Dr. Peter Basch, Medical Director of Ambulatory EHR and Health IT Policy, MedStar Health

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Mark Masse ll i: This is Conversations o n Health c are . I am Mark Masselli.

Margaret Flinter: And I am Marg a ret Flin ter .

Mark Masselli: Well Marg a ret , we are still accessing the mid - term elections that
gave the GOP control of both the house and the senate.

Margaret Flinter: And almost immediately Mark , the heir apparent to become
senate majority leader Mitch McConnell is following repeal of the healthcare law ,
and this is inspite of a number of polls that show a majority of Americans favor
keep ing the Affordable Care Act and instead working to tweak or improve upon
some of its more challenging aspects.

Mark Masselli: But more troubling the Supreme Court has agreed to hear a case
questioning the legality of the tax subsidies for Americans who p urchase
insurance on the federal exchange.

Margaret Flinter: Some may consider the premise of the superfluous centering
on simple semantics and the Affordable Care Act but the fact that the Supreme
Court has agreed to hear the case is certain ly a cause f or concern.

Mark Masselli: But this ( inaudible 0:54 ) back to the Supreme Court decision on
the ACA in 2012. That decision led to the patchwork qualitative coverage we see
across the nation as a majority of states refuse to expand Medica id based on the
S upreme Court ruling.

Margaret Flinter: That decision though not expected until June of 2015. So there
are still ways often another round of enrollment about to begin.

Mark Masselli: We are now officially in our second round of open enrollment.
We are expecting millions of more Americans to gain coverage from November
th th
15 of this year to February 15 .

Margaret Flinter: And one piece of legislation that’s had a direct impact on care
delivery in this country is the 2009 HITECH Act which incentivized providers and
hospitals to switch from paper records to electronic records , and we have seen a
dramatic uptake in the adoption since that legislation was passed but still a long
way to go to realize truly meaningful use of all these newly generated electro nic
health data.

Mark Masselli: Our guest today Dr. Peter Basch is an internist and is the Senior
Fellow for the Health IT policy with the Centre for American Progress.

Margaret Flinter: He has been utilizing electronic health records as a practicing
p rimary care internist for a couple of decades.

Mark Masselli: Lori Robertson, Managing Editor of FactCheck.org looks into
more false claims spoken about health policy in the public domain , but no matter
what the topic , you can hear all of our shows by go ing to chcradio.com.

Margaret Flinter: And as always , if you have comments , please e - mail us at
chcradio.com or find us on Facebook or on Twitter . We love to hear from you.
Now we will get to our interview w ith Dr. Peter Basch in just a moment.
Mark Masselli: But first , here is our producer Maria n n e O’ Hare with this week ’ s
Headlines News.
[Music] Maria n n e O’ Hare : I am Maria n n e O’ Hare with the se Health c are Headlines.
Round two of open enrollment is underw ay under the Affordable Care Act and
folks at the Department of Health and Human Services are expecting a smoother go of things this time around inspite of several difficulties with the online portals last year. More than seven million people signed up fo r insurance on the exchanges . Then millions of young Americans were able to stay on their parent’s
plan up to age 26. There has been time for recalibration. Some changes to the side have been made to enhance the capacity for volume processing. Meanwhil e the guy s at family foundation is offering five tips on how to navigate
the exchanges. Number one shop around, the policies have hidden costs and there are more options to choose from this year. Number two don’t get billed
twice. I f you are changing po licies through healthcare.gov, make sure the
existing health plan you have is officially cancelled. Number three find out if you
qualify for financial help or subsidies. Number four know all of the costs. Many
plans have higher deductibles and out of po cket costs. Number five ask for help. There is assistance online at healthcare.gov , and the phone as well , and they are
trained to navigate all the immediate options available to you. Numbers in health
news, 28,000, the number of doctors needed to fill gaps in the Veterans Health Administration. New VA secretary , Robert McDonald , says that a manic increase
in patient populations with the two recent wars has added to the strain and to the delays since problems at the VA came to light earlier this year. I am Maria n n e
O’ Hare with the se Health c are Headlines.
[Music] Mark Masselli: We are speaking today with Dr. Peter Basch, an internist and
Medical Director for Ambulatory EHR and Health IT Policy at MedStar Health. Dr. Basch is Senior Fellow for Health IT Policy at the Centre for American Progress. He represents the American College of Physicians at the Physicians EHR Coalition , and he has received numerous awards including the HIMSS IT

Leadership Award. Dr. Basch earned his Medical Degree at George Wa shington
University School of Medicine and conducted his residency at George
Washington University Hospital. Dr. Basch welcome to Conversations on
Healthcare .

Dr. Peter Basch: Well thank you. It’s a pleasure to be with you today.

