Doug Fridsma: Certainly, as you move from being EHR and practice-centric, into ones in which you are in the home and at a population level, the workflow that happens is actually in the home.

Keith Boone: So, now that we’ve gotten some prior regulators experience, I’d actually like to give some kudos to the ONC for a national program that has exceeding the expectations in terms of EHR adoption based on what any other national program is doing.

In five years we’ve gone from a lower adoption rate of EHRs to one of the highest in the world in the hospitals. We still have some work to go on the ambulatory side, but we’ve made tremendous progress. So, we’ve had some really good successes. I think we’ve also had some really big failures.

You’ve probably heard about the recent change in the patient engagement metrics and the most recently released ONC rule dropped just in time for HIMSS. Go find Regina Holliday in the hallway, she’ll tell you all about it. Just make sure you’ve got your ear plugs because it’s going to be wild.

So, essentially, they dropped the patient engagement metric from five percent to one patient. Well, how does that actually meet the goals? So, I think there’s some really good progress being made. I think there’s some missteps.

Quite honestly, this is a learning process for everybody. I wish some of it hadn’t been necessary. But, we certainly needed the incentives, we needed the kick in the pants, and now we no longer have an incentives program, but a penalties program. We need to continue with a kick in the pants and keep going.

Rasu Shrestha: I do believe that the government can actually help. The real question is, is this market driven or do you really want to drive the market?

For me, personally, I’d rather be behind the steering wheel than in the passenger seat—in front or in back—and when you look at an organization like where I come from, we’re a large provider organization, we’re sort of really trying to drive change forward and innovation forward. We’ve been doing interoperability for almost a decade. So, syntactic interoperability, semantic data harmonization, these are things we’ve actually been doing and have been talking about at HIMSS.

So, this is real. For us, since we’ve been looking at the eight petabytes of data that we have across our enterprise where we have multiple EHR solutions, we are actively bringing the meaning out of the data in terms of semantic data harmonization and then trying to bring that patient’s story to life because at the end of the day, it is about that patient’s story.

It is about enabling intelligent data workflows. But yes, I think that it’s interesting that we have the ONC really pushing the charge and the carrot-and-stick approach of Meaningful Use is pushing us along, which is really good, but at the same time, I think it’s really important for us to drive the market and really be behind the steering wheel and really show how it can be done.

Mandi Bishop: Now, you’re talking about we and I’m very curious, who is the we entity that you’re referring to?

Rasu Shrestha: So, it’s a good question. When I say we, it’s really leading health care organizations, it’s the industry at large, it’s IT leaders, it’s vendors who care to stand up and make a difference and not be part of the rat pack. It’s individuals and organizations at large.

These are individuals, these are groups, individuals, payers, providers who want to be on the driver’s seat. When HIPAA regulations came out, not to uncover another big issue, when HIPAA regulations came out way back then, there was a lot of “HIPAAnnoia” but individuals, organizations…

Mandi Bishop: That’s the best phrase yet.

Rasu Shrestha: Absolutely. It’s an excuse. For goodness sake, it’s not that we’ve been ignoring privacy and security before the HIPAA regulations came out. All right, so we, collectively, need to be in the driver’s seat, pushing for change, really pushing for innovation and doing things the right way, not just because we’re told that it needs to be done that way but because we know that that’s how it needs to be done.

David Muntz: Yes, as long as somebody said the phrase patient engagement as it relates to regulations, I just had to jump in.

One of the things that I am glad to see is the phrase patient and family engagement in the regulations. What I’m sorry to see is that the methodology that was selected is important, but it doesn’t go far enough.

Essentially what you do, if you look at regulations, is delivering data after the event has occurred. If you really want to interact with patients in a way that’s going to be meaningful and you want to have some significant impact, you really need to get data depictions in real time. That’s where interoperability has to be absolutely automatic. You have to be able to avoid going over the cliff.

It would be terrible if we didn’t have alarms that occur inside an aircraft to warn before something bad happened. It’s great that they pick up the black box afterwards but, essentially, that black box approach is ‘I’ll tell you what happened to you, but I won’t let you know while things are happening.’

So, I would like to see us take a much more aggressive approach about getting information in the hands of the patients and the families in order to be able to make wise decisions about what the course of treatment should be in the next minute, not after a visit occurred or before the next visit.

Doug Fridsma: So, I’m going to take you and raise it. I think patients need to be first-order participants in their care. They have to have equal standing. In fact, probably they need to be listened to more, and more time spent with them. So, it’s one thing to give them the data in real time and to be able to give them that information, but unless they are first-order participants, it’s doesn’t matter.

Mandi Bishop: I think they need to be empowered to feel that they can be first order participants in their care, right?

David Muntz: Yes, well, one of the things that happens, and we’ll talk about whether patients are consumers or civilians or whatever the appropriate term is… But, you’ve got to remember that when you start life, you start it as a patient and as a family. People have criticized me for using the word patient but, the truth is, when you’re born, it’s a mother and child event. So, at that point in your life, you’re incapable of participating. So, I’m raising you again, on this – not just patients but caregivers as well.

At the end of life, generally, and I hope this doesn’t happen to me, it could happen sooner than I like, but it’s you become incapable or incapacitated. So, we use that model.

We go back to patient and family and now, the patient and family is defined in a different way than it was at the beginning of life. The truth is not just the mother, it’s the spouse, the friends, or whatever the patient has chosen.

So, the question is why, during the entirety of life, do we not talk about patients and families. So, if we don’t have tools that allow participation—and I love your expression in the first-order participants—the question is why aren’t the patients and families first-order participants in the care process?

Please see Part 2 of the #HITsm at HIMSS15 transcript, coming soon.