Is Government Health IT Program Overreaching?

Ever since the government announced it would offer financial rewards of $44,000 to $64,000 to each physician who could show “meaningful use” of a qualified electronic health record, doctors have been wondering what meaningful use means. Today the Health IT Policy Committee, which advises the U.S. Department of Health and Human Services, took a major step toward providing a definition of this term.

The recommendations released by the HIT Policy Committee are not the final word. In fact, they are simply the product of a workgroup, and the committee’s discussion today made it clear that the provisions are subject to change and will be tweaked over the next couple of months. After the committee adopts a definition, it will be submitted to CMS, which will put the definition through its formal rule making process. Even when that’s completed, probably by the end of the year, it will apply only to 2011 and 2012 requests for government subsidies. In 2013 and 2015, the requirements will be significantly expanded.

To what end? The HIT Policy Committee has very grand ambitions. As it states in the preamble to its report, “We recommend that the ultimate goal of meaningful use of an Electronic Health Record is to enable significant and measurable improvements in population health through a transformed health care delivery system.” In other words, the committee members are not just trying to make sure that physicians are using the EHRs for which they’re seeking subsidies; they want to make sure they’re using them to “transform healthcare.”

The pertinent questions are whether what the committee is considering bears any resemblance to 1) the EMRs currently on the market; and 2) the environment in which physicians and hospitals (which will also be subject to the definition) operate. The answer to the first question is Maybe: most of the requirements for 2011 can be satisfied by the leading certified EMRs, but it’s unclear whether more than a handful of them will be able to keep up with future requirements. As for the second question, the ability of physicians to exchange information with providers that use different systems is very limited right now, and some of the other requirements in the future may discourage physicians from acquiring EMRs.

During the discussion period at the committee meeting today, committee member Neil Calman, of the Institute for Family Health, noted that it takes a while for physicians to get up to speed on EHRs and begin to use various components of them. “You can’t open up a patient portal on the day your EMR goes live,” he pointed out. So if the meaningful use criteria for 2013 are too advanced, he said, “A non-adopter will look at those criteria and say, ‘This is not achievable.’”

Calman suggested that as the bar is raised for meaningful use, first-year applicants for government subsidies be allowed to meet the original criteria in that year, and then go through the process of using their EMRs to reach higher goals. David Blumenthal, the national coordinator of health IT, said, “That’s more realistic in some ways.” But a CMS official stepped in and said the law doesn’t allow it. “The meaningful use criteria in 2013 have to be the same whether you’re a first-year or third-year user,” he stated.

That strikes me as a way to guarantee the program will fail. If the law doesn’t make sense, Congress should amend it.

Other committee members expressed reservations about the report. Gayle Harrell, a committee member and former Florida state legislator, pointed out that “this is a very aggressive model.” Some hospitals are taking a long time to roll out health IT to their physicians, she pointed out, and the degree of interoperability varies dramatically from one region to another. “Are we setting goals that are not achievable?” she asked. “I’m afraid we will set ourselves up for failure if we’re not specific and take smaller bites of the apple.”

After the meeting, Blumenthal announced he was asking the workgroup to revise their recommendations over the next month. I just hope that the HIT Policy Committee–perhaps with some input from practicing physicians–considers the issues raised by its members today before it issues its final definition of meaningful use.