Guerra On Healthcare: Meaningful Use Regs Potentially Dangerous
Despite modifications, the prescriptive directives of the final Meaningful Use regulations won't improve patient care.
All good managers know the key to getting optimal performance is not issuing prescriptive directives but communicating high-level goals, allowing the magical properties of ownership to foster a positive outcome. When people are told what needs to be done (treated like adults) they act like adults, think creatively, go beyond the minimum and often produce superior results. When people are told how it needs to be done, they act like the functionaries they have become, do exactly what has been asked, and await further instructions, regardless of what has actually been achieved.
It is the latter scenario I fear may result from the final Meaningful Use regulations. While a degree of flexibility has been injected into the mix, the fact that medical professionals are being told -- in excruciating detail -- exactly what they must do to qualify for the incentive monies will likely create an environment where they do only that, and, like the order-takers they have become, wait passively for the next round of instructions from CMS/ONC. This will never result in improved healthcare for patients, whether or not compliance with the measures goes beyond the minimums set forth.
The bottom line is that providers must take pride in the quality of care they deliver, and the Meaningful Use matrix cannot make them do so. What is still lacking in the entire HITECH program is a plain English web-accessible set of best practices around EMR readiness assessment (think gap analysis), vendor selection, workflow redesign and system maintenance (think ASP/SaaS) for the providers that do care, for those who desperately want to inject a technology into their practices they already believe in.
The ill-conceived and still distant Regional Extension Center program is too large, expensive and unwieldy to produce the kind of uniform best practices that are desperately needed by small practices and hospitals around the country. A single set of best practices in the aforementioned areas created by the top minds in the industry -- akin to the Policy or Standards committee structure -- segmented according to provider type and size could have gone much further toward reaching the elusive goal of widespread EMR adoption.
As I've written before, rather than creating a giant new bureaucracy with no revenue model beyond government largess, a much smaller sum of money could have been put profitably to use by directly funding to providers for the purchase of consulting services from existing firms. In a none-too-shocking development, the RECs are, in fact, looking to those same consultancies for help in creating and delivering their menu of services.
Are the final Meaningful Use regulations an improvement on the NPRM issued at the end of last year? Yes. Are they going to create improvement in the actual care that's delivered? Doubtful. In fact, they may simply represent a dangerous distraction in the current, already fragile, delivery of medical care. Just like you cannot make a bad employee care about doing a good job, you cannot make a burnt out or negligent medical professional care about doing right by their patients. The best you can do, as Jim Collins said in "Good to Great," is get them off the bus.
For those left who are left, give them the critical intelligence of how to select and implement electronic systems according to industry agreed-upon best practices. I guarantee you they will soon produce a list of accomplishments to rival any of the government's HITECH Stages. Show them the forest, give them ownership and watch the magic happen. I fear all the government has done is obscure a meaningful destination by crowding our view with meaningless trees.
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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