I was witness to an interesting discussion earlier this week at the Wisconsin Technology Network’s Digital Healthcare Conference in Madison, Wis.: Is meaningful use a floor or a ceiling?

One panelist, Judy Murphy, VP of information services at Aurora Health Care in Milwaukee, said Stage 1 meaningful use has caused the health system to alter its own IT plans by activating a patient portal and moving more toward interoperability sooner than intended. “We wouldn’t have decided to give electronic copies of clinical summaries at discharge [without meaningful use],” Murphy said.

But Murphy believes it’s a floor for many of the criteria, such as the requirement that 30 percent of patients have at least one medication order entered electronically. “No one would go into an implementation shooting so low,” she said. As a member of the Health IT Policy Committee as well as the Meaningful Use Workgroup of the Health IT Policy Committee, Murphy actually had a hand in shaping the standards. (Remember, though, the original proposal called for 10 percent for hospitals and 80 percent for physicians. The final Stage 1 rule set the threshold at 30 percent for both.)

Gartner analyst Vi Shaffer offered a counterpoint. “Meaningful use is not the floor,” she said. “All the existing quality measures that have been out there so long should be considered the floor.” Shaffer expressed frustration that so many 12-year-old National Quality Forum performance measures still haven’t been met.

According to Shaffer, the idea behind meaningful use is to “lift people up,” particularly when it comes to safety-net providers like critical-access hospitals. Shaffer said policymakers didn’t want to see “oligopolies” in local markets because smaller providers were forced to merge with large health systems because of EHR requirements.

Session moderator Dr. Barry Chaiken, chief medical officer at Docs Network Imprivata, and a former HIMSS chair, said he believes health IT will raise the norm for all providers and “lock in” better behaviors, suggesting that in some ways, meaningful use could be a floor.

By holding the conference in Madison, WTN was able to land the publicity-shy Judy Faulkner, CEO of Epic Systems in nearby Verona, Wis. Faulker noted that Epic shows a simpler version of its core EHR in overseas markets because the company had to add some functions for regulation and liability purposes in the U.S.

While plenty of providers are viewing meaningful use as a ceiling right now–perhaps an unattainable one–Murphy believes acceptance will come rapidly. “I think in 2015, we’re gonna look and say, ‘How did we even have healthcare without computers?’” Murphy said. She then said she had heard that HCA would attest this year to meaningful use at all of its U.S. hospitals.

Being the occasionally motivated reporter that I am, I tweeted this statement, asking for verification. Wouldn’t you know, HCA replied with this tweet: “Nearly all HCA facilities should achieve requirements 4 Stage I this yr. An exciting, important step for high-performance hcare!”

So maybe meaningful use is not a floor or ceiling, but the new norm.

What are your thoughts?

CORRECTION, June 13: Chaiken’s one-year contract with Imprivata is over, so he’s no longer affiliated with that company.

UPDATE: Check out more specific details on Obama’s EMR stimulus package.

UPDATE 2: Many of you will find my presentation on the ARRA EMR Simulus money of interest.

Details about Obama’s health care stimulus package are out. I prefer to call it Obama funds EMRs for medical practices. Here’s a summary of some proposed changes via HISTalk and John Glaser, VP and CIO at Partners HealthCare System (and thanks to Chris Paton for linking me there).

• Provision of $40,000 in incentives (beginning in 2011) for physicians to use an EHR
• Creation of HIT Extension Programs that would facilitate regional adoption efforts
• Provision of funds to states to coordinate and promote interoperable EHRs
• Development of education programs to train clinicians in EHR use and increase the number of healthcare IT professionals
• Creation of HIT grant and loan programs
• Acceleration of the construction of the National Health Information Network (NHIN)

He also adds. “All of these changes (and more) are accompanied by the infusion of $20B into the healthcare sector. To put this in perspective, in 2007 the HIT industry in the US was $26B (Gartner).”

It’s also important to note like John did that this is still just proposed legislation. In the next 30 days it will be turned upside down. However, what we can guarantee is that the government is going to make a huge investment in health care IT and in particular EMR and EHR software. Man, big EHR and EMR vendors must be licking their chops right now.

The funny thing is that I mentioned this investment in EMR to my wife’s OB/Gyn and she started to laugh. She said, “Like the government’s ever done anything to help the provider.” While I think the response was a bit jaded, you could tell that she sincerely felt like the government wasn’t going to help her get an EMR and honestly I don’t see her ever changing to one.

However, the perspective that the health care IT industry was $26B in 2007 and they’re looking at investing $20B really jumps out at me. It goes back to my thought that there aren’t enough health care IT, EMR, and EHR professionals out there right now. Can the health care IT market really support an infusion of $20B right now? I have my doubts. Of course, I don’t think that’s going to stop anyone in Washington. Plus, I find the possibilities for someone like myself who has experience incredibly exciting.

I’ll save my details response to these points for posts of their own, but it’s going to be a really interesting next couple months as we watch Obama’s investment in health care come to fruition. Of course, this assumes that the money doesn’t just get stuck in the political process and never actually makes it to the doctors who need the money to implement an EMR and EHR.