Senators Say Meaningful Use Program Needs Rebooting

Senators Say Meaningful Use Program Needs RebootingThis week, six senators released a white paper, Reboot: Re-examining the Strategies Needed to Successfully Adopt Health IT, that argues that there is no evidence that the $32 billion in taxpayers’ money being spent on meaningful use is returning the results it was designed to deliver. Although it would be naïve to discount the political motivation of the authors—all six being Republicans—they raise some of the same criticisms and concerns that I have written about in the past. They also make some claims that I feel compelled to dispute.

The senators have it right on these issues:

  • The success of the EHR incentives program should not be measured by the amount of money spent, yet every month CMS issues a report boasting how many billions of dollars have been paid in incentives. This is, of course, a proxy for EHR adoption and meaningful use attestations, but it says nothing about the impact on quality or cost of care—the motivation behind supporting EHR adoption.
  • The program is being propelled forward too quickly. It was the right move to delay Stage 2 for a year, but the requirements were set in stone long before a detailed evaluation could be made of the successes, challenges, and failures of Stage 1.
  • Program sustainability will be a challenge. The costs of participation are increasing for providers, given the added demands of Stage 2; for example, they will have to pay for interfaces to registries and HIEs and they will need to purchase a portal, if one is not provided by their EHR. As out-of-pocket costs rise, incentives decrease. This, combined with the challenges posed by the program moving too fast, will cause many physicians to abandon participation, which will threaten the program’s ability to deliver results.
  • There is no question that the proliferation of government programs with which physicians must contend has made compliance a challenge. The legislation is so complex and the requirements so cumbersome that they are diverting physicians’ attention from patient care.

I vociferously disagree, however, with the senators’ criticism regarding interoperability. Of course, we are not there yet—and clearly they are frustrated by that fact—but progress is underway toward that universally supported goal. Contrary to their claim that there are no meaningful use measures that require interoperability, there are in fact several in Stage 2, including the requirement that physicians electronically send a patient care summary for 10% of patients transitioned to the care of another physician or provider. This exchange is facilitated by the fact that all certified EHRs must communicate using the same formats.

Not only does interoperability relate to provider-to-provider communication, but it also allows for easy integration between products of different vendors, without requiring additional programming. I was recently speaking with another HIT vendor about a potential partnership arrangement, and we both talked the same language—XDR Direct for transport protocol and CCDA or HL7 in terms of content. This conversation would neither have been possible, nor would we be able to create a tight, simple interface between our products, were it not for the standards promulgated by the EHR incentive program. This kind of interoperability will ultimately be better for physicians and for their patients. The EHRA (EHR vendor association of HIMSS) hit the nail on the head: the appropriate role for government is to set the standards, but then the vendors should be free to innovate and let the market take over from there.

7 thoughts on “Senators Say Meaningful Use Program Needs Rebooting

  1. Meaningful use stage 2 is looking like a nightmare and physicians will need to dig deeper into any profits to satisfy the requirements, as currently written. Our payments have been reduced already and we face additional cuts in payments and are required to pay out more for goverment mandates. More and more physicians will be uable to afford paying for all the additional requirements and will ultimately close shop leaving many in the private sector unemployed. It is a trickle down effect. I hope that our lawmakers start looking at how all these government programs affect, especially the private sector and loss of jobs.

  2. Dr. Mostashari keeps touting the $$ he doles out ($12+Billion so far) because in about a year as CMS starts to cut provider payments to try to balance the fed budget he’ll be able to say (with a bow tie smile) ” We are here to collect our ROI on all that MU money we gave you last year”. The ROI they expect per ARRA is $800 billion for a $32 billion expenditure. A nice 25 to 1 ROI.

    Remember…ain’t no such thing as a free lunch, or system!

  3. EMR is not better for patients, for their medical care or for physicians. In fact I think EMR interferes with the care of patients currently.

  4. I have been in health care since 1973. I can’t count that high on the years. MU is just one example of federal requirement that is quickly dismantling the best health care in the world. I never thought i would see the destruction of healthcare as we know it but it is happening now. Future generations will not comprehend that their care is subpar from previous generations but this is your children we are talking about. We must continue to be vigilant to changes that will make this destruction sooner than later.

  5. I am not one to argue the merits of the law. If it is the goverment’s desire to have every person’s healthcare on a computer chip, then so be it. However, we paid a bundle of money on our EMR, and lost a whole lot more in reduced productivity from the implementation of our system. Millions!!! And now the government is looking to back out of the deal.

    Once again, like all faces of healthcare reform, the doctor gets screwed.

  6. I’m curious about the costs associated with Stage 2 and 3 that vendors have to take on. Are they going to pass those along to their practice customers, or are they going to eat those and maintain their current pricing? Would be interesting to see, particularly since I have doubts about many of the smaller vendors being able to meet these guidelines with limited resources.

  7. Not only does interoperability relate to provider-to-provider communication, but it also allows for easy integration between products of different vendors, without requiring additional programming. I was recently speaking with another HIT vendor about a potential partnership arrangement, and we both talked the same language—XDR Direct for transport protocol and CCDA or HL7 in terms of content. This conversation would neither have been possible, nor would we be able to create a tight, simple interface between our products, were it not for the standards promulgated by the EHR incentive program. This kind of interoperability will ultimately be better for physicians and for their patients. The EHRA (EHR vendor association of HIMSS) hit the nail on the head: the appropriate role for government is to set the standards, but then the vendors should be free to innovate and let the market take over from there.

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