Q: What about interoperability?
A: I was in front of the Finance Committee back in the summer, and one of the questions that Senator Baucus asked is what’s the deal with interoperability? How come we’re not seeing more information exchange? He’s right. It’s not nearly as extensive as one might have hoped, but I think it’s incredibly complicated and incredibly messy. Frankly, the HIE-interoperability area will be chaotic through the rest of this decade. The analogy I like to use is, if you go back to the 1900s, there were 26 different power companies in the city of Chicago. It took a while for that chaos of inconsistency – different standards, etc. – to settle in to a much more efficient highly standardized environment. But sometimes you’ve got to go through the chaos before you go to the broad industry standardization. That’s a rough message to tell Congress. It’s a really tough political message.

Q: At one point you said you were worried that we would go to fast. What are your thoughts on that today?
A: I deal with a customer base that in a lot of cases is really stressed. They’re trying to do ICD-10. They’re trying to do meaningful use, Doing those two things is not the only thing on their agenda. At the same time, there’s a reimbursement squeeze, so they can’t add staff. We’re pushing them hard under consistently stressed conditions.

Q: What worries you now?
A: I worry about a couple of things. I worry about sheer fatigue on the part of people, which causes them to leave. So you lose talent; you lose doctors. We need all the talent and hardworking people that we can possibly have in the next decade. The second, is that people progressively blow off the meaningful use program. They say, “the incentives aren’t strong enough past Stage 1, the penalties, you know, they'll get reversed, and I just can’t do Stage 2.” We might see people withdraw from the program. If you go too fast, you get drop-off – drop-off by vendors, drop-off by providers, which means we plateau. IT goes back to leveraging the technology. People are just getting it up and running and not inherently going after the process change. It’s being used at 40 percent, 60 percent, 80 percent, whatever the meaningful use requirement is, but are they more efficient? Is the quality up?

I think the biggest worry is that what we don't do as an industry is really start to work the technology to get the care gains. The biggest worry is that the real purpose for which we are all here, which is to make the care better, will not have succeeded to the degree that it should have.

Q: Talk to the pace of the federal intitiatives
A: I would have liked to have seen the extension of Stage 2 by a year. I think there’s a time, and I think it’s next year, for the industry to say, “let’s take a little of a step back, and look at what have we done, and take credit for all the good things. Let’s look at what hasn’t happened and what should have happened and what risks are emerging that we need to address, rather than just pressing ahead. I think a little bit of time-out and reflection would be a useful idea.

Q: Perhaps people are afraid to lose the momentum?
A: An inflection point has occurred and the momentum is unstoppable at this point, I tend to think. If you think momentum means stall, I don’t think it’s going to stall. It will keep going. It’s just a question of going thoughtfully along the way.