Russell Branzell, President and CEO of the College of Health Information Management Executives

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Mark Masselli: This is Conversations on Healthcare. I am Mark Masselli.

Margaret Flinter: A nd I am Margaret Flinte r.

Mark Masselli: Well Margaret Congress is back in session. There is a lot of talk on
health matters coming out of Washington . The new veterans affair secretary Robert
McDonald telling law makers that significant changes are already under way at the VA
starting with the Phoenix facility that was ground zero for the breakout of the veterans
health administration scandal.

Margar et Flinter: He says that they are proceeding with rigorous investigations into
issues that more than 100 facilities that currently are treating veterans across the
country.

Mark Masselli: He did know that a 150,000 appointments were completed in May, Ju ne,
July. A s ignificant improvement over the previous years the VA has also reached out to
a quarter million veterans across the country to get them off waitlist and into care and
treatment.

Margaret Flinter: And since he took office th ey have hired 54 new clinicians at the VA
facility in Phoenix , so looks like they are beginning to make some real progress in
getting to the bottom of this problem of treatment of the nations veterans and ensuring
up staffing where it’s needed the most.

Mark Masselli: Mc Donald vowing to learn from the experience in Phoenix and correct
the problems , strong words as well as actions from the new VA chief.

Margaret Flinter: And Mark also some strong words and actions coming from the new
chief of health and human services. In her first major speech first HH secretary Sylvia
Matthews Burwell promised to devote all of her efforts to improving the functionality of
healthcare.gov. The problem plagued Federal Insurance Exchange, her recent hirer of
Kevin Counihan to run the Fede ral Exchange that was a positive first step.

Mark Masselli: He will be working in concert with a highly specialized team to make
sure the system is ready for primetime come open enrollment in November.

Margaret Flinter: Well Mark it really comes down t o how easily information can flow
from the customer through the portal to the appropriate officials. Something that

happens so easily in other industries like banking still seems to elude the healthcare
space , but certainly making great strides in a relat ively compressed period of time.

Mark Masselli: On that note , Margaret , its National Health Information Technology
week showcasing the essential role of FIT as it improves quality, expand access and
helps curb cost of healthcare in America.

Margaret Fli nter: Well health IT issues is certainly essential to the responsibility of
healthcare providers around the country and still so much to learn in that space
something our guest today knows quite a bit about.

Mark Masselli: Russ Branzell is President CEO of the college of health information
management executives , an organization that promotes policies that strengthen the
health IT landscape. It’s an evolving discipline and much needs to be done to support
that space.

Margaret Flinter: FactCheck.org , Ma naging Editor , Lori Robertson will stop by with
more false claims spoken about health policy in the public arena.

Mark Masselli: But no matter what the topic you can hear on all of our shows by going
to chcradio.com.

Margaret Flinter: We will get to ou r interview with Russ ell Branzell in just a moment.

Mark Masselli: But first here is our producer , Marianne O’Hare , with this week’s
headline news.

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Marianne O’Hare: I am Marianne O’Hare with these Healthcare Headlines . The US
government is ai ding an international efforts to fight the burgeoning spread of the deadly
Ebola virus through a number of West African nations. Liberia , which is the epicenter of
the worst of the outbreaks has one of the least efficient health delivery systems , t he US
G overnment is setting up a temporary hospital unit in Liberia that will house the flow of
p roviders coming into the region safely. Scientist are honing in on a treatment utilizing
blood parts from those who have survived the virus to produce a quicker vacc ine.
Meanwhile officials of the CDC are focused on a different kind of virus outbreak in this
country affecting school aged children mostly in the mid - west. The e nterovirus 68 can
mimic cold symptoms but quickly deteriorate to far more serious conditions . A number
of children have been hospitalized so far though it’s noted 68% of those afflicted suffer

