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Anthony Guerra
Anthony Guerra
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Guerra On Healthcare: Is The Sky Falling On Meaningful Use?

IT executives' testimony on the difficulty of qualifying for federal electronic health record incentives stands in stark contrast to the government's blue-sky perspective.

If ever the expression "the devil's in the details" was called for, it's around meaningful use. In fact, the words seem tailor made for the program. That much was made crystal clear during testimony last week by those who've made inroads toward meeting requirements which sometimes behave like slippery eels when grasped.

I'm taking about those requirements around certification that don't seem to make sense -- and certainly don't seem fair: mandates around quality reporting that are too onerous to expect compliance with, and the breathtakingly clear fact that since sophisticated and well-funded organizations with ample IT-related resources (both human and material) are having such trouble grappling with the program, one can only imagine the fits they are giving the less fortunate -- that's even if they've bothered to delve beyond the executive summary version of meaningful use into the shifting mire beneath.

So as far as I see it, meaningful use is a brakeless train heading for a solid mountain. Some, to be sure, will jump before impact, abandoning the program rather than continuing to throw good money after that spent on a project which will not qualify for reimbursement. Far worse, others will continue to shovel coal into the rickety engine of their organization, pushing the train beyond capacity and hurting patients in an attempt to qualify for monies, ironically, set aside to help them. Any which way you slice it, this is ugly and going to get uglier.

Not surprisingly, the vision above is quite at odds with that put out recently by the Office of the National Coordinator for Health IT (ONC) and its head, David Blumenthal, MD. In a recent letter, he said everything is coming up roses. EMR adoption, Blumenthal explained, is going strong. Everybody and their cousin, apparently, is jumping on the MU bandwagon, and happy times are here again.

While I do not question the statics cited, I do question the spin ONC's putting on them. First off, the stats only show that many are adopting/implementing EMRs and that they plan to apply for the meaningful use monies. While Blumenthal acknowledges that implementation and, in fact, basic EMR usage will not qualify one to receive incentive monies, far too rosy a picture is painted by the report that many will apply. I would bet you dollars to donuts that the number of those who think they will qualify for the money would be a fraction of those who said they plan to apply, if those same individuals knew the gory details of what qualification requires.

You see, the blue-sky picture ONC is painting with its survey data is quite different from the more realistic "sky is falling" picture painted by some super-smart healthcare IT executives who testified before ONC's Implementation Workgroup last week.

Even so, more IT-savvy and well-funded hospitals will, I believe, find a way to wrestle the slippery MU eel into submission. However it's the eligible providers who will be left holding the EMR, so to speak. They may have the money to invest in an EMR, but they certainly don't have the time to figure out what ONC wants of them, especially when ONC is having such trouble figuring that out for itself.

While ONC may be "gratified that such sizeable percentages of physicians and hospitals intend to take the plunge," that doesn't mean we'll ever see them rise from the deep. The bar is still far too high and unsteady. Blumenthal started his letter by stating, "the tide is turning." Unfortunately, all I see are the waters steadily rising.


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

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