Guerra On Healthcare: Stand Firm As 'Meaningful Use' Changes

Ignore the advice to "think outside the box" and stick to your plan, even as federal agencies continue to alter the criteria they'll use to award health IT incentives.

Slideshow: Who's Who In Healthcare IT
(click for larger image and for full photo gallery)
One of the biggest buzz phrases of the last decade declared superior service can only be delivered by thinking, acting, and creating "outside the box." My company often receives requests for proposal which call for just such products and, at first, I reacted with the unquestioning obedience of the novice. But one quickly realizes the difference between selling something you can produce versus that which you can't.

At that point, you begin to appreciate the value of the box some want you to so lightly discard. A well-conceived and -created box is not an impediment to delivering superior service and achieving excellent results, but a key ingredient of it. Staying in that box is absolutely essential.

Boxes should be developed after much reflection on the organization's strategic goals, key differentiators, and resources. As many management gurus have suggested, focus only on those products and services where you can be number one or two in the market, and leave all others by the wayside. This allows you to concentrate your energies on a few select areas and pound away, like an old blacksmith fashioning molten metal into a sword.

Venturing outside the box, at the request of a customer, diffuses energies which could better be used towards a concentration of forces. Your competitors that adhere to this principle will always outshine you in the niches they have staked out. If they more faithfully honor the boundaries of their box, it is only a matter of time before you become an also-ran.

Most successful business -- and make no mistake about it, hospitals are businesses -- are created when a market need is identified, then filled. During the period between identification and fulfillment, entities that predefine their target customer (the box), and constantly seek to work only with them, do well. Clarity of purpose and consistent management are key.

I truly feel sympathy for many healthcare CIOs, as the Department of Health and Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), and the Office of the National Coordinator for Health IT (ONC) and its federal advisory committees feint left and right before finally picking a direction in this most painful of meaningful use dances.

For example, at first those organizations indicated computerized physician order entry (CPOE) in the emergency department (ED) would not count toward the hospitals' totals, then the final rule indicated they would. Now, "clarifications" say only ED visits that result in admissions (or who are treated as observation patients) will count.

What's the difference? Quite a bit. CIOs who have been instructed to get the meaningful use cash at all costs (i.e., most of them), are redirecting their resources every time the government changes its fancy. I wonder if those involved in this policymaking realize the real-world ramifications of changing a word here, a requirement there.

Unfortunately for CIOs, the government is bending and shaping their boxes to the point where they no longer provide a structure for decision making. In such an environment, what's the point of having a strategic plan? If meaningful use qualification has become the raison d'etre, the hospital C-suite can cancel its strategy sessions and simply tune into the federal advisory committee meetings.

Paul Roemer, a blogger on, has written consistently on the dangers of hospitals abdicating their strategic plans to the government's Health Information Technology for Economic and Clinical Health (HITECH) program, of handing their box to CMS and ONC. Since this has largely been done, many healthcare CIOs are in the unfortunate position of waiting for the next "clarification" to see if they're headed in the right direction, or if they are somewhere outside the box.

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]