from asthma and other related respiratory issues. The veterans administration is
targeting VA health facilities around the country that were found to hav e violated the
VA’s requirements for treatment of patients , wait times have been reduced , and
clinicians are being hired. But that’s not the same tune being sung by scientists across
the country funded by the National Institutes of Health. There has been a steady
decline of funding at NIH since 2012 when conservative elements in Congress began
slashing funds for scientific and health related research. Many long - term research
teams are being unfunded closed altogether or having to cut back greatly on thei r work ,
and a woman who discovered the first gene for breast cancer BRCA1 is out with a new
research suggesting the gene once thought to be primarily prevalent in families is now
more widespread than that. She is urging all women over 30 be genetically sc reened
for BRCA1 and BRCA2 , a gene mutation associated with ovarian cancer as well. About
half the women who presented with those genes in her most recent studies had no
family history of the disease. I am Marianne O’Hare with these healthcare headlines.

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Mark Masselli: We are speaking today with Russell Branzell President and CEO of the
College of Health Information Management Executives or Chime and Organization
serving the professional needs of over 1400 Chief Information Officers and senior health
IT professionals. Mr. Branzell has served as CEO of the Colorado Health Medical
Group during which time they are in the distinction of being the most wired, most
wireless hospital by information week. Mr. Branzell has served in numerous leadership
roles at Chime and is a board certified by the American College of Healthcare
Executives . Russ welcome to Conversations on Healthcare.

Russell Branzell: Thank you very much for having me today.

Mark Masselli: You know so much transformation underway with the adoption and
implementation and hopefully meaningful use of all this new electronic health data , but
the Department of Health and Human Services recently issues a final rule on achieving
meaningful use status in 2015 and your organization has take n strong issue with that
rule. Can you tell our listeners about the rule and what Chime has recommended is a
better option for stakeholders?

Russell Branzell: We came out with a lot of other organizations actually 50 strong
associations that signed on t o a memo asking for flexibility in the program, specifically
timing flexibility. I think there was a underestimation, the complexity and the
requirements for this much adoption of technology , and the ability to optimize that
technology over , it was really a compressed period of time. To their credit helping new

resources came out with a notice for a proposed rule making earlier this year which did
give some flexibility. The problem is given the timing of what that process takes what
really encourages is the process takes months and months to become a final rule. The
biggest concern we had though was the changing of the 2015 implementation period to
be a 90 day reporting period instead of the entire year 365 , and the reason that’s so
important is if you h ave a 365 day reporting period , you need to be ready on 1 October
that beginning of a new fiscal year if you are a hospital trying to comply with the
program. Many will not be ready to start collecting data.

Margaret Flinter: Well Russ , obviously it see ms like we are still in something of a
nascent phase in the field of health information technology and if we look back over the
recent years certainly the growth of adoption of electronic health recor ds (inaudible
7:40) park by the High - Tech Act which prov ided significant infusions, billions of dollars
to help institutions transition away from paper records but through all this time we have
had that tower of babbled problems, so many information systems that aren’t able to
talk to one another or understand one another. How does your organization approach
the breath of this problem and what are your recommendations for improving
interoperability?

Russell Branzell: Most of our systems grew out of a period of isolation and
competitiveness not at every period of collaboration and patient care sharing and so to
move that process, to move that needle some , it’s going to take quite a bit of effort.
That really was part of the adoption of meaningful use in the High - Tech Act , and I think
there are a lot in this co untry both in Washington and out everywhere else that are
misinformed and thinking that somehow magically , we are going to jump to the latter
stages of meaningful use benefits while we are actually in the early stages of adoption.
The easiest way to descr ibe this is by an analogy of a house build we are just finishing
up the process of pouring the foundation. We haven’t even started framing up our
house now a few organizations have but the vast majority in generalizing this out are
just finishing up blowi ng out of the foundation. As we move into stage two we will start
the process of erecting that house and eventually we will move to stage three which is
finishing it out and furnishing it, living in it and having interoperability but to assume we
are goin g to have stage three interoperability and exchange of information while we are
just finishing up stage one I think is a little short sighted. Now there are many things we
can be doing working collaboratively with other organizations, with other industrie s but I
think we also need to recognize we are just really entering into the period where
interoperability can be enabled by the early stages of adoption that we have had.