Mark Masselli: Well that’s great and you are a self described physician gig , w e
love those who was one of the early adopters of electronic health records about
20 years ago , and the nation’s practices were rather slow to adopt these
technologies until the 2009 HITECH Act spur red adoption to switch from paper to
electronic health records , and a recent health affairs blog post we observe that
we’ve reached sort of this pivotal juncture with EHRs. So what’s the realistic
assessment of where we are on the path to meaningful use a t this stage?

Dr. Peter Basch: I am a practicing doc and one who early on saw benefits in
Health Information Technology applied to clinical practice, not really a gig. Now I
have nothing against gig s but whereas I have often seen from gigs is what I
wou ld describe kind of a zealous love of solutions in search of a problem. You
have identified me as one of probably several hundred or several thousand early
adopters going back decades ago , and if we had stayed on that same adoption
path, it would probably be several more decades before we saw an advancement
of health IT options. So we need to credit (inaudible 6:16) for use or rapid cycling
adoption and improving basic electronic health record literacy as well as very
importantly the concept and practice of sharing information with patients. We
have to give credit to MU for helping to move EHRs from gig stream to
mainstream. But all kidding aside, I believe we are at an inflection point now
where there is a serious risk of pr ogram collapse. Just last we ek, CMS released
its latest MU at the station stats for stage two showing only 17% of hospitals and
only 2% of doctors have attested for stage two this far. In my opinion, MU is a t
serious risk of failing.

Margaret Flinter: You are a primary care intern ist, so well familiar with all of the
issues trying to improve our work and prevention and health promotion and
chronic disease management as well as taking care of the problem the patient
showed up today. We talked a lot about this aggressive campaign th at was on
the way to accelerate the pathway to its meaningful use in the coming decade
and so maybe tell us more about that roadmap that you think we need to be on to
keep that momentum moving forward.

Dr. Peter Basch: Anyone not just Dr. Dasilva [PH] , b ut anyone who believe in
the potential for health IT to be enabling infrastructure for making healthcare
better and safer wants to hurry up and get the job done and it seems to me that
we are moving in the wrong direction. It’s prudent to stay on the same path and
just go faster. I think not and I think accelerating progress in provider use of
EHRs or acquires a midcourse correction and most likely even more flexibility

and measures or alternate pathways for success. The 10 - year roadmap for
interoperabil ity is based I think smartly on moving forward iteratively. But I am
afraid it’s predicated on a faulty foundation. The early years of the
interoperability road map depend on EHR usab ility of the receiving provider
which is ideally a non coercive way to drive providers to choosing digital
commendation over found facts or what often happens how is no communication
at all. So we know that a particular format of information to find the usefulness
and usability, the so called five rights of information, the right information in the
right format, we are the right vehicle to the right person, at the right point and
workflow. This first stage of interoperability provides for only two of the five
rights. Further more providers complain that they take more time finding
information in the EHRs than in paper records. We have added a burden of
assisting through way too much information and this is a mandated format upon
which current interoperability is founded regardless of setting a specialty. The
result is in m y view a bloated and unreal set of data, in many cases exceeding
the equivalent of 70 through a 100 pages with most of it un wanted (inaudible
9:27 ). Certainly that’s not a situation anybody wants to think. So what do we
need to change first? I think fir st we need to pivot from the current monolithic
view of CMS and OMC that the potential benefit and use of EHR should be the
same for all providers and the regulatory driver for EHR development has lead
unfortunately not to innovation but I believe EHR homo genated and the result
being that many docs find this EHR look s like it was built for someone else and
it’s not only not useful for the specialty or for people such as me who are in
primary care, we feel that the EHR doesn’t offer the complexity that we ne ed to
make it useful in our field. Secondly , having an electronic send and receive
requirement that moves messages faster but mandates the messages that
include 100s if not 1000s of your relevant data points that needs to be undone.
All providers to prov ider and provider to patient messaging has mandated field.
Further there are mandatory measures in states too that are irrelevant from any
providers. So if you don’t practice preventive or chronic care, 10% of your
patients must get reminders for prevent ive or chronic care. Certainly, not just a
waste of time but a way to make providers, who might consider meaningful use
meaningful, changed their mind.

Mark Masse ll i : Dr. Bash, we will require far more co - operation between the stake
holders and policy m akers to sort of incentiv ize inter opera bility . In your recent
health affairs (inaudible 11:05) did acknowledge that a majority of providers at
the hospitals across the country now have functioning health IT systems and
there is a growing degree EHR litera cy all of which has begun to yield some
positive effects with patient provider relationships where have you seen those
benefits best displayed?

