EMR: The 11th Hour

The waiting is just about over—we’re a week away from the anxiously anticipated release of the final rule defining meaningful use for 2011–12. Physicians will soon lose their major reason for delaying a decision. It will be time to get off the fence—either they buy a government-type EMR and attempt to meet the meaningful use measures, or they determine that they are not interested in pursuing the incentives now, and focus on implementing an EMR that they feel will best help them achieve their own goals. John Lynn’s EMR and HIPAA blog pointed out the inescapable irony that the incentive program has actually damaged EMR adoption in the short term rather than promote it. Like me, however, he encourages physicians to now revive their EMR search, based on the benefits the right EMR will deliver rather than on the government money.

It’s been eerily quiet for the last few weeks. The various stakeholders have advocated for their positions during the comment period and—despite the voices of physicians imploring the government to reconsider the excessive demands and unreasonable burdens of its initial criteria—the prevailing sentiment among the pundits is that the final version will not differ significantly from the proposed rule. Even the fact that model healthcare systems like Intermountain, Kaiser, and Partners HealthCare will not be able to meet the proposed criteria, (according to a recent New York Times article, “Doctors and Hospitals Say Goals on Computerized Records Are Unrealistic”), probably won’t affect the final rule. In a recent interview, John Glaser—who served as advisor to David Blumenthal and is VP and CIO of Partners HealthCare—said that the government’s philosophy was to start high and be prepared to back off a little. But it doesn’t sound like the Office of the National Coordinator for Health Information Technology (ONC) is planning to back off much at all. Last week in his ONC blog, David Blumenthal made it quite clear that while he has heard the concerns of providers “loud and clear,” he does not agree that the government is “pushing too hard, too fast.”

For specialists, the relevant question is: Will there be a definition of meaningful use that is meaningful to specialists? Likely not—a review of the 25 proposed meaningful use measures reveals few that specialists find valuable. As I’ve discussed before, the focus of the incentives has always been on hospitals and primary care. Since the changes needed to make the incentives relevant to specialists would be significant, physicians should not expect to see them.

Expect some extra fireworks this 4th of July.

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