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.

I was browsing through a document on the House Ways and Means website and I was really interested in what I found listed for what I believe is the basic assumptions and plans Congress and the House used to pass the HITECH act through congress.

Health Information Technology for Economic and Clinical Health Act
or
HITECH Act

Health information technology helps save lives and lower costs. This bill accomplishes four major goals that advance the use of health information technology (Health IT), such as electronic health records by:

• Requiring the government to take a leadership role to develop standards by 2010 that allow for the
• nationwide electronic exchange and use of health information to improve quality and coordination of care.
• Investing $20 billion in health information technology infrastructure and Medicare and Medicaid
• incentives to encourage doctors and hospitals to use HIT to electronically exchange patients’ health
• information.
• Saving the government $10 billion, and generating additional savings throughout the health sector,
• through improvements in quality of care and care coordination, and reductions in medical errors and duplicative care.
• Strengthening Federal privacy and security law to protect identifiable health information from misuse as the health care sector increases use of Health IT.

As a result of this legislation, the Congressional Budget Office estimates that approximately 90 percent of doctors and 70 percent of hospitals will be using comprehensive electronic health records within the next decade.

The opening line underscores what I believe is their basic assumption “Health information technology helps save lives and lower costs.” The main problem with this assumption is that it’s not complete. A more complete assumption would be “Well implemented and designed health information technology helps save lives and lower costs.” Unfortunately, you can take a look through this long list of cases to see that poorly implemented EHR can do just the opposite. My strongest hope is that doctors will understand this and choose an EHR wisely instead of focusing on the potential stimulus money.

We could discuss many of the other points in more detail, but the one that stood out to me was the purported $10 billion in government savings from the HITECH Act. At least all of the other bullet points had a section in the document which at least at a high level described how it would be done. Somehow the description of how the HITECH Act would achieve $10 billion of government savings was missing from the document.

Can we seriously believe that the $10 billion in government savings from the HITECH act is anything but conjecture? I can’t remember the last time I looked at my savings and it ended on a nice round number like this. Maybe this calculation was done in the math class I never took in college.

I’m not saying that HIT can’t save the government money. I’m a huge proponent of leveraging technology to save money and improve quality. I just wish the HITECH act would tell me how they think this is going to happen.