H. Stephen Lieber, President and CEO of HIMSS Worldwide

Mark Masselli: This is conversat ions on health care I’m Mark Massel l i .

Margaret Flinter: And I’m Margaret Flinter.

Mark Masselli: Well Margaret insurance companies are weighing in on the President’s
response to the millions of cancelled health plans that didn’t meet requirements under
the Affordable Care Act . The President offered a public solution let those folks keep
their plans for one more year .

Margaret Flinter: Well that decision is now not s itting so well with some insure r s who
say it really push them in a bind, they have to figure out how to make those plans fit the
requirements under the Affordable Care Act which must include the so called tenant
essential benefits which is the primary reas on that they were cancelled in the first place .

Mark Masselli: We’ll see how they respond to their President’s solution on a state by
state basis .

Margaret Flinter: Well Mark I still think that it’s a pretty safe bet to say that once most of
these once most of these folks see what they can find in terms of Affordable Health
Insurance in the online insurance marketplaces they won’t be so eager to hang on to
the old plans many of which had very high deductible s and only minimal coverage but
people are oft en pretty resist ant to change .

Mark Masselli: But there are many changes on the health care horizon that often get up
secured by the retaract most especially of the impact technology is having .

Margaret Flinter: And that is something that our guest today is quite knowledgeable
about Steve Lieber is the President and CEO of HIMMS Worldwide that’s the Health
Care Information Management System Society . Their mission is simple but pretty vast
in scope improving healt h care through information technology and he’ll be talking about
some of the many breakthroughs underway that are poised to transform traditional
health care as we know it.

Mark Masselli: Lori Robertson Man aging Editor of Factcheck. org will be stopping b y.

Margaret Flinter: And to no matter what the topic you can hear all o f our shows by
googling CHC Radio .

Mark Masselli: And as always if you have c omments please contact us at chc radio.com
or find us on Facebook or Twitter we’d love to hear from you .

Margaret Flinter: We’ll get to our interview with Steve Lieber in just a moment .

Mark Masselli: Bu t first here’s our producer Mari anne O’Hare with this week’s Headline
News.

(Music)

Marianne O’Hare: I’m Marianne O’Hare with these Health Care Headlin es The White
House is still sticking to its promise of functioning online insurance marketplace by
th
November 30 but they’re scaling back the numbers . In the recent press briefing White
House’s spokesman Jay Carney said one in five Americans who tries to log on to this
site won’t ultimately end up buying insurance on healthcare.gov in spite of the fixes to
the website there are some people who just aren’t comfortable purchasing insurance
online and for the others the ir tax situations are too complex to calculate the subsidies
o nline without assistance . The White House is considering other options to deal with
that issue including adding more trained navigators who can assist customers over the
phone or in person . Me anwhile as predicted the passive enrolment has picked up
significantly since the launch of healthcare.gov doubling the amount from the week
before and folks on the frontlines of treating cardiovascular disease had been given a
new tool for assessing risk f or heart attack and stroke but turns out this new online
calculator meant help them to determine a patient’s need for cholesterol treatment is
flood, it’s based on 20 - year - old data and heart attack and stroke rates are much lower
now . The new calculator r eleased by the American Heart Association exaggerated the
true risk of heart attack or stroke by an average 100 % but the American Heart
Association and the American College of Cardiology don’t plan to change or eliminate
the calculator in part because ther e’s no good alternative .

I’m Mari anne O’Hare with these Health Care Headlines .

(Music)

Mark Masselli: We’re speaking today with H. Steve n Lieber President and CEO of
Health Care Information and Management Systems Society Worldwide also known as
HIMSS Worldwide , it’s a global cause based not for profit health care association
focused and achieving better health with information technology . Mr. Lieber sir is on the
Board of Directors of HIMSS Worldwide and its related organization . He is also one of
th e founders of the Certification Commission for HIT and the Health Information
Technology Standards Panel to promote Health IT Interoperability . Steve , welcome to
Conversations on Health Care .

Steve Lieber: Great thank you very much .

Mark Masselli: Wel l we’re not going to talk about the problems with Affordable Care Act
website .

Steve Lieber: It does involve technology , doesn ’ t it ?

Mark Masselli: But we really want to talk about the great work you and your
organization have been doing on the frontli nes or promoting a culture that supports the
use of information technology to improve health care delivery and so for our listeners
who don’t know about HIMSS , c ould you describe your organization for us and what is

your mission exactly and how do you see it leading to the triple aim of improved excess
better quality of care in reduced cost?

