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Far From Shovel-Ready

December 1, 2009
by Anthony Guerra, Editor-in-Chief
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Legislation that took weeks to write will wreak havoc for years.

Though some Cliniticos (clinicians turned politicos) increasingly refer to HITECH as a “brilliant” piece of legislation, it's clear the impending market damage is only now coming into focus.

My unpalatable HITECH morsel of the moment centers, generally, around the lack of healthcare IT workforce necessary to make the legislation's goals a reality and, more specifically, the bizarre market dynamics that will be precipitated by the half-baked Regional Extension Center (REC) farce.

Let's do what Congress and the lobbyists didn't - think this through logically. HITECH calls for the industry to work towards a goal at the same time it is defining that goal (meaningful use). I have been told, “That's the way life works,” by some, but I just can't figure out what that means. Any project manager worth his salt will tell you it's critical to have a vision of the end point when designing a strategy. I've spoken to a number of people who say that, rather than spurring the market, HITECH has put much activity on hold. People, it seems, do want the clarity some say they shouldn't require.

At least HITECH took care of the financing issue around EMRs, though it offered no money upfront to support purchases. Many say this is the most “brilliant” part of the legislation, not merely paying for a system, but rather its meaningful use. OK, maybe brilliant is a bridge too far (we didn't split the atom here), but that's a sensible plan to make sure tax monies are well spent.

But maybe it didn't solve the funding issue after all, as cash-strapped providers that scrape together the purchase price often have nothing left for critical consulting help needed to select the right system, negotiate a contract and redesign workflow.

While the government could have solved that by providing some upfront funding for providers to hire existing consultancies, it chose instead to mandate the creation of 70 RECs. These organizations will receive taxpayer funding, averaging $8.5 million, but can charge providers whatever they want. Thus, there's no guarantee they'll be a more cost-effective solution to what's currently offered on the market. These organizations only have to come up with a 10 percent match on operating costs and can pump whatever “profits” they make back into the organization (see salaries, TandEs, etc.).

As if the proposal wasn't bad enough, the mandate for these organizations borders on the ridiculous. RECs are supposed to help approximately 1,000 primary care providers become meaningful users of certified EHR technology within 24 months of receiving their first financial infusion. Running the numbers shows that each center would have to make a meaningful user out of more than 40 practices per month, many of which are not even on an EHR today. With the scope of their mandate including system evaluation, selection and on-the ground technical assistance, it's unclear how success is possible.

It gets better. These organizations are supposed to show no bias toward any particular vendor, which means they have to know the pros and cons of each certified ambulatory EHR on the market, a list that will surely run to dozens. And don't think the vendors haven't identified that much of their bread will be buttered in these 70 lairs of government-funded not-for-profit haze. More than one has told me they'll be “working” closely with the RECs to make sure they understand the “benefits” of their particular offering. And will those same vendors be watching for bias at each center? Like hawks.

Beyond that, the larger question is how these 70 centers will be staffed. Even if all currently employed healthcare IT consultants were suddenly transferred from their employers and distributed appropriately to the new RECs, it's doubtful enough manpower could be found to fuel these embryonic organizations. This means the fight for healthcare IT talent, which everyone agrees is heating up, will get doubly vicious, with hospitals, large practices, vendors and consultancies - and now 70 RECs - competing on what will be an uneven playing field for scarce talent.

Why uneven? Because the RECs will be able to pay fantasy wages, taxpayer funded wages, to woo the cream of your healthcare IT workforce.

At the recently held annual CHIME conference, I spoke to the CEO of a boutique HIT consultancy who said he, “needed 50 people TODAY,” but had no idea where they would come from. John Glaser, Ph.D., CIO at Partners Healthcare and special advisor to National Coordinator of Healthcare IT David Blumenthal, M.D., recently wrote that those who employ healthcare IT talent must be sure their wages are fair and their work fulfilling, as poaching season is fast approaching.

Everyone talks about how schools must start churning out the workforce the healthcare IT workforce of tomorrow, problem is HITECH, and the lobbyists that wrote it, artificially created the need for that workforce today. Many “shovel-ready” projects were appropriate targets for a rushed stimulus bill. There was absolutely nothing shovel-ready about healthcare IT implementations and - RECs or not - there still isn't today.

Anthony Guerra, Editor-in-Chief
Healthcare Informatics 2009 December;26(12):8-76