Guerra On Healthcare: Meaningful Use Proposal Has Some Seeing Red

The more health IT pros look at draft rules, the less they like them.
We've all heard about the five stages of grief experienced when mentally processing the death of a loved one. First, there's denial, then anger, bargaining, depression and, finally, acceptance. To me, the healthcare IT industry is very clearly moving through distinct stages as it processes the evolving HITECH legislation.

American Recovery and Reinvestment Act of 2009, which contained the HITECH provisions, was signed into law on Feb. 13 last year as the country, many believed, teetered on the brink of complete economic collapse. At that time, banks weren't lending to each other, and a credit crunch had seized up the nation's liquidity. People were scared--really scared--something had to be done. Thus the $900 billion ARRA passed fairly easily, and one of the most palatable political chunks of that abomination was $20 billion for healthcare IT.

Tucked into HITECH is that clever little mechanism called "Meaningful Use," actually quite an ingenious device to get the program passed into the legislation quickly, while leaving the messy details for later. Of course, that plan would have worked just fine if those defining Meaningful Use had resisted trying to automate the U.S. healthcare system essentially overnight.

HIMSS (the Healthcare Information and Management Systems Society) put on its show in early April last year, meaning that when it kicked off, the industry had spent a few months deciphering HITECH. It was clear CIOs had already moved from an initial state of euphoria--"Oh, my goodness, all that money for me!"--to anxiety--"Oh no, my CEO/CFO said I better get every dime of all that money!"

This year's conference kicks off this week, and the industry has entered the anger phase. That's because the government's Notice of Proposed Rulemaking (NPRM) on Meaningful Use, the first real indication of what the requirements will be, was made public at the end of December. Two months later, it's been fully consumed, and many have indigestion.

The latest, clearest, and most constructive expression of this dissatisfaction is the recently released comment letter that the College of Healthcare Information Management Executives (CHIME) sent to the Centers for Medicare and Medicaid Services (CMS), the group that drafted the Meaningful Use requirements. CHIME, the largest hospital CIO organization in the country, isn't alone with concerns--many comments made by the Advisory Panel in our February SnapSurvey also show extreme displeasure, particularly with the all-or-nothing approach to Meaningful Use compliance.

And if you thought the Policy Committee was reading the tea leaves on public sentiment, their attempt to lower the bar left many wondering if it hadn't actually been raised.

HIMSS 2010 will be the place the industry coalesces around a "They have to be kidding" mantra. It will be the place industry organizations, such as HIMSS' state chapters, shake the uncertainty out of their anti-Meaningful Use NPRM talking points, as they find kindred spirits all around them. It will be the place that anyone listening can get an earful about the ramifications of ramming through the current regulation as is.

Those involved with health IT have moved from euphoria to anxiety to anger. What's next will almost certainly be acceptance--we're not talking about anarchists here. That makes it all the more important that the Department of Health and Human Services, CMS, the Office of the National Coordinator for Health IT, and the Policy and Standards Committees and their workgroups lower that bar. There are two possible outcomes of not doing so: either very few will qualify for the stimulus money or, far worse, rushed implementations will cost lives. Then we'll all be grieving.

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]

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