Meaningful Use or Useful Life? Can Both Exist?

People who make and sell "stuff" love living in a disposable economy. The idea that you can sell a product or manufactured item in such a way that it will need to be replaced by its next version in a year or two or three makes for a nice, repeatable bottom line.

I'm sure many of you can relate to how I spent the holidays, which are the disposable economy at its worst. Like any parent, for me the day after Christmas was for exchanging the karaoke CD player that flat didn't work, and throwing away the radio-controlled helicopter that lasted all of two bumpy flights.

You almost expect anything that has on on/off switch made for kids to break before the box is thrown away these days. Add to that the two-year-old leaf blower that started to smoke and the still shiny kitchen faucet that turned into a garden hose. Even if you did have the time to research and order replacement parts, the market tilts to make it cheaper, quicker, and much easier to buy a new one.

Is it the same with electronic medical record systems? In an industry still as woefully unwired as healthcare, it makes sense to focus for now on spreading access and utilization. CMS' "meaningful use" objectives are meant to do just that and not much more. The core components of meaningful use are all performance objectives that must be met incrementally between this year and 2015.

What is less clear is whether meaningful use will form the foundation of a sustainable, "useful" investment in a baseline IT foundation that can pay dividends much past the 2015 end of the program.

Sasha Kramer, MD, a dermatologist and sole practitioner from Olympia, WA, testified last summer before the House Health and Technology Subcommittee that she spent $41,349 on an EHR system in 2009, including a one-time grant of $19,964 from the Washington Health Information Collaborative for Health Information Technology. The cash investment was on top of the estimated 160 hours she says she spent on selection and implementation, and a month where her patient volume dipped as she went through integration. Less than two years later she got a call from the vendor.

"I was notified by my software vendor that it had been acquired by another company and that the new vendor's products would not support my current network platform," she testified. "The new vendor offered a different product, but because of the significant cost and concerns about the company's stability, I am looking at alternative vendors. Currently, I am looking at a new system that will cost in excess of $27,000 with $6,000 in annual charges; all of which must come out of my business cash reserves. It's not just the financial investment; I will again have to take time away from my patients to implement and train my entire practice on this new system."

Dr. Kramer describes one of the most wasteful reasons why EHRs and EMRs have such a limited life cycle. Other explanations include compatibility changes from mergers and acquisition, regulatory and data burdens which make systems obsolete, and, of course, performance issues when current systems don't perform or are not accepted as had been hoped.

One reason I never hear for replacing electronic health record systems, though, is from Moore's Law, the axiom named for Intel founder Gordon Moore which posits that computer speed and memory double every 18 months to make the former iterations of everything from core processors to digital cameras obsolete.

IT is and always will be a fluid and ongoing investment. Using a reliable system of interoperable electronic medical records is the single make-or-break operational evolution that has to happen in this decade for healthcare to have even the chance to reduce costs and improve care. There is a difference, however, between a sustained investment in a long-term "utility" and throwing capital at vaporous, "disposable" systems.