Mar 18: Are the Government’s “Meaningful Use” Standards Meaningful?

I went down to Orlando, Florida a few weeks ago, joining about 35,000 of my closest friends to learn about the latest developments in healthcare related information technology. The convening authority was HIMSS, which stands for Healthcare Information & Management Systems Society. As you might imagine, it drew loads of savvy techies who work for hospitals and healthcare providers, and a fair number of vendors who desperately want to sell goods and services to them. As a neophyte, it was a bit intimidating to wade into an event of this scale and scope, but it was informative (pun intended) and there were some interesting developments that drew my attention.

One thing that is evident practice among healthcare IT aficionados is the extent to which they resort to the use of unhelpful hyperbole in describing their businesses.  They appear well intentioned, and they may be accustomed to addressing audiences with limited background in technology, but there is an annoying reduction of ideas down to simple, if not simplistic, catch words and phrases that are utterly devoid of meaning.  For example:  “We apply sophisticated analytics.”  “We leverage population health metrics.”  “We work with providers to enhance health care solutions for patients.” One of the highlights of the convention was an entire room devoted to firms whose business model focuses on the essentiality of “interoperability” . . . that sounds useful at first blush, but meaning what, exactly?

Boil down the rhetoric, and it’s about making information readily available and connecting healthcare providers — how do you get “disparate health IT systems to talk to each” other, as one provider has asked?

We all have our favorite stories among the legions of anecdotes about patients whose doctors order duplicate tests or are unaware of prior diagnoses or who simply cannot get records from other medical institutions despite repeated requests. The solution requires that we develop and employ tools that make patient information more accessible and transparent, digesting and better incorporating health metrics, developing and referencing clinically appropriate therapeutic models (including the exploding volume of medical literature), and above all measuring costs (on a center by center and doctor by doctor basis) to drive efficiencies within practices, hospitals and systems.

This is a dynamic, fluid environment reflecting the massive changes that are ongoing and forthcoming within our healthcare system. The fact remains that we have not yet applied the full weight of existing information technology to reduce the horrible inefficiencies in the delivery of services. As such, there are shared values and a common vision among healthcare IT professionals focused on remedying this shortfall, but innumerable variations as to the precise approach and emphasis and it is virtually impossible at this point to demarcate those who will win and those who will lose.

The big boys like IBM, McKesson, Optum, Cisco, etc. were all in Orlando, but it is not just the major players who are doing interesting things in healthcare IT, as some entrepreneurial firms are making an impact. Take a look at Collective Medical Technologies, based in Salt Lake City. It is a firm of only 8 employees that was started in 2005 and yet has managed to sign up 90 of the 91 hospitals in the entire State of Washington, including the flagship University of Washington (where it should be noted I hold an affiliate faculty appointment and serve on a UW Medicine advisory group).

The firm has developed software that tracks patient visits and connects hospital ER units in a particular state or region to assist them in evaluating the legitimacy of the medical complaints presented by the patient who waltzes in at odd hours looking for a prescription or an evaluation.  As a software licensee of CMT, you are part of an integrated network of ER facilities that share a patient’s medical history.  The UW Medical Center physician now will see that the person before them has appeared the day before at a community hospital in Tacoma and gotten a controlled substance prescription that should last ten days before refilling.  Or that a particular imaging test was completed only a week before at a hospital in Olympia. Under the State of Washington’s Emergency Department Information Exchange (EDIE), that was developed by CMT, the Washington State Health Care Authority recently reported a projected $31 million in cost savings by reducing unnecessary ED visits by Medicaid patients by up to 23%.

The CMT demonstration dashboard is user friendly, but it’s not the software itself that is the driver; it’s the network. The company’s bottom up marketing strategy seems to be gaining traction. They tell me that they are having the same success in Oregon and several other western states.  It seems that if you can reach the tipping point in a major metro area or a region, it compels a major university medical center to sign on lest they be left behind –literally and figuratively.

The confab sessions also raised an important policy question:  can government mandates and incentives actually transform healthcare delivery? That is what begs to be answered following a keynote address given by CMS Administrator Marilyn Tavenner.  She appeared on the final morning, together with the new National Coordinator of Health Information Technology, Dr. Karen DeSalvo. Since the adoption of the so-called Meaningful Use (MU) guidelines established by CMS under the authority of Title XIII of the 2009 Recovery Act, DeSalvo reported that physician use of electronic health records (EHR) has increased from less than 7% in 2008 to close to 70% at last year end. More than 80% of US hospitals have met Stage 1 Meaningful Use standards and qualified for the HHS incentive payments. Still, DeSalvo acknowledged that most of the data collected and digitalized remains in silos (either within institutions or specialty areas) and does not necessarily help patients.

Going forward, Tavenner insisted that the Stage 2 MU criteria (more e-prescribing, electronically available lab results, more extensive patient reliance on electronic data, greater exchange of information between institutions) must be met.  These requirements are hitting providers who have complained that meeting the Meaningful Use standards may not be so meaningful to them, and are not necessarily in accord with a hospital’s strategic objectives.

In Q&A, Tavenner said that CMS has heard the hue and cry of many institutions (prominently represented in the audience) that do not believe they can meet the deadline. In response, CMS is “going to try to listen” and will be generous in its awarding of “hardship” exemptions from compliance that would defer the Stage 2 deadline for those who “have really done their best but can’t quite get there.” But providers must expect to meet all Stage 2 requirements in 2015, when Medicare payment penalties for non-compliance will begin to be levied.  “Now is not the time for us to stop moving forward,” Tavenner said.

In other words, I am from the government and I am here to help. You can read more here.

I spoke later with a major hospital CIO who said that despite these proclamations, the government was going to discover that EHR systems sold by vendors like Epic and Cerner were going to prove inadequate to enable many institutions to qualify and this was going to be a major problem for the government, for vendors and for hospital systems. Let’s just say many in the audience at HIMSS shared this sentiment, bemoaning the vagueness of the pronouncements and predicting litigation.

I do not dare predict how this will play out, but it seems a slow motion train wreck in the making.  If I were in the position of Tavenner or DeSalvo (and I have served in the Federal government), I would probably be saying the same things that they are saying.  But if I were a member of Congress or their staff (and I have worked for members of Congress), I would be thinking about holding a hearing that evaluates whether or not the formulaic Meaningful Use standards really will increase data availability and collaboration among medical providers that results in better outcomes for patients at a lower cost to taxpayers.

It may well be that Meaningful Use will turn out to be not so meaningful. Source