Steve Lieber: Sure . HIMSS is a more than 50 - year - old not for profit cause based
organization , functions globally . We ha ve offices in the US, Europe and Asia and we
also do programs in the Middle East . The vision of the organization is better health with
information technology . Those systems and applications that carry information , the
various applications and computer systems that take information from a variety of
places in other words it’s the elimination of the old clip board when checked in for an
electronic system that ’s able to follow you around wherever you are receiving treatment
for so long information and health care was tied up in paper records but paper records
don’t move very well . A nd so what happens is care is not well coordinated and so this
really gets to the issue of triple aim in terms of improving quality reducing cost ,
increasing access , who we work is over ideal stakeholders starting with gover nment ,
government is a huge influencer not only in the United States but around the world in
health care policy , even in a private system like the United State we follow the lead of
the Federal Government as it establishes the national health policy , the c ompanies that
make these products . We work very closely with them in terms of insuring that there is
a degree of standardization so one, commercial product will be able to communicate
data to another . We work with clinicians , administrators , patient orga nizations , and
trying to move the health care system from really a fairly or (6:38 inaudible) 121 which
st
is 21 Century able to realize the promise of health care by eliminating errors, making
sure better information at the point of care .

Margaret Flinter: Well , Steve , we recently have one of the great champions of health IT
Farzad Motashari the recent National Coordinator of Health IT for HHS on our show .
He put some of these in perspective by talking about the incredible milestones that we
have achieved in health IT so far really in relatively few short years since two major
pieces of legislation where past on e of course the Affordable Care Act but the other the
High Tech Act maybe you can speak to how these two pieces of signature legis lation
have brought us closer to the improved health care delivery system through a better use
of information technology .

Steve Lieber: Sure , Margaret . The 2009 American Recovery and Reinvestment A ct ,
The Stimulus Laws we remember it that the country wa s in terrible economic situation
and so early days the Obama A dministration they pass ed this legislation which was full
of all kinds of things related to recovery but it also had that other R word and it’s titled
Reinvestment and the administration picked three major policy areas education, energy
and health care to put significant investments in that piece of legislation to move
America to different place .

And we can do a little bit of comparing and contrast with our neighbors to the north o n
Canada where similar focus on the improvement of Information Systems but without an
Investment Act and so what’ve seen is that in Canada according to an eight stage
model that we’ve developed that tracks , the adoption of information technology in
hospitals seem very little change in terms of movement up that scale while in the United

States there has been a dramatic change from the S tage 2, Stage 3 to Stage 4 and
Stage 5 which are much higher levels of IT adoption and all of this has occurred since
2009 . S o there’s clearly no doubt about it that the High Tech Act very much created the
stimulus necessary f o r hospitals to be able to invest . The n you got the 2010 Affordable
Care Act which creates really much more around the reimbursement issues , the access
is sues far less to do with technology other than it create situations where you won’t get
paid for example if you treat a patient in a hospital and they’re readmitted within 30 days
under certain conditions you don’t get paid because the assumption is and th e research
shows you didn’t do what you were supposed to . Well having technology in place will
allow you to better identify those patients more likely to be readmitted in a short period
of time and do the right things to prevent that from happening . S o t here’s an indirect
affect that the ACA A ct also has in terms of driving great er adoption of information
technology .

Mark Masselli: Steve , you’re a member of the Original Health Information Technology
Standards Panel and it’s a public - private partnership to develop and promote
Interoperability Standards for health IT and area and we’re still seeing quite a few
challenges and I was surprise to read that you still think we’re at the sort of gold rush
phase of innovation here in Health Tech Development that there are tens of thousands
of new IT systems and apps being develop but they are not communicating with each
other . I was kind of surprised the little I know I thought HL7 and others were really
design to make people talk to each other but it still sounds like it’s a tower or babble so
what’s involved in setting these standards and how should they be functioning in the
health care marketplace ?

Steve Lieber: Mark , I’ve been at the HIMSS for nearly 14 years now and when I first
came in the word Inter operability didn’t even exist . The concept of systems being able
to integrate was the word used at the time was there and a tremendous amount of effort
was put into the writing of interfaces that basically translated one system into another
the problem is that we don’t have a system that really and I’m not talking about
information system but a process which really drives absolute adoption of common
standards . We’re just now getting to the point where there is an acceptance that the
data needs to given ba ck to the patients so that they can share it with other practitioners
thin g s that if we sort of compare it to other activities that we do in the financial systems ,
the easiest one is that the demand for integrated systems became absolute very early
on for those of us -- in my age group we remember the time when you couldn’t go to
every ATM and get money out you had to go to ones in --

Mark Masselli: Mm - hmm

Steve Lieber: -- your network well the public didn’t put up with that for very long
because we’re much more mobile now, we ’ve got to be able to access and money is
very important t us . Patients and citizens still have not gotten to that point where we
take accountabili ty for our health care and insists that we have control of it . S o that
same sort of driving force for Universal Adoptions Standards doesn’t exist . There are
health care organizations who now put into their request for proposals , certain

requirements to ensure better interoperability but the other thing to remember is that the
health care record is far more complex than a financial records . It’s not uncommon to
hear a CIO in a hospital talk about the hundreds of information systems that t hey
manage within the environment .

