Climbing the Meaningful Use Mountain

Not long before I joined HealthLeaders, I found myself engrossed in a subject that involved technology and medicine, but took place far from the operating room.

The subject was mountain climbing. And the parallels to health system leadership are many. I'll explain. Scaling one of the world's tallest peaks remains an expensive endeavor. Not all calamities can be foreseen. Risks are high. Public exposure is great. (These days, many mountaineers tweet their way to the top.)

In each endeavor, technology continues to make great strides, but often requires a leap of faith, and months, if not years, of preparation. And yet, the best expeditions are guided by seasoned veterans who've often learned the hard way, through failure.

In healthcare, as in mountain climbing, there is great pressure and prestige in being first. But what's playing out now in healthcare technology is, in part, the downside of being first. In mountaineering, trying to get to the top first, you can end up like George Mallory did in 1922: dying somewhere short of the summit.

In healthcare, those who rushed into a hodgepodge of electronic medical record technology a few years back are now, sometimes, paying a bitter price. They may have realized incremental savings on this or that subsystem, but these systems may not talk to each other, and have no easy way to be upgraded to do so.

Along comes the juggernaut that is Meaningful Use. Like an unwanted early summer monsoon in the Himalayas, Meaningful Use deadlines are staring healthcare providers in the face. In the Himalayas, competing mountain-climbing teams must learn to cooperate and coordinate their expeditions if all wish to reach the summit and descend before the bad weather moves in.

Healthcare isn't so lucky.

Nowhere does that scramble present itself right now like the comments flowing into the Centers for Medicare & Medicaid Services as the deadline approaches for feedback on Meaningful Use Stage 2 rules. Even with a year's delay, extending Stage 1 into 2013, it's inevitable that in the course of climbing the Meaningful Use mountain, the stronger teams will pull farther ahead, and the weaker teams will fall further behind.

How one reacts to this development probably speaks to one's political leanings. In mountaineering, there are those who feel that strong climbers should make allowances for weaker ones, and there are those who feel just as strongly that strong climbers deserve the prerogatives of their abilities.

On the slopes, though, there are inevitable conflicts. Weaker climbers start earlier and clog up fixed lines. Stronger climbers may have to start even earlier to avoid climber traffic jams, or if they start later, must carefully wind their way around the weaker climbers—a risky maneuver.

In the healthcare world, our equivalent of these bottlenecks is the handful of vendors implementing most of the Meaningful Use electronic medical records in software. Some are like the toughest mountain guides, demanding much preparation on the part of their customers before they can even get their number on the waiting list.

Other vendors may be bogged down, spending 80 percent of their effort on a small number of providers who bring a disorganized hodgepodge of existing systems to the table and expect the vendor to work miracles, while well-prepared providers languish, waiting for their numbers to be called.

In the tough and unforgiving mountains, miracles are few and far between. Teams can only do so much climbing each day. In tech, it's been demonstrable for nearly 50 years that adding people to a software development project doesn't even linearly improve productivity of that project. The reality is somewhere far shorter than that.

So, what to do? Should we really slow down the Meaningful Use movement to allow the weaker climbers to catch up?

It all depends on what you define as success.

In mountain climbing, only one climber in each expedition is going to be first to the top. That climber will often garner all the accolades while fellow climbers, maybe only a few minutes behind, often play second fiddle in the media and the history books.

In technology, healthcare leaders often pride themselves on being first. That isn't going to change, no matter what Meaningful Use rules CMS devises, or how they change after the end of this comment period.

My own opinion is we should let the smartest, most clever, and most well-provisioned Meaningful Users get to the top at their own pace. They should not let anything the rest of the climbers are doing slow them down. Compelling success stories, as you well read in these pages, will inspire those coming behind them.

If that means letting some of the better-prepared providers jump their place in line, so be it.

But we should also give a helping hand to those climbers who are struggling. They may not have the best equipment. They may have great challenges in other areas of their enterprises. It should be possible for the leading practitioners of Meaningful Use to pass along their expertise, just as veteran mountain climbers do.

So in general, let's sweeten the incentives to achieve Meaningful Use in all its stages, and lessen or postpone the disincentives. And let's also apply our knowledge as an industry as widely as possible. The worst mountain climbing disasters usually occur because of ignorance of conditions.

Let's find ever more ways to network to each other to see that all get to the goal and back safely. As mountain climber Ed Viesturs likes to say about climbing, getting to the top is optional. Getting down is mandatory.