In a recent article, I was portrayed as someone who does not fully believe the benefits of EMR adoption are, shall we say, meaningful. The author went on to describe the tremendous benefits one health system has gotten from the use of EHR and how terrific the new HITECH regulations and incentives are. I assume the genesis of this article was based on some comments I made in a recent HIT Policy Committee (HITPC) meeting where I voted against the current HITPC recommendations for Meaningful Use Stage 2. In an effort to describe to the HITPC why I was not supportive of these recommendations, I used the analogy of a ski race.
The analogy of a race is simple (whether skiing, running, or even soap box derby). The race is fair if all the participants are starting from the same point, however in this race (Meaningful Use) the participants are beginning from many different points (see sidebar below). Some are beginning at the starting line with literally no experience or skills in HIT. Others have a very large head start and have been using EHR for many years.
The HITPC definition of Meaningful Use and the escalator for attaining value from EHR is actually quite good. However, the timeframe for clarification, rule making and subsequently for implementing the technologies and the process change to achieve the recommendations is very difficult for those beginning the race at the start. The current MU process is rewarding those who were already in the lead. However, it is the organizations that must begin the process at the starting line of the race who need the most help.
The goals for MU remain vague and the plan for our nation to attain MU lacks definition. Broad MU will require true leadership as well thought-through steps, following the Covey principle of “beginning with the end in mind.” Meaningful Use can be an excellent tool to achieve tremendous benefit for healthcare, but much greater value will be realized if it is done appropriately.
Specific functionality, mingled with special interest requirements and vague “signals,” is not the best approach for what our country needs.
Meaningful Use incentives based on a real plan, outcomes and nationally accepted rigid standards would greatly increase the likelihood of achieving the very important benefits of EHR.
I do believe that Electronic Health Records can improve the quality of healthcare and lower costs. My career has been based on this belief. However, the race for Meaningful Use incentive dollars is not fair and the Stage 2 MU requirements exacerbate the problem. Those with big head starts will continue to win the prize, while those who need the most help will struggle to finish the race prior to being penalized.