A Ray of Hope from Washington? Don’t Rush Meaningful Use
[Editor’s note: this
blog was originally written by Alan Portela, CEO, AirStrip]
I was very pleased to see that U.S. Senator Lamar Alexander
is recommending the delay for Stage 31 of Meaningful Use,
since it would drive the entire system to its knees. We all agree that the
industry needed to change. This has been a bi-partisan initiative that started
with President Bush and his appointment of David Brailer as the National Health
Information Technology Coordinator back in 2004. For the past decade, this
effort has been continued by the Meaningful Use program under the ONC.
I am not criticizing the initial goals of Meaningful Use
(Stage 1 – Data Aggregation & Data Access; Stage 2 – Healthcare Information
Exchange and Care Coordination; and Stage 3 – Outcomes Improvement). Rather, my
extreme disappointment is directed to the fact that we did not pay attention to
the first pillar – Data Aggregation and Data Access – to achieve outcomes
improvement, which cannot be accomplished without clear and aggressive
guidelines on interoperability requirements. Instead, the effort was directed
to the implementation of EHRs for data entry, which created silos around few
vendors. Of course, the consolidation and collaboration of healthcare providers
that resulted from the Affordable Care Act (ACA) exposed the failures of Stages
1 and 2 around interoperability.
If the right level of interoperability is not established
early in the program, then the healthcare system cannot easily migrate to Stage
2 – Healthcare Information Exchange and Care Coordination. Why? Because the
only data available is now centered around very limited interoperability
standards of C-CDA & HL-7 and to the Fast Healthcare Interoperability
Resources (FHIR) – which, due to its many shortcomings, should really be called
SHIR for Slow Healthcare Interoperability Resources.
Rather than immediately addressing the issue of limited
access to clinically relevant data, the ONC came up with a 10-year road
map2 that brings the industry to where it needs to be toward
the end. To top it off, the push to Stage 3 – Outcomes Improvement – would
force a value-based reimbursement model without giving caregivers access to
clinically relevant data to make informed decisions – again exposing the
limited success of Stage 1.
It seems as if developments are now moving at “Washington
Speed” – driven by political elections and not by the original mission and
vision of the Meaningful Use program. It is time for the government to start
listening to the providers and patients, not the vendors. This could be a
win/win situation – providers and patients know what is good for the industry,
and can help get the politicians the votes they need.