All of those or many of them are developed by different companies , there are HL7
S tandards , there are other standards organizations and different kinds of data have
different standards , big problem is we still don’t have the absolutely compelling case for
everybody to adopt them exactly the same way so that brings in one final piece on this
issue of standardization i s that a physician group looks at a patient record and said I
want things this way or that way as customiza tion , well once you start moving things
around having it displayed differently , having it captured differently and actually
suddenly makes that system not compatible with someone else’s and you have to map
them to one another . S o what we’ve tried to do is that a very thin level of data sitting on
top of a patient record is established in a universally adopted format so that the critical
information that a physician or nurse must have about a patient does flow from one to
another , that’s first step we’ve be en able to achieve and across all of your major
electronic health records and it is part of the meaningful use for requirements that the
governments imposed for eligibility to receive these incentive payments you’ve got to
have that .

Margaret Flinter: We ll , Steve , in our experience as we coming on the closing out close
to a decade since first adopting electronic health records is that we absolutely are
seeing the meaningful use payoff , we’re seeing our ability to make substantive
improvements in the quali ty care through health data management , maybe give us a
sense of h ow does this look in other parts of the world where HIMSS is conducting
surveillance and research on health IT who are the real standard barrier author that you
think of substantially skille d the heights of meaningful use of electronic health records in
technology ?

Steve Lieber: In the United States let’s set the baseline here pretty high adoption 80%
of US hospitals have at least begun the process of adopting full - fledged electronic
medical records , physician practice s you’re moving on 50% now when you go over to
Europe , the European system by virtue of how they pay for care which is much more
centralized at the regional or national level they focused on the continuum of care far
long er than we have which starts with primary care , not starts with hospitalization .

So in the Scandinavian countries for example you find virtually a 100% of the primary
care practices are linked by an electronic medical record nationwide , so huge , huge
prog ress there, and not recent I mean this will go back six to 10 or more years ago .
A nd again it’s that focus on the continuum of care not so much the acute phases . Now
when I look it up micro level they are certainly no better examples of IT adoption
anywh ere in the world than you’ll find in the United States , so you know what we’ve
done by virtue of our private health system is those who have the resources recognize
the benefits and the reduction of medical errors, the improvement of quality outcomes ,
the improvement of profitability through adoption of technology and they’ve invested .

We don’t have a system that takes care of those intercity rural very small hospital s who
don’t have those kinds of resources or primary care practices to make sure that they
can achieve the same level .

Mark Masselli: We’re speaking today with H. Steve n Lieber , President and CEO of
Health Care Information and Management Systems Society Worldwide also known as
HIMSS Worldwide it’s a health care association focus on achieving better health with
information technology . Steve , there’s another issue that has to be examined that’s
broadband and in recent speech you shared a pretty astounding fact that by 2016 we’ll
be showing 1.2 million video minutes over the internet every secon d and there’s going
to be required an impressive amount of broadband capability that you say we just don’t
have which is surprising so tell us what’s the big picture , who’s keeping track of the
national broadband capabilities by the way and how do we stack up against the rest of
the world ?

Steve Lieber: Broadband is the movable type printing press of this period . The United
States in 2012 we had about the same level of broadband connections as Japan but
two countries for example France and South Korea ha d about half again as many
connections you go back 10, 15 years ago you know just coming out of the dial - up
modem phase into now WiFi we think it’s being fairly ubiquitous but it’s really not , you
know for those of us that live in cities we don’t find it d ifficult at all . When you start
getting out from major metropolitan areas it drops off and on the health care side there’s
just no question about it . The ability to transmit information, images over distances is
critical , the concentration of medical exp ertise is -- has a relationship to metropolitan
areas and so the ability to connect those areas with high quality, high resolution, high
speed connections is absolutely critical for us to be able to achieve the objectives of
high quality health care where v er you might be .

Margaret Flinter: Steve , you have multiple offices around the country and the world
where you conduct ongoing research and outreach but you just opened up a new kind
of enterprise in Cleveland , it’s called the HIMSS Innovation Center des cribed as a year
round destination for audiences from health care providers to developers who want to
better understand how the sharing of patient health information works , as well as
vendors who want to introduce a new product to rigorous testing so tell us what was the
impetuous to place this Innovation Center in Cleveland and what do you anticipate is
going to emerge from this new innovation hub ?