Dr. Peter Basch: I would venture to say that that part of meaningful use, most
doctors, really did a careful m edication and allergy list review with their patients.
This review, going through the medications and allergies with patients routinely is
now a common practice and I believe it is likely responsible for preventing more

medication errors in e - prescribing that. Second, I think it’s also said that for the
most part of meaningful use the patients would also leave their doctor’s offices
with anything if verbal instructions, so I would have applauded you for having the
foresight to make part of stage 1 , the id ea of sharing something with patients. A
result of MU stage 1 has been many 100 or 1000s or even millions of patients
have left their doctor’s offices sometimes with first time in their lives with
something that was written and or sent to the portal where they could see their
problem list or med list or allergy list and other relevant concise expressions of
the data. And third the EHR has led to the possibility of performing regular office
visits and making them into what I would called transformed office visits with
short agendas where EHR informational displays and decision alerts make it
possible for a visit for any reason to also include awareness an or actions for all
unmatched preventive and chronic care opportunities. As an example my health
system , we have been a partner with health and human services million hearts
initiative and what we have done structurally is leverage the EHR as a virtual
member of our care team thus making it possible for every adult primary care
visit for every patient to al so see is there any missing or out of date information or
should the patient be considered for aspirin use. I think these are real benefits
and these are occurring now.

Margaret Flinter : Well I would like to focus for a moment on a very specific
benefit and that was with e - prescribing how do we take what we benefit from
terms of e prescriptions and reduced errors to say how do we turn out to big data
that really helps us improve care and how do we take these things (inaudible
13:49 ) to a next level of re ally improving care.

Dr. Peter Basch: Sure, it’s a great question and actually reminded me 3 months
into when I brought my EHR live in my even small primary care practice. It was a
recall of a diet pill and I recall having a conversation with one of my colleagues ,
and I sat down with her to say Oh gosh did you see the headline. I am sure we
have some patients on this diet pill combination , and she looked at me and said
well Peter, there is probably a report you can pull to figure out what’s in the activ e
med list and two us together 10 minutes later had list of everybody in our practice
who was on that drug and it started us on a process that we finished off
notification and monitoring of this patient so particularly an example of how we
can do things ri ght. A big difference with kind of the narrow business case of e -
prescribing, and because it worked so well I would say that once Docs gets into
habit of doing and getting used to the workflow, something that is build well is
workflow informed. Essential ly it makes the right thing easier to do. I think
another benefit is it could actually do it faster once we have introduced Docs to e -
prescribing in our health system Docs found that e - prescribing was as close to
instant as we put that so it was self sust ained. It was one of a multi stake holder
gathering including stake holders who prior to putting e prescribing together were
competitors in business market but they all came together to create a real
solution and not just come up with a mandate induced re quirement on providers.

Mark Masselli : We are speaking today with Dr. Peter Basch , an internist and
Medical Director for Ambulatory EHR and Health IT policy at M edS tar Health.
Dr. Bash is senior fellow for health IT policy at the Center for American Pro gress.
So you talked a little earlier about ONC and they certainly are going through their
changes. What I want your relationship had been within in this transition trying to
address ONCs one size with all approach?

Dr. Peter Basch: Well you know, I th ink that ONC is certainly doing the best it
can in this point of transition where many of their senior leaders have left so the
solution in my opinion is not to return the paper. Meaningful use needs to be
saved from its own (inaudible 16:29 ) which as I s aid before make forced
correction and I would add that I believe ONC now recognizes this and has
started working more closely with provider organization. Just to restate my
opinion MU needs to make it clear that EHR use should be different for providers
i n different specialty to achieve benefits for patients and to make the EHR work
for providers, which could lead us to having even elegant EHR that are highly
usable feeling quaky in the hands of providers because they don’t need their
work flows. I also b elieve that OMC should reconsider what it means to be
successful attester for meaningful use. Certainly, one task would be for added
flexibility. To pick and choose a set of measures based on what makes sense to
one’s practice. This would c ertainly move us quickly away f r o m what a lot of
d ocs focus on now which are work around that make no sense in clinical
practice , but they have to do them merely to meet all the measures that are
required for meaningful use. I think another thing to do to move away fr om a
model of checking boxes at all. And the purpose of this is not the over burden
doctors with check boxes or to say doc, now that you had a EHR use course,
make eye contact again with the patient and even use what’s in the EHR to help
inform your visit that we, you know, don’t reverse that and say well now you have
got that straight, now you have to look very carefully at what you do and a
sequence of what you do because otherwise it doesn’t count. You move right
ahead to use for quality or improved sa fety. I will bring up the example of million
hearts again, which I think is a wonderful program, which, can succeed in helping
to a limited on million, new heart attacks and strokes in this country. If I were
someone who was in charge of the program I wo uld seriously consider at least
for relevant specialties of internal medicine and family practice cardiology let’s
say, that involvement in million hearts would deem you as a meaningful user.

