Guerra On Healthcare: Is HITECH A Bait And Switch?

Most hospitals say they expect to qualify for meaningful use incentive funds, but most shouldn't plan to see a return on their health IT systems investment.
Anyone who has gone through the rigors of college and advanced graduate studies can appreciate the value of cramming. Actually, this value is largely understood to be short-lived, with the crammer retaining the information -- which has been so superficially absorbed -- only until "pencils down" is called.

While cramming may have its shortcomings, people don't usually identify it as a dangerous practice. But cramming to qualify for electronic health record (EHR) meaningful use is dangerous, in that it can require processes which take years, when done properly, to be done in months.

I've long decried that the meaningful use bar has been set so high by the Health IT (HIT) Policy Committee, Office of the National Coordinator for HIT (ONC), and the Department of Health and Human Services (HHS). "Why have they set the average hospital up for failure?" I've asked over and over in my mind.

Unfortunately, if it ever was intended to be attainable by the average hospital when written by Congress and/or signed into law by the President, once meaningful use got into the hands of the policy wonks assigned with its formation, it no longer was subject to that yardstick. You see, many of those wonks are political appointees, thus they have constituencies that want specific results. It is to these constituencies -- often focused around patient empowerment, privacy, etc. -- that they have allegiance when crafting measures, setting bars, and so forth, not to the folks who must meet the requirements.

I believe early on the wonks deemed it was not important, or even desirable based on the available funds, that most hospitals qualify for the incentive monies. However, I think this message has either not been delivered directly, or failed to reach the industry. Thus, we have what amounts to a giant disconnect between those crafting meaningful use and the industry which must implement it. Looked at cynically, this amounts to a giant bait and switch.

Practically speaking, the meaningful use measures constitute an Advanced Placement test that the entire student body assumes it should sit for. What is the result of such an exercise? A large failure rate. Add to that the fact that students have been charged to sit for the test (invest in systems) with the assumption they'd be reimbursed after passing, and you'll not only have a large number of disappointed hospitals, but many who'll then have to figure out how to absorb the financial shock of not getting anticipated funds they may have baked into future budgets.

But the worst part, as I mentioned earlier, is that many will end this race not only disappointed and broke, but broken. I interviewed a CIO the other day who said he spent 2.5 years researching a new system for his organization. After making a selection, he negotiated a 10-year deal so he wouldn't have to start another multi-year vendor evaluation for a long, long time. These are the types of timeframes which HIT selections, implementations, and adoption take. Almost every CIO I've interviewed says rushing these processes decreases the likelihood of success exponentially.

The bottom line is that only the most advanced hospitals -- in terms of their sophistication with advanced clinical technologies -- should attempt meeting meaningful use in the time periods required. If you decide to give up the meaningful use race, read this excellent article by industry insider Frank Poggio of the Kelzon Group, in which he demonstrates that the incentives are actually minimal, and the penalties likely nonexistent. It will make you feel better.

If you still feel bad, give your Congressional representatives a call -- tell them the Health Information Technology for Economic and Clinical Health (HITECH) Act was written into a stimulus bill -- so one would assume the money was supposed to be spent. Much stimulating has been done to RECs and HIEs, with a seriously questionable return on investment. More stimulating should be done to the average American hospital, which can truly put those dollars to good use, if not attaining meaningful use as it's being defined, than taking the small, slow, and appropriately measured steps toward a safe electronic environment.


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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 [email protected].