, and a whole lot more complex. Those who have been in healthcare—I've been in healthcare 35 years— those of us who have been in healthcare for a long time, know it's a very complex business, and it's very difficult to just make assumptions on what people will and won't do in terms of signing up for insurance or whatever it might be.

"The website itself, that's just project management, so the fact that it didn't go as it should have, it is kind of laid at her feet."

Miller hopes HHS will be more transparent going forward. "You need somebody who understands the complexities of one-sixth of our economy," he says. "There's the old adage that physicians who are honest about their mistakes, even when they make them, get forgiven a lot more often than physicians who aren't. That transparency piece buys you a lot of favor across the industry, so that's what I'd like to see that I didn't think existed at all before."

As for programs such as meaningful use and ICD-10, Miller also believes in staying the course. "We've plowed a lot of money into making this happen," he says. The University of Arkansas for Medical Sciences is scheduled to go live on the Epic EHR on May 3 in its hospital and two thirds of its clinics. Although ICD-10 technology will be ready this October, the Congressional ICD-10 delay provides "a little bit of a breather" for physicians currently immersed in their Epic training, Miller says.

Sylvia Mathews Burwell, the current director of the Office of Management and Budget who President Obama nominated last week to take Sebelius' place, impressed one other physician leader.

"I do like the idea of someone coming in who has what seems to be maybe more experience in running large organizations, and we'll see if things go a little more smoothly in the future," says Lyle Berkowitz, associate chief medical officer of innovation at Northwestern Memorial Hospital in Chicago.

"At this point we can't do everything," Berkowitz says. "They've reached the sort of saturation point of change, and we have done a ton. We've set the groundwork to do a lot, but there's only so much we can do, particularly as reimbursements are going down."

The next HHS secretary has to "step in and evaluate all the programs, figure out where to focus, and listen and understand what people are doing, and then move forward and do it better than we ever have in the past," Berkowitz says. "That's certainly my hope for any new people coming into the system."