Guerra On Healthcare: Policy Makers Must Get Serious

A multibillion-dollar industry is hanging on the Health IT Policy Committee's every word -- it's time for less flexibility and more gravitas.
While all organizations have mission statements and basic objectives, the ability to morph those on the fly can be key to success or failure. Of course, it's better when the organization itself determines the changes, and they're not imposed from outside. That's because outside entities can, of course, change their minds.

I felt that way after listening to the latest meeting of the Health IT Policy Committee, the group that's mandated to advise the Office of the National Coordinator for Health IT on the definition of what constitutes the "meaningful use" of electronic medical records.

I fear the healthcare industry is listening to an outside entity apt to change its mind. Some members seem a bit too nonchalant about changing the program they've only recently laid out--throwing in a measure here, redefining a stage there. It's enough to make you wonder if the committee realizes there's a multibillion-dollar industry hanging on its every word.

If I were a healthcare CIO, the last Policy Committee meeting would have just about done it for me. I'd no longer be trying to read its tealeaves to anticipate the final form of meaningful use or those of the standards committee as it determines how EMR products will be certified.

And that's not just because they seem to be making it up as they go along. (I know they are, but now that's painfully obvious.) It's because the policy and standards committees aren't really making policy, they're just advising National Coordinator Dr. David Blumenthal, on it. And he's not even making policy, he's just advising Department of Health and Human Services Secretary Kathleen Sebelius on it. Sebelius, at the same time, is getting a much more influential earful from the Centers for Medicare and Medicaid Services (CMS).

So while the advisory committees get their say--and it's true quite a lot of what they've advised has gone into the notices of proposed rulemaking and interim final rule--they certainly don't have that last word.

Of course, that doesn't really make it less disturbing to hear members ask if they're tied to the Staging methodology they themselves developed or if their plan to wrap all programs in stout privacy and security protections shouldn't be replaced with a patient-centric wrapper.

To me, it's quite unsettling that a few months short of Stage 1 opening, the committee is debating the fundamental nature of the staging, and that while organizations are gearing up to meet its extremely proscriptive criteria, the committee is rethinking the need to be so prescriptive.

To be honest, I'm not sure what's happening to the HITECH sausage right now. After the comment period, can we assume people from HHS, CMS and ONC are huddled around a table with the original NPRMs and IFR, along with a pile of letters, reading each out like story time with eraser rubber flying? Who will stand behind these regulations when the final ones come out?

Everyone involved with this process--from advisors to writers to revisers--had better get very serious, very fast. While the committee members certainly don't lack grace (they're the most cordial bunch I've ever heard) they seem to lack a certain intensity, a gravity I'd expect from those crafting something so far-reaching and impactful. The industry needs to know that the street signs are grounded in concrete, not subject to a change in the wind.

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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