Guerra On Healthcare: New Perspectives On Meaningful Use

The chairman of the Health IT Policy Committee seems to be adopting a more realistic attitude about what's possible versus what's desired.
One of the main gripes we have about politicians is that they say whatever is necessary to get elected, then largely act as their predecessors had.

But the less nefarious and less satisfying reason for this eternal phenomenon is that campaign promises are, by their very nature, aspirational. They aim at some semi-utopian state of affairs, but can only survive in the protective shell reserved for the un-implementable. These promises are, of course, un-implementable because the person advocating them is unable to move forward with their execution at the time they are being made.

If, however that individual attains the position being sought, he or she faces the unpleasant prospect of having to face the consequences of those promised actions.

There is often a huge gulf between talking and doing, between proposing and executing, between "doing the right thing" and doing what is possible. The industry's meaningful use experiment has provided a splendid test lab to study the tension between these two worlds.

To roughly divide the characters in this play between two camps, we have the wish listers and the realists. To a large extent, the wish lister ranks include those who won't have to adhere to the measures they put forth, while the other camp will. The wish listers are composed of special interest groups, often represented by experienced and capable advocates/lobbyists accustomed to exerting influence over regulative and legislative affairs.

The realists are composed of those who must deal with the aftermath of these recommendations and final rules. On that side, we see the healthcare providers, payers, and vendors.

Notice how some people shift from one camp to the other. Recently, I've noticed an influential wish lister inching toward the realist camp.

Faced with the now well-known stage 2 timing glitch, Paul Tang, MD, VP and chief medical information officer (CMIO) at Palo Alto Medical Foundation and chair of the meaningful use workgroup, has been a strong proponent of some remedy or relief. Though he lives in the provider world, I would have previously described Tang as a wish lister, someone very interested in aggressively catapulting the industry forward through the mechanism of meaningful use.

But it seems the combination of being on the provider side--in a position of high responsibility and visibility in the meaningful use program--and a good listener ever more sensitive to industry feedback, has caused Tang to seek a more moderate course.

What may be happening here is akin to an elected politician getting perilously close to enacting a campaign promise, and finally hearing his advisers and constituents warning, "If we do that, this is what will likely happen."

In fact, even the likes of Dr. Ferdinand Velasco, CMIO at Texas Health Resources, who chides the industry for meaningful use "whining" wants some stage 2 timing remedy.

I never require perfection as a prerequisite of appreciation but what does engender my respect, even admiration, is the ability to absorb critical feedback to the point where one changes a strongly held position. While I don't claim Tang has had such a Road to Damascus moment, there has been a noticeable change in his willingness to challenge, rather than champion, the meaningful use wish listers. To the extent that Tang is, in fact, ready to tone down stage 2, he has my vote of approval.

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].