Political Heat Scorches Meaningful Use Timetable

Until recently, MU has had a bipartisan aura about it. But now the desire for a delayed deadline for Stage 2 is growing among healthcare providers and technology vendors. Could this be the moment that MU becomes another partisan issue in Washington?

July has been full of FUD—fear, uncertainty, and doubt—for electronic health record technology.

Committees in both the House of Representatives and the Senate have heard officials make the case for providers to get more time to comply with Stage 2, beyond the current September 30, 2014 deadline.

The AHA and AMA joined the call for delay. And CHIME renewed its call for a delay of Stage 2.

In a statement, the organization of healthcare CIOs said the additional 12-months for meeting Stage 2 "will give providers the opportunity to optimize their EHR technology and achieve the benefits of Stage 1 and Stage 2; it will give vendors the time needed to prepare, develop and deliver needed technology to correspond with Stage 3; and it will give policymakers time to assess and evaluate programmatic trends needed to craft thoughtful Stage 3 rules."

Farzad Mostashari, MD, National Coordinator for Health IT, defended the existing Meaningful Use timetable, but found few allies outside the Department of Health and Human Services, other than the Bipartisan Policy Center and assorted patients' rights groups, for whom the coordinated care and quality controls that Stage 2 will hard code cannot arrive fast enough.

"A pause would stall progress," Mostashari told the Senate Finance Committee. "We need to give Stage 2 a chance."

But clearly the public has grown weary of hearing Mostashari and other officials proclaim how many incentive dollars have been handed out implementing Stage 1. And his beginning-of-year pledge to make 2013 the year of interoperability isn't panning out so far.

Ever since President Bush pledged to bring an EHR to every American by the year 2014, Meaningful Use has had a bipartisan aura about it. Could this be the moment that it becomes yet another partisan issue in Washington?

If the existing Meaningful Use deadlines and eventual outcome milestones get extended, critics of the Obama administration get to point to yet more healthcare dollars spent on Obama's watch with too little to show for it.

If Meaningful Use doesn't get extended, hasty implementations could lead to a series of embarrassing headlines and, in a worst-case scenario, HIT-triggered preventable patient deaths.

My pessimism arises from the continuing politicization of everything in Washington, and a fear that the Obama administration is taking an inflexible position on Meaningful Use for political purposes, a fear that arises out of recognizing that IT transitions of this magnitude take a long time.

Last week, I outlined the complexity of the health insurance exchange data integration effort. It is arguable that the HIX challenge is relatively simple compared to what is being asked of Meaningful Use, particularly if one is looking for solid returns on the investment, returns that can only be quantified with certainty after the outcomes-oriented goals of Meaningful Use are realized.

Originally, outcomes were to be achieved at the conclusion of Stage 3 of Meaningful Use. Given that we haven't yet defined exactly what is going to be in Stage  3, much less begun building it into our IT systems, it is clear that we won't be looking at measurable outcomes for several years to come.

Shouldn't we all agree to allow Meaningful Use to move forward beyond the Obama administration before we see measurable outcomes, or will the program end up dismantled like so many earlier attempts to fix healthcare?

Can the political process and the American people hold its breath that long? Should we expect technology to fix healthcare, and not nearly as fast as the next iPhone will arrive?

Somewhere down the road, Meaningful Use is going to reap dividends. If the program were going swimmingly right now, the Obama administration could take all the credit for having it implemented in ACA. Instead, it could continue into a new administration which would then likely reap the political benefits of its success, assuming that the ROI of Meaningful Use appears by 2020.

Another assumption is that the existing healthcare system doesn't collapse into a heap in the meantime.

"EHRs are like a utility. You've got to have one," says one healthcare IT consultant I know. But so far, we haven't been able to measure its return on investment in a consistent, predictable way.

This is like no utility ever built in the history of technology. Quality metrics are proving to be a tough thing to standardize across EHRs and providers. "Any decision to delay Stage 2 should establish clear expectations on [quality] standards harmonization," says Bill Spooner, CIO of Sharp HealthCare.

In fact, you could argue that incentive programs have institutionalized at the federal level proprietary EHR systems with currently inconsistent and half-baked quality measures. The question now is how do we make sure that when the last of the funding for Meaningful Use has run out—not that far off in the future—that we have truly open technology managing this country's healthcare information technology?

Where will the leadership come from to make that happen? ONC has been a cheerleader for the process, but it's not working out the way it had hoped.

The HIMSS organization doesn't want to alienate its main vendors too badly, and yet, those vendors are dealing with enormous pressures. Software consultant Frank Poggio points out that ONC has continued to update some Stage 2 software compliance test suites as recently as this month, and those weren't just fixing typographical errors. Does such tinkering at this late date help vendors meet their deadlines, or just make the existing deadlines look more unrealistic? 

CHIME's visionaries are trying to integrate all this technology, and they speak with a clear voice for you, the customers.

If leadership does not appear, at the end of this $26 billion experiment, we won't be too much further down the line than we are now.

If the next administration is Republican, and manages to roll back part or all of Obamacare, and in the process can put its own stamp on Meaningful Use, rearranging or recasting the program, then that administration, which potentially has until 2024 to get the program right, could claim the political payoff and continue to heap scorn on predecessors in a time-honored political tradition.

I would like to think politics isn't behind some of the thinking going on behind delay, or behind rushing to implement prematurely. With the move toward accountable care—a move only made possible at scale through ubiquitous deployment of EHRs—it's clear we are on a journey, but nowhere near its end.

Last week, a doctor who should know told me it would take a decade from today to realize a true return on investment on the move to electronic health records. An insurer I spoke with last week assured me that its ACO partners have five years to prove their value, and only a handful are in year two.

So, setting politics aside for the moment, let me close with a few hopeful signs:

• This month HIMSS launched its Health IT Value Suite, which categorizes money-saving and quality-improving health IT stories, a first step toward an evidence-based repository of healthcare IT best practices.
• The HIMSS Electronic Health Record Association now has an EHR Code of Conduct.
• 190 million e-prescriptions have been filled so far. How many medical errors were avoided due to lack of indecipherable handwriting? How many dollars and lives has that saved?
• Despite the sequester, CMS and ONC have continued to hold many online meetings to educate providers about their current efforts, and to continue preparatory work on Stage 3 of Meaningful Use.
• There are hundreds of knowledgeable committee participants at the ONC policy and standards committee and subcommittee levels. Without a doubt, they are dedicated to tackling the tough technology issues that lie between where we are today and the outcomes we desire from Meaningful Use.
• They also see the coming wave of ubiquitous medical sensors and are working hard to integrate them with our health records. The tone of these meetings is refreshingly collegial, in welcome contrast to the rancorous debate found in the political realm.

Every week in this column, I find someone improving quality or lowering cost in a small way through technology. But if you've ever read Nicholas Carr's Pulitzer-nominated book, The Big Switch, you'll know that electric motors provided a lot of value to individual businesses long before there was an electric grid. We're at that point now with healthcare IT. We've paid for most of the motors, and are hoping that the grid to move information from healthcare business to healthcare business will inevitably follow.

But we are not there yet, and much remains to do.