Mark Masselli: Another item which was the delay in implementation of ICD - 10 call f or
st
everyone to be ready October 1 of 2014 , and there were many practices including ours

and this was postponed for one full year. Talk to us about your feelings about this
delay?

Russell Branzell: We were extremely disappointed in the delay , especiall y in light of the
timing at which it was delayed , for most of the organizations both hospitals and
providers , they were either in the implementation phase or actually finishing up the
implementation phase of adopting their ICD - 10 technologies well then the ir financial
systems and revenue cycle processes. For most organizations , they actually had the
software running behind the scenes live and ready to go and a vast majority of the
country were actually ready for this . W e think this delayed for probably in appropriate
reasons and actually create a quite a bit of burden for organizations. In many cases
organizations had done enough change and enough adoption that they couldn’t go
back. Many out there today have this system running. It’s operational, it wor ks . T hey
are doing all behind the scenes work in the front and work of coding to the standards
then people are manually going back and down coding back to ICD - 9, which is
expensive, it’s laborsome and we are looking forward to getting this adopted in 2015 ,
but the reality is there was probably a short - sighted process considering how far we are
behind with the rest of the world from the ICD - 10 perspective.

Margaret Flinter: Certainly it make s it harder the next time around for people to believe
it’s actua lly happening among the other unanticipated consequences.

Russell Branzell: You know that’s one of the questions that I get at almost on a daily
basis via email or phone call from our members. I am being asked whether I should go
ahead and spend the mon ey for this now. What should I do Russ ? A nd well I tell them
in many cases I am not sure yet .

Margaret Flinter: So obviously just tremendous amounts of innovation and challenge
and change in the healthcare landscape. Tell us what are the services that you provide
for your members, what do they look to you for and what policy directives are you
promoting as you move forward with this mission of integrated health IT world?

Russell Branzell: We are a group of professionals . I lived in this world from 2 0 years as
a CIO and that is an association that comes together to help each other out , so it’s
actually an organization of peers looking for ways to both serve in an educational role to
one another, share best practice and really lean on each other to sho rten the adoption
curve and shorten the hard work that needs to be done. We really serve our role to
advocate and educate both at a state level and at mostly at a national level to try to
assist in the understanding of how this affects our industry that w e can really get to what
is often referred to as the triple aim and that is most importantly improving patient care,

improving safety , and reducing this burdensome cost that we have that’s hurting our
national economy . W e are 1500 strong CIO’s and they re ally have a primary goal and
that is to help our country serve our patients and our families and communities in a
better way and to make this affordable , which I think is everybody’s goal.

Mark Masselli: We are speaking today with Russell Branzell , Presi dent CEO of the
College of Health Information Management Executives or Chime , an organization
serving the professional needs of over 1500 Chief Information Officers and senior health
IT professionals in the healthcare industry. Russ security breaches are another big
concern. Tell us if you would where you see the most urgent vulnerabilities right now?

Russell Branzell: This is probably the greatest challenge facing the HIT professionals
that are out there. We launched about a little over a month ago a new association and
probably association of executives and healthcare information security and in just a first
few weeks of that being launched we had over 150 members join this organization. The
days of security and easy security are over. If the CIA ca n be hacked, if the federal
government with all resources can be hacked the average hospital or medical group out
there are going to have trouble just being able to protect yourself. There are a very few
organizations that can even afford the type of tech nology solutions that are needed to
implement a very robust security.

Margaret Flinter: Well and certainly the generation that’s coming into healthcare as
providers are digital natives what fundamental changes in trainee do you anticipate as
we prepare t he next generation of healthcare providers and professionals how this
helped IT factor into that paradigm shift?

