I saw this question hit my email this morning: Should We Hit the Pause Button on Meaningful Use?
It’s a controversial question without a really solid answer. A number of organizations have already called for a delay on meaningful use stage 3. They have some reasonable points to be made for why MU stage 3 should be delayed. I won’t be surprised if we see a delay in future stages of meaningful use. ONC won’t want to do it, but I think they’ll be pressured to the point that they see no other option. The government approval process just can’t work fast enough.
However, the idea of pausing meaningful use is a bit different. A delay isn’t necessarily a pause. If you delay MU stage 3, then people are still required to attest to MU stage 2. Some people (including some in congress) are asking if we should pause MU completely. The idea being that we should do an analysis of the impact of MU stage 1 and how we can make MU stage 2 and 3 more effective. The problem with this idea is that many have committed a large investment to their EHR and so pulling out promised EHR incentive money won’t likely happen.
There’s actually a growing voice to stop meaningful use completely. Certainly this will upset plenty of organizations, but I find the discussion of stopping meaningful use incredibly intriguing. Would stopping meaningful use and not paying out any more government money for EHR software have a negative impact on EHR adoption?
That’s a hard question to answer. I imagine there are a few hospitals that have started down the road of EHR adoption that would definitely step on the brakes. I don’t think the same is true in the ambulatory space. Those who’ve started down the path to EHR are already on their way and likely won’t turn back.
I’m sure stopping the meaningful use EHR incentive money would cause quite an uproar. I can’t imagine them doing it, but I think it’s unfortunate that we can’t at least have the conversation. Last I checked we’d spent about $8 billion in EHR incentive money. If the estimated $36 billion is still accurate, that leaves $28 billion of EHR incentive money left. Don’t you think we should at least consider whether we should spend that $28 billion the way we’re doing it?
John
You speak of the remaining $28,000,000,000 as if it actually exists. In actuality it is a furtehr increase in our deficit, not real money. Not spending it would help decrease our deficit (Less money our grandchilderen will eventually need to pay off).
Removing MU will remove some of the ridiculaous things mandated that Doctors hate, such as printing a visit summary that does not contain a summary of the visit, or clicking smoking status when there is no benefit to anyone for doing so.
It will relegate the EHR back to being a document repository available from anywhere (Which is useful) rather than being a palce where Doctors are forced to enter structured data at great expense in money and time, with no return.
MU has made EHRs universally hated, while EHRs that make data available from anywhere without the overhead of meaningless extra clicks would potentially make EHRs something Doctors would support.
This will force vendors to sell based on quality rather than based on mandates and fear of penalties.
I see a lot of good in dumping this program.
With ONC without a leader, there may be the possibility of getting this done. Doctors and your grandchildren will thank us.
We at gMed believe the benefit of Meaningful Use far outweighs the cost. Data is starting to show that EHRs are improving population health. As a society so focused on healthcare, we are on the fringe of a real-time exchange of patient information between providers, hospitals, community health centers, etc. – All thanks to Meaningful Use. Putting this initiative on hold would not only delay the most important initiative to improve care coordination and reduce waste in the healthcare system, it would derail our ability to understand how effective our providers are and the impact on outcomes they make. At the end of the day, it’s about our ability to improve outcomes while reducing costs and inefficiencies. Meaningful Use is a pivotal part in this process.
I agree with Matt that MU is working. In the last month, I saw a press releases stating two notoriously closed EMR systems were sharing information. While the press raved about these two companies, the real story is the 2014 requirements for EMR vendors. Once these 2014 systems become prevalent, the goals for MU will start to become easier. NONE of this would happen without the strong push the industry received from outside.
Moreover, we have seen upcoming EMR solutions that actually turn the model on it’s head and put the physicians needs first, while still enabling attestation. This too would not have happened if not for the MU program.
Now… as for stopping most gov’t spending. I’m in favor of it.
Matt and Mike,
For this conversation, let’s say that MU has had its effect. I think there’s little doubt that EHR adoption is higher thanks to MU. We could argue things like whether it encouraged the right EHR adoption, whether it was a good use of money, etc, but that’s for a different post.
My question is whether stopping MU now will stop what’s already been started with MU? Will the 40-50% of doctors that haven’t adopted EHR not want to adopt EHR because MU is gone? Will the 50-60% of doctors who use EHR stop using it if MU is gone?
I believe the toothpaste is out of the tube. Those using EMRs will continue to do so and those who are not yet doing it, will consider it even without MU funding. Here is why I think this.
1) There are productivity gains and patient engagement gains when physicians select the right EMR and are allowed to spend more face to face time with their patients.
2) Physicians who are still on paper will have a tough time selling their practice when it is time to retire. Migrating to EMR is the ambulatory equivalent of painting your house and landscaping prior to putting it on the market. Everyone wants to maximize their investment.
3) The MU funding will likely disappear, but the penalties tend to stick around longer. I read that MA has passed a law where they can revoke physicians license if they are not MU compatible. “Basically, strictly speaking, it says that physicians need to meet the meaningful use standard to be licensed,” said Dunlap, a cardiologist who practices in Weymouth.
4) Some of BuildYourEMR’s customers use our EMR because it works for them. Pediatricians and other groups who are not eligible for MU still use our tools because it makes them more effective.
In regards to hitting the pause button, I believe this will deprive the healthcare industry of some highly valuable interoperability features that are just around the corner. My blog explains this in more detail along with the ONC justification. http://www.buildyouremr.com/build-your-emr-blog/2013/8/12/emr-interoperability-you-can-stop-holding-your-breath-now
Mike,
What if they stripped MU down to just the interoperability features? I agree there’s some possible benefit to interoperability and standards related to that exchange of health data. So, let’s change MU to just that meaningful feature.
John,
I think we can (and should) debate the merits of each and every Meaningful Use requirement. In the end, there were a lot of vendors who threw together something to enable MU stage 1 that have given the industry a black eye. This blame rests on these vendors and on the physicians IT shops, and pundits who didn’t do their homework (not you, of course). We should stop promoting the vendors with the largest market share and promote more innovation and vendors who focus on the needs of the provider. This is what is wrong with MU, not the program itself.
We should get behind MU in 2014 and encourage patients and providers to go beyond chasing the cash and doing the essential reporting to thinking about ways to truly take advantage of the new features becoming available. These features include more ubiquitous interoperability, clinical decision support, simple secure messaging and data sharing, and better quality reporting. ALL of these are good for the industry if we stop fighting it and start using it.