Why meaningful use isn’t meaningful … yet

While many people outside of the healthcare world may not know a lot about our IT issues and challenges, almost everyone has heard about meaningful use. But, nobody truly has an understanding of what meaningful use should be - and this includes the regulating agencies that turned the definition of these two words into an eight-hundred-page defining document that still required clarifications.  Healthcare IT software vendors are scrambling to help their customers meet the letter of the law, while still protecting the unnecessarily proprietary nature of their solutions. Unfortunately, what could have been something very good for improving healthcare has turned into a bizarre and complicated exercise, sort of like the way Stephen King might interpret watching a group of clowns riding mini-motorcycles in figure eight patterns in a parade.

As part of the American Recovery and Reinvestment Act of 2009 (ARRA) nearly $19 billion of funding was dedicated to improving the infrastructure of healthcare IT. This money is slated to go to hospitals and physician practices who fully implement an Electronic Medical Record (EMR) system. On the surface I believe this to be a good thing. The ultimate goal is to have portable electronic medical information available to any caregiver at the point of service regardless of where the patient is. While some people are worried about the big brother aspect of this, it can only be beneficial in improving clinician decision making, and it will ultimately be good for healthcare.

The problem is that we ended up with a huge disconnect between what made sense and what was possible once the politicians and work groups in DC tried to give some definition to the original law.  While the resulting regulations were very onerous, I believe it still isn't prescriptive enough to lead us to the final objective of creating one portable health record nationally. There is still too much interpretation between software vendors, hospitals, and providers to gain consistency in data that must be shared. I am sure that there will be an evolution over the next five to seven years that will help solve this, but it will keep us all in a state of confusion during that time.

Another unintended consequence is that the software vendors upon which we rely were also completely unprepared for making such drastic changes to their software capabilities. Since there is incentive money available for the hospitals and physicians who meet the current definition of meaningful use, the vendors are scrambling to build new functionality into their environments - meaning that they had to change their R&D focus from developing new functionality to meeting these requirements. In some cases we are left with somewhat immature new products while the vendors work to meet the requirements for their thousands of customers. Again, this adds unnecessary delay into the overall process of building a complete and functional EMR.

Of course, while difficult to manage through this transition from a development perspective, this has been quite a coup for the software vendors who now have outsold their ability to implement and support. In some cases a purchase today means an implementation in 18 to 24 months, or longer.  Ouch!  Imagine you don't have a car.  You go buy one today, but you can't pick it up for 24 months. The reason you bought the car today is because you need a car today. So, this is great news for the P&L of these vendors and their future viability, but again it's not really helping the providers who are trying to improve their care delivery process.

Don't get me wrong, I believe that a true focus on maturing our electronic capabilities in healthcare is absolutely the right thing. I feel that one day we will have a true national health record that will be available to all caregivers, when and where appropriate. This will be a good thing. I just don't think the way the legislature was developed is the best way to get us there.  Maybe I'm just impatient. It's one thing to define this complicated thing called meaningful use, and it's definitely another thing to get us there. 

But we will get there.           

Ed Ricks is the Head Tech Guy at Beaufort Memorial Hospital. You can contact him at LinkedIn or visit BMH at www.bmhsc.org.

Copyright © 2012 IDG Communications, Inc.

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