Meaningful Use Deadlines Clash With Software Best Practices

participating in the Meaningful Use program find themselves on and how different that is from how an enterprise normally deploys technology.

"We got our 2014 certified software, but we've also gotten five major patch fix updates since that was originally released," he told me a few weeks ago. With each of those releases, his staff has to go through a cycle of testing, so "we're busy constantly doing that."

Many of the patches from Meditech, St. Claire's EHR vendor, were also driven by regulatory requirements -- even after securing certification, Meditech continued to get feedback that the way its developers had implemented certain requirements didn't match the regulators' intent, forcing further revisions, McCleese said.

Most CIOs have something close to a hard-and-fast rule against being the first to deploy a new version of any piece of software -- better to let someone else go first and be the one to find all the bugs. If they install new software at all, most prefer to do so first in a test environment where they can debug the back-end interfaces and allow their early adopters to experiment with the user interface so they can help with the rollout and training when the time comes. That's why so many organizations always seem to be running the last version of Windows, or SharePoint, or most any on-premises installed software you can name.

Of course, this is one of the arguments in favor of cloud software in which the vendor takes turnkey responsibility for the back end, and all users can be kept up to speed on the latest and greatest front-end features. That's a great argument in favor of using cloud software for something like enterprise social networking, where user expectations are shaped by the latest features added by Facebook. However, although cloud EHR software is gaining popularity among medical practices, it has yet to make a dent in the hospital market. Given that errors in medical records data can lead to life-and-death consequences, the conservatism of hospital IT leaders is understandable. But the architects of the Meaningful Use program, in their impatience for change, have tended to force a cloud-like implementation schedule on an industry that's not ready for the cloud -- at least not for core EHR functions.

Hospitals found themselves implementing new releases of software, certified to the 2014 standards, almost as soon as the vendors released the certified versions. That's almost like implementing Windows 8 immediately after it was released.

As the CIO of a midsized Kentucky hospital, McCleese would have been unlikely to rush a new release of an EHR into production and endure the flurry of patches that followed, if not for the looming Meaningful Use deadlines. In contrast, St. Claire is likely to adopt a Web-based practice management product that Meditech plans to release in 2015 "but we've already said it will be at least 2017 before we install that," he told me. "With the regulatory requirements, we don't have a choice."

Has meeting regulatory requirements gone from high priority to the only priority for healthcare IT? Read Health IT Priorities: No Breathing Room, our latest digital issue.