Geeta Nayyar, MD, PatientPoint
Call her a poster child for the health IT generation. When Geeta Nayyar, MD, chief medical information officer at PatientPoint, graduated from medical school in 2003, one of the things she looked for in a residency program was that the hospital had some sort of electronic medical record.

"Everything was paper-based – charts, labs, X-rays," she recalled. She did not want to spend her time prowling around the bowels of a hospital to find patient information, she said.

By the time she started her fellowship, that hospital had a fully integrated EMR.

"We have this whole different ball game today where the EMR is basic and a lot of the graduating students don't use paper charts," Nayyar said. "In 10 years, we have come a very long way. It's not just the infrastructure being laid. Even more important, it's the application." 

What do you wish had gone differently?
CIOs don’t tend to be a coulda-woulda-shoulda bunch, but they don’t mind engaging in a little Monday-morning quarterbacking now and then. So, what might have gone better in the past 10 years to nudge U.S. healthcare to an even better place on the digital continuum?

“I wish we had made greater progress towards standardization – vocabularies, care practice, etcetera  – and interoperability,” Spooner said. “I wish EMR products had opened to interoperability much farther than has been the case.”

For Halamka, it was without a doubt, “certification and overall program timing.”

“Part of the problem, as I've discussed previously, is that the certification criteria are overly burdensome and in many circumstances disconnected from the attestation criteria, requiring very prescriptive features that go beyond the intent of Policy Committee and Standards Committee,” he wrote in a Nov. 27, 2013, blog post, titled “Rethinking Certification.”

In that blog, Halamka discusses the benefits of “agile technology” over “waterfall technology,” which was the method used to derive the regulatory language and certification scripts.

“I've spoken with many EHR vendors (to remain unnamed) and all have told me that they created software that will never be used by any clinician but was necessary to check the boxes of certification scripts that make no sense in real world workflows,” he wrote.

In a November 20, 2013, blog post on fine-tuning the healthcare IT timeline, he wrote: “People are working hard. Priority setting is appropriate. Funding is available. The problem is that the scope is too big and the timeline is too short.”

On Dec. 6, 2013, CMS and ONC announced an extension to the meaningful use program.

“Under the revised schedule, Stage 2 would be extended through 2016 and Stage 3 would begin in 2017 for those providers that have completed at least two years in Stage 2,” acting national coordinator Jacob Reider, MD, and Rod Tagalicod, director of the CMS office of health standards and services, announced.

MacLean is on board with all the changes that have been required to move healthcare from a paper-based system to a digital one. But he wishes it could have been accomplished differently.

“I wish the industry could have reformed itself without government intervention and public spending,” he said. “I think it's unfortunate that the myriad regulations stifle innovation in clinical care and payment models.  Still, we have tipped the fulcrum on HIT adoption and I don't think we'll be going back.”

Hickman, at Albany Medical Center, said he wishes “we knew when to understand that something didn’t need to be invented here. We could have done more, and faster.”

Looking to the future
Glen Tullman, former Allscripts CEO, turned venture capitalist and – as reported in Crain’s Chicago Business – creator of Ignite Glass Studios, a 20,000-square-foot, $5 million glassblowing facility he built in Chicago, continues to be bullish on healthcare IT.

"In the last 10 years, electronic health records have laid the foundation for everything that will change health and healthcare going forward,” he said, “just as computers paved the way for the apps that changed how we do almost everything in the rest of our lives. We’re closer than ever to enabling the intelligent, connected health consumer and, as in other industries, consumers equipped with information, mobility, transparency and access will change everything.”

He recognizes that many challenges remain, but he remains optimistic.

“As for those who point out what’s not working, those are just opportunities for health IT leaders to solve,” he said. “I believe we’re closer than ever to improved outcomes and bending the cost curve in the right direction.”

Spooner envisions a future – perhaps in 10 years – of smooth interoperability.

“Patient information will be interoperable across EMR systems, he said. As he sees it, the patient will be able to transport his full record from provider to provider irrespective of EMR choice. The patient will own the record and will enter/edit his own data to the EMR. 

Also, “the U.S. will adopt a uniform patient identifier,” he added.

Compared to 10 years ago, Tang says, “I am more confident that the country will make the necessary paradigm shift from fee-for-service transactional care delivery to one focused on community health and wellbeing now that we are building the necessary information tools to support that transformation.

Denni McColm, CIO at Citizens Memorial Healthcare in Bolivar, Mo., recalls that it was 10 years ago – in December 2003 – that Citizens Memorial eliminated paper medical records.

“At the time, we thought everyone was doing the same thing, but found out over time that others were still just talking about it,” she said. “I'm surprised by how many hospitals still have paper medical records now. I'm thankful we were naïve enough not to know any better back then.”

Mulling it over today, she said, “It did teach us that following what everyone else is doing in IT is not always the best approach.”

Citizens Memorial Healthcare, a 76-bed fully integrated healthcare system, has never let its small size stand in the way of progress. In 2005, it was awarded the prestigious Davies Award from HIMSS, and in 2010, the health system reached Stage 7, the top level, on the HIMSS Analytics EMR Adoption Model scale.

MacLean’s high hope for the next 10 years of healthcare IT is that “we as consumer/patients will engage with the system and hold providers and payers accountable for quality and service.”

As for Halamka, he likens healthcare IT progress to air travel.

“When I became CIO in 1998, it was the Wright Brothers era of healthcare IT – building new technology was an amazing accomplishment,” Halamka said. “Today we're in the biplane stage – solutions are commercially available but they are not agile or usable. I look forward to the Airbus 380 stage when the technology is safe, convenient, reliable and well engineered for purpose.”

Tang apparently prefers the train analogy.

“The journey, and work, is far from over,” he said, “but with the progress the country has achieved, the train is well out of the station, and we are well on our way towards a more adaptable and rational health system.” 
   
HIMSS Media Executive Editor Tom Sullivan contributed to this article.