Russell Branzell: We so have a unique dilemma right now and that is this is one of the
first time just not the only times we have to deal wit h three almost four generations of
learners in trying to adopt new technologies. We are moving to a whole new social
media based platform where the days are going to a traditional website in grabbing
things really don’t exist anymore so I think part of th is is waiting for people to come to us
from rather from us to come to them with the things that are there. Interaction with
peers in creating small groups of communities so they can share in their needs. We
have launched a program called our leads, leade rship and development program that
small regional events 20, 30, 40 people at a time to really intimately sit down and talk
about hardcore issues that they are trying to solve and this year just happens to be on
your previous question which is on cyber sec urity a nd the ability to implement those so
you have to hit the whole spectrum of training , but the concept of engaging people in
their natural life that’s probably the foremost that what we are looking to engage people
on.

Mark Masselli: Yeah I now I wa nt to pull the thread a little on that because it is one of
the most daunting problems , I think , you know , we have seen some initiatives, all the
portals that we have seen are very clunky and you have to very interested in that getting
data but it’s not pa rt of or daily life and so we have this big struggle between they are
almost generational but unless we design something that is more user friendly. I don’t
think we are ever going to really achieve this full integration that being discussed there
sort of thoughts on that.

Russell Branzell: Well I think what we are going to have to see and I like your
comments there is this natural evolutionary process we are going through is going to
take too long and it’s going to be too complicated and it will be too costly. Who would
have thought even ten years ago that something like a Facebook would even change
the way we share our information and our pictures and keep connected with people that
in many cases if you move you just kind of lost contact with them. Th e same is true you
have to implement technologies in such a way. Our new solution that we are partnering
with an organization called Next Way to Connect is actually trying to do just that, try to
connect all of your CIO’s, our HIT professionals in such a way that it just native in
sharing information on daily basis of things that they need to. I see email in my email
inbox and if I have got 20, 30, 40 new email s, I just look at it as 20 or 30 new emails. If I
look down at one of my social media apps on m y phone , and I see a little red number
next to it somehow I have a panic attack , and I think I better get on that because it must
be something important. I think that’s the integration with our natural life and we are
going to have find those examples to also legally, respectfully, privately and securely
exchange patient information to help our providers care for people.

Margaret Flinter: Well Russ we have really observed and appreciated the focus that the
current administration in Washington has put on bringing in the IT brainpower from all
around the country, from private sector and from Silicon Valley Todd Parks who we had
on the show early on he has left his post. He is chief technology officer at the White
House returning to Silicon Valley probably to recruit more tech talent to lend their
expertise to government and he is replacing a former Google VP Megan Smith thought
to be a very powerful pick for the post. What more do you think needs to be done from
a policy perspective to improve the environm ent for health information technology and
maybe from a regulatory perspective as well what’s government’s role in advancing all
of this?

Russell Branzell: Probably the biggest gap that we are seeing at this point still is
appropriate government standards that truly are standards based and that is in many
cases what we see is a facilitation of a natural process out in the industry that probably

takes too long and there is a time and place for the government to clearly lay out
standards and requirements, pa tient matching and patient identification is a great
example of that , just like (inaudible 18:26) study now well over a decade ago , the same
thing is occurring with patient matching and patient identification. People are being
harmed, injured , and killed almost on daily basis if not on a daily basis because of
inappropriate patient matching. That’s a good place for the government to step in with
good standards and apply across a very large brush stroked a part of the industry if not
nation in such a way t hat we can facilitate great gains in those areas and I think what
happens is as we deal so much in a world where we think things can’t be government
lead in certain perspectives that we end up fighting that and end up with poor solutions
where we could hav e a clear standard that’s out there and I think this is a great example
of clear standards, clearly enforced standards now that can be true the certification
process that can be through government over site and audit through something that
goes CR. No mat ter how it’s done there is an appropriate place for the government to
come over the clear standards. That’s probably the area where we still think there is an
appropriate place for government intervention.

Mark Masselli: We have been speaking today with Russ Branzell the president CEO of
the college of health information management executives or Chime an organization
serving the professional needs of over 1500 chief information officers and senior health
IT professionals in the healthcare industry. You can learn more about their work by
going to CIO - chime.org or follow him on Twitter@chimeceo. Russ thank you so much
for joining on Conversations on Healthcare today.

Russell Branzell: Thank you very much for having me.

