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Tuesday, October 26, 2010

If you want them to read, YOU must communicate

I spent the latter half of last week at a small (about 150 attendees) conference in Valley Forge, PA.  One of the points that I was there to make at the conference is that attendees can assert some control of the national agenda.   Right now more local organizations and smaller practices don't seem to be a) aware of what is going on around them or b) know (or trust) that they can provide feedback that MUST be addressed.  Barbara Connors, Chief Medical Officer for CMS Region III made that last point rather strongly after I spoke.  If you comment on pending regulation, then the regulator must, BY LAW, address those comments.  (By the way, if you have an opportunity to get Barabara to come speak at your event, DO IT.  She presented information about the Incentives rule that even I didn't get from READING it twice.  You can find her contact information here.  On my suggestion, they may even present these slides on video, as you really need someone like Barbara to make sense of it)

The Meaningful Use agenda being set in Washington, and the standards being developed to meet that agenda are both open processes that anyone can participate in.  Glen Marshall's recent post RTFM complains that it isn't really about lack of opportunity.  I would agree, the opportunity is certainly present, but frankly, very little is being done to make that opportunity either known, or in some ways available to those constinuencies that are going to be the hardest hit by Meaningful Use.  One of the audience members complained, and rightly so, that participating in these efforts is a daunting challenge, especially for smaller practices.

I would imagine that other countries have had the same issue, but given the differences in our healthcare systems, it's probably less of a problem.  In countries like Canada or much of Europe or Asia where healthcare is provided by the Nation, communication to healthcare providers is probably a bit easier.  There would also seem to be a tendency away from "large" IDNs like we have in the US.  But I don't live there, so I'd love for my non-US readers to chime in.

There are two separate issues.  The first is communication.  There needs to be some way to communicate to these constituencies to get their input.  That input needs to be actively sought out by ONC.  Find me anyone on the HIT Policy or Standards committee that IS a small provider, rather than someone who claims to be "representing" them.  I think it is incumbent on the larger standards community to seek out that input and bring it forward, but I also want ONC and the SDOs to hear from them directly.

So, we need a way to make that happen.  One thing that I might suggest is to provide a larger budget for communication to make these providers more aware of what is happening.  The second is to create opportunities designed to get their input.  Those opportunities need to be something other than "come spend a day in Washington", because frankly, even if the travel is covered, that's an investment of time that many cannot make.  There should be some way to bring the "national experts" to the local events to gather input.

The second piece is to encourage participation, and again, I have some concrete thoughts here.  If you want my pediatrician's input, you need use the forums where she is already engaged.  Focused questions would seem to be best to get very specific answers, but I also find that very broad questions elicit some very interesting responses.  They often address issues that may not be "national priorities", but are fundamental if national priorities are ever to be addressed.  But the other part of this is to somehow address the cost of participation.  There are a couple of thoughts here.  One of them capitalizes on the fact that participation in these activities is an education, and providers already have a responsibility for ongoing education.  It sounds like there might be an opportunity here to set up a CME program where providers get credit for participating in the process.  That would probably need to be structured in some way.  Another possibility are "micro-grants" which would offer smaller providers grants to participate in some of these activities in exchange for bringing their knowledge back to their communities.  Another possibility would be to provide some sort of "scholarship" mechanism for smaller providers.  And speaking of scholarship, why don't we connect with the educational centers and let them know of the opportunities to participate in these processes.

I routinely recieve 2-3 e-mails a month from people who have students who want to learn more about standards, and I put them in touch with the different organizations.  But the SDOs and ONC could certainly do more outreach here.

Still thinking...


  1. Keith:

    While your description of the Canadian system is a bit simplistic (health care in Canadia is provided PARTLY by the nation, as in the US), you are bang on that Canada has the identical issues around the engagement of stakeholders in the standards development, harmonization, maintenance and ADOPTION processes.

    The governance structure of the Infoway Standards Collaborative is actually designed around maximizing engagement, and participation in all standards initiatives is open to any individual or group that wants to contribute. Response has been very positive, and I think pretty much every stakholder group is represented.

    Communications is also considered paramount, and the SC employs many methods of messaging to foster collaboration: f2f gatherings, e-news, education, outreach, etc.

    So... issues are the same, urgency is the same, barriers are the same. The difference is that Canada has been at this actively for 5 years, while it's still relatively new for the US...

  2. Keith,

    I am an informatics educator and avid reader of your blog, both to be informed as well as to find good information for teaching. I completely agree with your last statement about the awful job that most SDOs, especially in our field, do with regards to educational materials. I have complained to Chuck Jaffe as well. I would love to see much better materials to teach about the theory and use of things like RIM, CDA, etc., etc..

    Bill Hersh
    Oregon Health & Science University