Margaret Flinter : Well Dr. Basch, what do see in terms of how t he availability of
this electronic technology is changing the way we are training and educating our
health professionals of tomorrow and our people arriving is kind of digital natives
and what’s your perspective?

Dr. Peter Basch: So some of the core issu es that we have with physicians who
do not grow up to using technology in every other aspect of your life, we don’t
see in younger people. I do think that there is a problem however and that
students are basically still mentored by senior clinicians but t hey also have as

many more senior physicians to negative attitude towards EHRs in health IT that
this is important on students. So I think we certainly need to spend more time on
better teaching of how to use technology to improve care. Not just to docum ent
care and digitize status quo. And I think that we really could spent some time to
improve on interviewing skills enabled by Health IT so that we no longer have
issues at least for younger d ocs who grow up being kind in appropriately with this
whole iss ue of eyes down on a computer screen for (inaudible 20:05 ) person in
the room.

Mark Masselli: Absolutely. We have been speaking today with Dr. Peter Basch,
an internist, Medical Director for the Ambulatory EHR and H ealth IT policy at
MedStar Health and Senior Fellow for the Health IT policy at the Centre for
American P rogress. You can find his recent article on health affairs blog and
learn more about his work by going to medstarhealth.org. Dr. Basch thank you
so much for joining us on Conversations on Healthcare t oday .

Dr. Peter Basch: Thank you. It’s my pleasure.

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Mark Masselli: At Conversations 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 advocate for voters that aim to
reduce the level of deception in U . S . politics. Lori, what have you got for us this
week?

Lori Robertson: Well, the mid - term elections aren’t quite over yet and that means
we are still seeing ads making claims about the Affordable Care Act. In the
Louisiana Senate Race, Democratic Senator Mary Landrieu and Republican
th
Representative Bill Cassidy will compete in the December 6 run off and an ad
from the National Republicans Senatorial Committee makes the misleading claim
that Landrieu agreed with President Obama on ‘raising our taxes’ a reference to
her vote for the Affordable Care Act. The law does include about one trillion
dollars worth of new taxes over 10 years with the heaviest burden falling on high
income taxpayers. But it also includes more than one trillion dollars worth of tax
credits. So Landrieu would have voted to lower taxes as well. The law’s new
taxes includ e 318 billion dollars in new revenue from taxes on individuals making
more than 200,000 dollars a year and couples making more than 250,000
dollars. That includes an additional 0.9% Medicare payroll tax and a new 3.8%
tax on investment income on those ear ners. Other taxes include those on high
cost healthcare plans starting in 2018, a tax on manufacturers of drugs and
certain medical devices and taxes related to the employer and individual
mandates. But then there are the healthcare subsidies of more tha n one trillion
dollars worth for those who buy the red insurance. The nonpartisan Kaiser
Family Foundation estimated in 2013 that about half of those who buy their own

healthcare coverage would be eligible for those tax credits. And that’s my Fact
Check for this week. I am Lori Robertson , Managing Editor of FactCheck.org .

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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 Univ ersity of Pennsylvania. If you have a fact that you would like
checked, email us at c hcradio.com, w e will have FactCheck.org's Lori Robertson
check it out for you here on Conversations on Healthcare .

Each week , Conversations highlight s a bright idea abou t how to make wellness a
part of ou r communities and everyday lives. The flu doesn’t just exact its toll on
public health; it impacts a meaningful punch on the economy every year as well.
Comprehensive vaccination programs have had an impact on curtailin g flu
outbreaks, but there is still a lot of room for improvement. In 2011, an estimated
100 million workdays and close to $7 billion in lost wages were attributed to the
flu, largely because many employees without paid sick leave are more inclined to
wor k while sick. An estimated 80% of those who come down with flu - like
symptoms ignore doctors’ orders and go to work, leading to more widespread co -
infections.

In a first of its kind study, researchers at the University of Pittsburgh School of
Public Healt h decided to analyze the impact on flu outbreaks in the workplace
and to ask what would the difference be if there were universal access to paid
sick leave. Lead researcher Dr. Supriya Kumar says their study showed a pretty
dramatic link between access to paid sick leave and a reduction in flu outbreak in
the workplace. They also created another option, what if there were new sick
leave category focusing just on flu days.

Their model showed that if those workers, specifically diagnosed with flu, were
gua ranteed just one payday off to recuperate, there would be a 25% reduction in
the spread of flu. And when workers were guaranteed two paydays off, the
numbers went up to a 40% reduction in co - infection. A universal paid leave
program for all workers that has the potential to greatly reduce flu co - infection in
the workplace, positively impacting both public health while saving billions of
dollars in the overall economy, now that’s a bright idea.

This is Conversations on Healthcare . I am Marg a ret Flin t er.

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

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