Looks like HHS and ONC have been hearing less than rave reviews about the ARRA EMR stimulus program. About a week ago, HHS posted a presolicitation asking to evaluate the “potential harmful unintended consequences” of the EMR Stimulus. Here’s a few excerpts from the notice that describe the problem:

“While we expect for these programs to help achieve the many desirable outcomes envisioned by Congress,” the notice said, “a sense of responsibility for activities we support, historical experience, as well as mounting evidence of unexpected problems, demand that we consider potential downsides,” the notice said.

“By ‘unintended consequences’ we mean outcomes that are not intended, even though, upon investigation and reflection, they are, at least in part, a natural consequence of the activities. While some unintended consequences are desirable, the purpose of this contract is to identify and address those that are undesirable and potentially harmful.”

I don’t completely understand the government process, but I wonder if this request isn’t a means to an end. For example, maybe HHS and ONC want to modify the requirements for meaningful use and certified EHR, but are strapped because of the details of the legislation. By doing a study that shows major unintended consequences to the legislation, maybe it will open the door for them to be able to make changes to how you gain access to the stimulus money even if it doesn’t match the initial legislation perfectly.

I could be all wrong here, but otherwise why would you do a study of the harmful unintended consequences? So, you can say we told you so after those harmful events happen?

The always interesting Evan Steele, CEO of SRSsoft, has taken this idea and listed his top three unintended consequences of the HITECH Act on his blog (Side Note: Evan and I are going to be on a bloggers panel together at HIMSS. That will be a lively panel.):

• There will be more EMR failures than successes, particularly among high-performance specialists.
• “Certification” will stifle innovation.
• Alternatives such as hybrid EMRs will lead the market among high-performance physicians.

I agree with the first 2 items. I’d just clarify the first one to say, “more EMR failures by those trying to get EMR stimulus money” For those not going after the EMR stimulus money “windfall,” I predict we’ll have an increase in successful EMR adoption. Of course, Evan’s final point is a little self serving since he’s the CEO of a “hybrid EMR.” Although, I do think the EMR software companies (hybrid or otherwise) that stay focused on a physician’s productivity and reimbursement will be the big winners in the long run.

Back to the study by ONC, I’ll be interested to hear who wins the contract for this work, if we’ll ever be a part of the study and if we’ll get to see the results of the work that’s done. Looking through the list of interested vendors, I wonder if any of them really have any expertise in EMR or healthcare.