Like most people, I've worked my way up in my chosen profession. For me, in journalism, that started with formal education, then entry-level jobs focused on learning the basics like copy editing, interviewing, and writing. After that came practice and eventual comfort with the multi-sourced feature story, which called for weaving several perspectives into a readable tapestry.

By the time I had moved into a position of management, I had mastered the tasks those reporting to me would be responsible for. I didn't just have an idea of what it took to complete those tasks--from both a skill level and time requirement point of view--I knew exactly what it took. That meant I could properly set assignments--including topics, number of sources, and deadlines--with confidence. I could subsequently recognize high-level work and remediate that which had fallen short because, again, I had done the work myself.

Most of you are in the same position, having worked your way up from ground-floor positions in the IT shop to ever higher levels of responsibility and management. Today, you find yourselves in the CIO role. Such a path to power means you also know how long things should take and are able to appreciate superior work, while holding to account those who fall short of reasonable expectations.

The problem with the Meaningful Use program is the undue influence by those who have never worked in the healthcare IT trenches, never implemented a system, never received a verbal thrashing from a cardio-thoracic surgeon who'd been up for 36 hours and found himself unable to remember a password he'd recently been prompted to change (7 characters, 2 caps, and at least 1 digit, please!).

Never have the trenches been better illuminated than the seminal "Meditech 6.0 Diary" series, which chronicles one organization's upgrade from Meditech Magic 5.63 to Meditech 6.0. It's being written by Jorge Grillo, CIO at Canton-Potsdam Hospital. Amazingly, we're already at Part 10 of the monthly chronicle, and continue to see the sausage being ground in all its gory detail. For those who've never seen code before, this is what healthcare IT change takes--and here we're talking about an upgrade, not even a new install. The series is all the more relevant and representative due to Meditech's vast footprint in the market.

I know some on the federal Health IT Policy Committee are going by feel, rather than fact, because I've literally heard them say as much. Statements like, "I just feel like they should be able to do better than 10% on this," aren't as rare as one might hope. Consistently, one who lives in the trenches, Intermountain CIO Marc Probst, has asked if there isn't better data upon which to build the Meaningful Use measures, yet the speed with which the program inexorably roars downstream leaves little time for quantitative analysis, let alone reflection.

And though reflection would be the best treatment for this patient, it has to be done right. Simply reviewing the applications of those who've attested won't do. If only five students from a class of 30 show up for the final exam, and all get As, should the teacher get a gold star? Perhaps the teacher would like you to think so, as his bonus may be tied to performance, but we know better. We know the 25 who didn't show up matter. We have to find out if they thought the test was too hard to bother, or (in the case of eligible providers) if they never even heard about it at all.

Anthony Guerra is the founder and editor of healthsystemCIO.com, a site dedicated to serving the strategic information needs of healthcare CIOs. He can be reached at aguerra@healthsystemCIO.com.

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