The always opinionated Anthony Guerra has an article up on Information Week that describes why he thinks the Meaningful Use sky is falling. Add that to a recent comment I got on a previous post that links to a Healthcare Data Management article talking about the potential repeal of the HITECH act and it seems worthwhile to assess the state of meaningful use.

I’ll start with the potential repeal of meaningful use first. We’ve known for a long time that the house was going to be going after healthcare reform once the republicans took over control of the house. In fact, we posted about the potential impacts to HITECH from the new Congress before.

I personally get the feeling that not much has changed on this front. I’m going to reach out to some of the government liasons for EHR vendors that I know that follow this even closer than I do. However, I still believe that:
1. The HITECH funding or at least the Medicare and Medicaid stimulus funding is safe from Congress. I’ve read this a couple of places and so I believe it to be true.
2. Any legislation that is passed by the house still has to pass through the democratic controlled Congress and avoid the Presidential veto. These two seem unlikely.

Of course, when it’s government work you could always be surprised by some loophole in the process that impacts funding or legislation. I won’t be surprised if one of these loop holes appears and affects the HITECH act. However, I still argue that if something does happen to HITECH, it will likely be a casualty of some other political agenda (ie. cutting whatever costs they can find) and not actually because they were specifically targeting HITECH.

Long story short: I still feel like the EHR incentive portion of HITECH is likely safe. Maybe some of the other funding will be cut short. We’ll see.

Now to the points that Anthony Guerra makes in his article. He describes the challenges that many hospitals are facing in regards to meaningful use. Plus he highlights the potential difference in the number of people who “think they qualify for the money” and those who “plan to apply.”

I might argue that if EHR adoption is the goal, then this might not be such a bad result. The idea of “forcing” meaningful use on people has always bothered me a little bit. Encouraging people to show meaningful use is only as good as the meaningful use criteria. If the meaningful use criteria is not very good, then do we really want everyone showing meaningful use?

For example, imagine that a doctor or hospital decides to use an EHR based on the EHR software’s ability to improve the efficiency of their office and the quality of the services they provide to the patient, but deems meaningful use as contrary to those goals. This seems like a great outcome to me. In fact, it seems like a better outcome than a doctor trying to force themselves into the meaningful use hole.

Obviously there are parts of meaningful use that can be very beneficial. For example, having an EMR that can communicate using a standard format (CCD for example) is important and valuable. If it is beneficial, then I see most doctors implementing these features regardless of whether they showed meaningful use or not.

One thing definitely seems clear from all the surveys and other stats I have: interest in EMR has never been higher. Whether that translates to “meaningful use” of a “certified EHR” or physicians meaningfully using an EHR of their choice, is fine with me.

You know my mantra: Select and implement an EMR based on the benefits that you and your clinic want to receive from the EMR. Don’t select and implement it based on a government handout. Those hand outs will be gone after a few years, but your EMR will be with you long after.

It seems like a theme is cropping up around meaningful use. It has little to do with the regulations themselves. Instead it has to do with the fundamental concept of meaningful use essentially “Telling Physicians How They Should Practice.”

A comment on a previous post described it well when they said, “I am willing to bet that no matter what the final rule was, the majority of those involved in this industry would be upset with them.” It’s an enlightening point since I think it’s right on point.

It also illustrates that it’s not the meaningful use regulations that really bother people. Most physicians want to provide great care to their patients and many of the meaningful use requirements are no brainers. Physicians just don’t want to be told what someone else defines as great care. Physicians aren’t alone in this either. Just take a look at children’s reactions to their parents and you’ll see that for the most part humans don’t want to be told what to do and they kick against anything or anyone that tries to tell them what to do.

Anthony Guerra, founder and editor of Health System CIO, in an Information Week article highlights some similar points. He aptly points out that optimal performance is achieved not by issuing “prescriptive directives,” but by creating high level goals and let ownership of those goals take effect.

Anthony even suggests that the HITECH act money should have been spent to create a “set of best practices around EMR readiness assessment (think gap analysis), vendor selection, workflow redesign and system maintenance (think ASP/SaaS) for the providers that do care” While a certainly noble and worthy goal, I think there’s little evidence that this would have much impact. Why would doctors look to a government process to provide a best practice any better than they now look on meaningful use guidelines?

Meaningful use and the pile of EHR stimulus money reminds me a lot of a parent child relationship. The parents think they know what’s best and so they tell the child what they should do. The child kicks against those things regardless of whether it’s a good or a bad thing that the parent’s asking them to do. The parent then dangles the money in front of the child and says that if they want the money, then the child better do what the parent told them to do.

This is where we’re at with meaningful use. The parents (the government) have required something (meaningful use) of the children (the physicians) if they want the benefit (Stimulus Money). Now we’re waiting to see if the children will rebel or listen to their parents. I’m predicting physicians to be a little more rebellious than the average child. It’s not like the parents in this situation have a great history of past responsibility.

I just read one of the best blog posts I’d read in a long time. So much so that I just had to post part of it a link to it on my site. The post is called “Far From Shovel-Ready” by Anthony Guerra. I think you all should go and read the entire post. It’s well thought out and well written. I don’t know Anthony Guerra personally, but our paths have regularly crossed on the internet. I hope one day to have the pleasure of meeting him (maybe at HIMSS?).

His blog post starts out with this statement, “Legislation that took weeks to write will wreak havoc for years.” I’m not quite as certain as Anthony that it WILL wreak havoc. However, I’ve been warning of the possibilities of problems for a while now.

He describes the main points of his post like this:

My unpalatable HITECH morsel of the moment centers, generally, around the lack of healthcare IT workforce necessary to make the legislation’s goals a reality and, more specifically, the bizarre market dynamics that will be precipitated by the half-baked Regional Extension Center (REC) farce.

You can read the article for the rest of the details. However, those interested/worried/concerned about the workforce shortage in healthcare IT will enjoy this part of the article:

This means the fight for healthcare IT talent, which everyone agrees is heating up, will get doubly vicious, with hospitals, large practices, vendors and consultancies — and now 70 RECs — competing on what will be an uneven playing field for scarce talent.

Why uneven? Because the RECs will be able to pay fantasy wages, taxpayer funded wages, to woo the cream of your healthcare IT workforce.

At the recently held annual CHIME conference, I spoke to the CEO of a boutique HIT consultancy who said he, “needed 50 people TODAY,” but had no idea where they would come from. John Glaser, Ph.D., CIO at Partners Healthcare and senior special advisor to ONCHIT, recently wrote that those who employ healthcare IT talent must be sure their wages are fair and their work fulfilling, as poaching season is fast approaching.