Healthcare 2.0 – Here We Go Again

Just when you thought it was safe to get back into the water…

It is a strange day when the smartest people in the room are the ones who did absolutely nothing.  Whether doing nothing required divination and prescience or merely resulted from having no idea which way to tack the boat need not be determined.

So, what exactly will be the impact on your IT and business strategies after the bloodletting in Washington?  How is the whole Meaningful Use strategy going to bear fruit?  Unfortunately, the most favorable answer to a large provider may be, “We don’t know.”  If nothing else, now that Washington again has a two party system and is hosting a tea-party — Blanche Lincoln will be drinking coffee — one can be certain reform will be stalled if not derailed.

Most of the verbiage prior to yesterday focused on how much of an impact healthcare reform would have on the election, a P implies Q argument.  I think those individuals were too busy minding the P’s and Q’s when they should have been focused on their Q’s and P’s.  that is, how much impact will the election have on healthcare reform.

Twelve months were invested in the first debate on healthcare reform.  Ten more have since passed. In grouping periods of time, I find it helpful to develop naming conventions to distinguish between two events or periods of time.  To at least pretend to be apolitical, allow me to label the healthcare reform and all the dollars invested by large providers to prepare their organizations to meet it prior to November 2, 2010, BP Reform.  All things after the royal coach turned back into a pumpkin at the stroke of midnight shall be labeled AP Reform—I will let you sort out the acronym.

Did I mention that under AP Reform the new governors will be appointing the new state insurance commissioners?  These individuals will be the ones responsible for implementing AP Reform.  These same people are responsible for determining the medical loss ratio which plays into how much insurers must spend on Medicare.

On November 2, you could not walk the hospital corridors without bumping into something unknown about the impact of BP Reform.  Today the conversation is simpler in that everything is an unknown.  What happens to the $400 billion in Medicare cuts and the states enacting legislation to forbid mandatory insurance?

How will the election affect the financial sustainability of Health Information Exchanges (HIEs)?  This alone is enough to cause one to question the viability of the National Health Information Network.

Bearing in mind that it will take many months to sort out the impact of yesterday’s election on the healthcare IT implications of AP Reform, what topics might be worthy of consideration at the next meeting of the EHR Steering Committee?  Here are a few that come to mind for me:

• Will the healthcare legislation change?  If so, how?
• Will certification continue to exist?
• What will happen to Meaningful Use?  Will the requirements change?  What about the deadlines?  Will the incentives remain as they are?
• How will it impact HIEs and the N-HIN?
• What will AP Reform do to the development of Accountable Care Organizations?  How will ACOs need to be supported and reported?
• How will Patient Experience Management differ?
• How should the organization’s strategic plan be altered?
• What should our HIT plans look like?

The one thing I think we can agree on is that having an Electronic Health Records (EHR) system will be an integral part of whatever comes about.  What it is, how it gets there, how you implement it, and what it will be able to do remains up to you.

I have been telling my clients to approach EHR and Meaningful Use as though Meaningful Use did not exist.  Given that the number of business uncertainties has just skyrocketed my counsel to large healthcare providers is to approach EHR with a narcissistic attitude.  Select and implement EHR as though Meaningful Use did not exist.  Why handcuff your EHR to constraints that will certainly change?