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Mark Masselli: At Conve rsations on Healthcare we want our audience to be truly in the
know when it comes to the facts about healthcare reform and policy. Lori Robertson is
an award winning journalist and managing editor of FactCheck.org a nonpartisan,
nonprofit consumer advocat e for voters that aim to reduce the level of deception of US
politics. Lori what have you got for us this week.

Lori Robertson: Over the years we have seen an avalanche of advertising against the
Affordable Care Act and with mid - term elections approachi ng that’s continuing. In
Colorado for example an ad from a conservative group cross roads GPS exaggerate a
few personnel anecdotes to claim that many Coloradans pay roughly a 100% more for
health insurance since the healthcare law was passed but the new s tory the ad sites to
backup that claim says that some resort area residence for paying that much more and

get too personnel anecdotes. The couple who say they were paying about double and
a woman who said their premiums have gone up 66%. The story was ab out
Coloradans who buy their own insurance on the individual market so the ad takes a line
in a new story about some resort area residence and turns it into many Coloradans in
the ad. As the narrator speaks the viewers sees the quote from the newspaper on the
screen with the word some left to ask. It’s true the Coloradans within in ski resort areas
and some rural areas of the state have complained about high premiums for those
buying their own coverage but residence in those areas pays higher health cost before
the Affordable Care Act two. One of the issues for rural residence is the low number of
healthcare providers. The Ad references that issued too but wrongly implies that the
Affordable Care Act was to blame it says on the eastern plains patients no w outnumber
doctors 5000 to 1 but that figures comes from a 2013 data on the ratio of total residence
to primary care doctors and it’s the first time the study was conducted. The authors
don’t fake the healthcare law whose major insurance provisions , TEDM ED taken affect
for the problem and that’s my FactCheck for this week. I am Lori Robertson, managing
editor of FactCheck.org.

Margaret Flinter: FactCheck.org is committed to factual accuracy from the country's
major political players and is a project of the Annenberg Public Policy Center at the
University of Pennsylvania. If you have a fact that you would like checked, email us at
chcradio.com, we will have FactCheck.org's Lori Robertson check it out for you here on
Conversations on Healthcare.

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Margaret Flinter: Each week conversations highlight a bright idea about how to make
wellness a part of our communities in everyday lives. September is suicide prevention
month and it’s a particular interest to the veteran’s administration. An estimat ed 22
veterans per day are taking their own lives and what’s being described as a post war
suicide crisis. With a lack of behavioral health clinicians available for every veteran who
is experiencing difficulty , the VA has launched a campaign aimed at all Americans who
know veterans who maybe struggling. To be aware that they can make a difference just
by reaching out , it’s called the power of one campaign. The idea that one person
reaching out to one veteran in a caring manner can make a difference.

Fem ale: The power of one small action, one conversation or one phone call can make
a difference in the life of a veteran going through a difficult time. For free 24x7
confidential support call the veterans crisis line or the military crisis line.

Margaret Flinter: According to Dr. Katelyn Thompson , Deputy Director of VA Suicide
Prevention Program it takes only a moment and just one small act can start them down
the path to getting the support they need. The VA has launched a new suicide
prevention hotline . It’s now collaborating with community groups across the country to
prepare them to better address the needs of these veterans many of whom don’t know
how to ask for the help they need. Veterans, service members and anyone concerned
about them can call the veterans crisis line, 1800 - 273 - 8255. They can chat online at
veteranscrisisline.net/chat or send a text to 838 - 255. Even if they are not registered
with the VA or enrolled in healthcare , all veterans crisis line resources are optimized for
mobile dev ices. A dedicated program aimed at reaching out to veterans across the
country and empowering community groups and individuals to find ways of offering
support to getting veterans , the help they need before it’s too late now that’s a bright
idea.

Margare t Flinter: This is Conversations on Healthcare. I am Margaret Flinter.

Mark Masselli: And I am Mark Masselli. Peace in health.

Conversations on Healthcare, broadcast from the campus of WESU at Wesleyan
University, streaming live at Wesufm.org and bro ught to you by the Community Health
Center.