Is the Workgroup on Meaningful Use aiming at flexibility, or just piling on additional requirements?
It sounded promising. The HIT Policy Committee’s Workgroup on Meaningful Use was taking about flexibility, about no longer forcing providers to meet all its requirements in order to get one penny of HITECH stimulus cash.
Dr. Paul Tang, chairman of the workgroup and CMIO at Palo Alto Medical Foundation, said he heard the provider community's complaints about the Notice of Proposed Rulemaking's high bar and 100 percent compliance requirement, so his team was recommending a more flexible approach, one that would allow hospitals and physicians to defer a few measures to later years, while still reaping the benefits of a good-faith effort.
But just when you started thinking the HITECH ship was finally on a sensible course, the old bait and switch revealed it was still heading straight towards the rocks. That's because, as I wrote in a news story last week, just as it paid lip service to the concept of flexibility, the same workgroup piled on requirements HHS and ONC had left out of the NPRM, leaving providers (and journalists) who thought it was already prohibitive with their mouths agape.
But it gets even better. On the heels of Tang’s "one more thing …" presentation came one that made it all the more clear the bar needed move down, not up. That presentation came from the Workgroup on Certification and Adoption, co-chaired by Entrepreneur Paul Egerman and Intermountain Healthcare CIO Marc Probst.
Probst, one of the most reasonable and cautionary voices on the overall committee, laid out 16 administrative burdens that the NPRM would require providers to master, noting that today's EHRs can't handle most of them. For example, providers will have to do significant amount of manual recording to ascertain the denominators, or "total" orders, that need to live under the electronic numerators for many of meaningful use's quality measures.
Here are some of Probst’s quotes throughout the meeting:
"We are not talking about a simple field being added to the system. There is much additional work involved with flowing data from a billing system to the EHR."
"Some of these changes do cause a significant amount of trickle-through work, such as workflow and system changes, etc."
"It’s still too aggressive. I love the flexibility, but the AHA is totally against requiring CPOE before 2015. I think we need to fully define Meaningful Use over the next five years and allow greater flexibility in sequencing how we get there. I am very concerned that we will take current best practices that are saving lives and cause organizations to reprioritize them into specific tasks to meet Meaningful use."
"There are thousands of different people starting at different points along the way, and even if we could select one system for everyone, I’m not sure we could have them meet Meaningful Use by the end of 2012. The bigger challenge is not about IT, but workflow. I spoke to a physician who said that if everything which is currently in Meaningful Use stays in, he’s not even going to attempt it."
"I went to our quality review department at Intermountain and gave them the NPRM. They said it would present a very significant burden to report on all the measures. There is a disconnect between what we’re asking to be collected and what the systems can actually do today."
There is also a disconnect on the Policy Committee between those I would call realists, like Probst, and the true believers who want automation at any cost. The realists know how wonderful HIT can be, but also know how much time, intellectual capital, and financial resources must be mustered to achieve true patient safety gains. The true believers want better healthcare too, they just want it too fast, they want it at any price, and they don't mind breaking a few eggs to bake this cake.
The implementation of healthcare IT is not a riskless proposition. Systems jammed in without laying the proper groundwork--such as getting all constituencies on board, selecting the right system, negotiating a sound contract and rolling it out in a phased, measured approach--will not only fail, but take patient’s lives with them. As I’ve written before, the first rule of healthcare is do no harm. The Policy Committee, HHS/ONC and anyone whose pen touches an NPRM or IFR must be guided by the same principle.
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