Steve Lieber: In conjunction with the redevelopment of the convention center decision
was made to build adj acent to that Convention Center , a global center of health
innovation and this building is attracting organizations who are focused on looking at the
issues of cost quality and access in saying what can we do to help drive thinking an
actions to a different place . S o it was a natural for us because it was going to be a
gathering place for these types of companies and physicians and other clinicians who
are focused on finding the right keys to success and improving health care . A nd so
what we’re do ing is using this facility as a place where we will want test products
primarily available on the market . We’re offering the ability to test those products

against one another to ensure their interoperability and the impedous really is that the
center was there there’re others who going to be engaged in similar activities they’re
audiences they’re going to come to Cleveland to see sort of thing so it was a great
opportunity for us to leverage the focus that’s going to come to that global center for our
pur poses of helping drive the marketplace towards a new place .

Mark Masselli: We’ve been speaking today with H. Steve Lieber , President and CEO of
HIMMS Worldwide you can learn more about his organization’s work by going to
HIMSS.org . Steve , thanks so much for joining us on Conversations on Health Care
today .

Steve Lieber: Margaret , Mark , it was my pleasure.

(Music)

Mark Masselli: At Conversations on Health Care we want our audience to be truly in the
know when it comes to the facts about health care r eform and policy , Lori Robertson is
an award winning journalist and managing editor of factcheck. org a non partisan, non -
profit consumer advocate for voters that aim to reduce the level of deception in US
politics . Lori , what’ve you got for us this week ?

Lori Robertson Well in late October Health and Human Services Secretary Kath leen
Sebelius testified on Capitol Hill about the trouble s with the Health Insurance Exchange
Websites . She said it was illegal for her to obtained and churns herself on exchang es
which lead Colorado Representative Cory Gardner to accuse d her of lying . It turns out
Sebelius is right . She didn’t explain this to Gardner when he was questioning her but
the exchange plans can be sold to Medicare and relief and Sebelius in addition to
having insurance to the Federal Employees Health Benefits Program is a Medicare
enrollee . Gardner as k Sebelius why she wasn’t in exchange and she initially said she
has affordable coverage through work so she is not eligible , that’s not correct . Those
getting employer sponsored insurance could buy exchange plan s but it wouldn’t make
financial sense in most cases as employers often make sizeable contribution towards
workers premiums . Gardner urge the Sebelius to find a way to join the exchange and
she blurred it out its illegal with no explanation . Gardner later accused her of lying but
as HHS explained she also has Medicare Part A making it illegal for an exchange plan
to be sold to her . Meanwhile Gardner and other members of Congress and their
staff ers are required by the Affordable Care Act to give insurance on the exchanges in
2014 . A nd that’s my fact check for this week , I’m Lori Ro bertson managing editor of
fact check . org .

Margaret Flinter: Factcheck. org is committed to factual accuracy from th e country’s
major political players and is a project of Annenberg Public Policy Center at the
University of Pennsylvania . If you have a fact that you’d like to check email us a t
chc radio.com . We’ll have factcheck .org’s Lori Robertson check it out for you here on
Conversations on Health Care .

(Music)

Mark Masselli: Each week Conversations highlight s a bright idea about how to make
wellness a part of our communities into everyday lives . Outgoing New York City Mayor
Michael Bloomberg is leaving his post with another public health feather in his cap
launched in May of 2013 the City Bike Sharing Program has in a few short months
reached to mile stone. In the first five months since the program launched City Bike
users h ave logged over 10 million miles in over five million rides f a r outstripping similar
programs in other cities throughout the United States . How popular is the Bike Sharing
Program very , they are reaching an average daily ridership of 35,000 . The estimate d
number of calories burns since the program began in May 403 million the equivalent of
732 ,000 big max the B ike Sharing Program has been so successful , the city has plans
to scale the program up to all five Burroughs Chicago and Washington D . C have simila r
programs and have plans to scale up their efforts as well and affordable Bike Sharing
Program that has encourage hundreds of thousands of city dwellers and visitors to
exercise their way to their destination , enhancing their health in the process now tha t’s a
bright idea .

(Music)

Margaret Flinter: This is conversations on health care I’m Margaret Flinter .

Mark Masselli: And I’m Mark Masselli , peace and health.

Conversations on Health Care , broadcast fr om the campus of WESU at Wesleyan
University , stream ing live at wesu fm.org and brought to you by the Community Health
Center .