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A Conflict of Numbers: This Feels Familiar

January 23, 2014
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As a new National Coordinator for Health IT steps into office AND leading provider organizations begin to prepare for Stage 2 of the meaningful use program under the Healthcare Information Technology for Economic and Clinical Health Act (HITECH), the government's mandate has stayed firmly under the white, hot microscope.

That was kind a long-winded way we’ll be seeing more of the same.

Last year, healthcare organizations, far and wide, attempted to push back against the Office of the National Coordinator (ONC) and the Centers for Medicare & Medicaid Services' (CMS) Stage 2 regulations. A variety of stakeholders, including several prominent legislators, even got involved. At the end of the year, ONC and CMS delayed Stage 2, but didn't provide relief for the 2014 penalties.

The folks at the College of Healthcare Information Management Executives (CHIME) didn't see the news as positive. CHIME CEO Russell Branzell said the announcement was good for Stage 3, but a more flexible start date for Stage 2 was needed to ensure the program's long-term success.

As we move into a new year, with a new health IT chief, the dynamics seemed to have undoubtedly stayed the same. This week, Karen DeSalvo, M.D., the new National Coordinator for Health IT, played her hand fairly strong. She wrote a blog on the White House's official website promoting the meaningful use program and its successes.

Relaying data from the 2013 version of the annual National Ambulatory Medical Care Survey from the Center for Disease Control and Prevention's (CDC) National Center for Health Statistics (NCHS), DeSalvo mentioned that nearly 80 percent of office-based physicians use some kind of electronic health record (EHR). The new ONC authority mentioned that this was a significant jump from 2008--the year before HITECH was enacted.

In addition, DeSalvo wrote that the NCHS researchers found approximately 70 percent of office-based physicians participate in the Medicare and Medicaid EHR Incentive Program, and about half of office-based physicians use a system that qualifies as a “basic system."

Reading that blog from DeSalvo gave me "flashbacks" to the charismatic speeches that Farzad Mostashari, M.D., the man she replaced, often gave over the course of his tenure. The unquestionably positive outlook, the regaling of numbers--I recognize he has only been gone for a few months, but this blog still felt very familiar. I suspect there is more where that came from. 

Yet, the report from NCHS wasn't all positive, and many press outlets noted that in their coverage, which was decidedly more negative than DeSalvo's blog. There was the mere fact that of the 10,302 physicians surveyed, only 13 percent said they were going to participate in Stage 2 and had EHR systems with the capabilities to support 14 of the 17 Stage 2 Core Set objectives for meaningful use.  Eleven percent said they were planning on dropping out of the program, 20 percent were unsure, and 56 percent said they wanted to continue to participate but didn't have the technology to do so.

DeSalvo noted that the survey was performed in early 2013 before 2014 certified products were even available. Even still, that 13 percent number will play into the hands of those who say the industry, and in particular the EHR vendors themselves, isn't ready for Stage 2. After all, they might ask, how can a number that low show a dramatic increase in just one year?

Take a look at this tweet my colleague Rajiv Leventhal tweeted from earlier this week. It very much personifies how the Stage 2 resistance, in my opinion, will react to that 13 percent number.

In other words, I expect the debate to continue. I expect more of the same.

Thoughts? Feel free to write something in the comments below or tweet me at @HCI_GPerna.