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The (Certified) Vendor Recovery & Reinvestment Act

May 21, 2009
by aguerra
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HITECH has never made sense to me, not from the moment I understood there would be no upfront money to help providers afford the systems being foisted upon them, especially not from the moment I saw the ridiculous deadlines involved. Later, as people came to understand that only CCHIT-certified systems might qualify for incentives payments, the act became even more disconcerting.

As I worked through questions, the answers left me perplexed.

Q: “You mean providers, many already on the financial razor’s edge, get no money up front to buy these systems?”

A: “Not really.”

Q: “You mean they only have until the end of 2010 to prove meaningful use of systems they may not even own today?”

A: “Yes.”

Q: “You mean they won’t even know for sure what constitutes meaningful use until the end of 2009?”

A: “Yes.”

Q: “You mean that studies are showing HIT adoption is incredibly low in all but a sliver of the nation’s hospitals and physician practice?”

A: “Yes.”

Q: “You mean it looks like only CCHIT-certified systems will qualify for incentive money?”

A: “Yes”

Q: “But what about hospitals and physicians that have invested in something not certified? What about vendors not getting clients onto a certified version of their software by the deadline?”

A: “I guess they’re SOL.”

Q: “What about the almost undisputed fact that these systems slow doctors down, show them so many alerts they ignore them all, and generally irritate them with their user un-friendliness?”

A: “Not sure.”

Q: “Well, who wrote this awful legislation?”

Apparently HIMSS did. And now it all makes sense.

This legislation has never been about the safe and appropriate use of healthcare IT to assist in, and improve, the delivery of care. That’s because, if such was the intention, there is no chance in the world the legislation would have been written as it is.

I have absolutely no doubt that if you asked the top 100 healthcare IT implementation professionals to write a national plan, not one of them would have come up with anything slightly resembling HITECH. As the pages of HITECH evolve into practice, what’s been done so far verges on the comical. I’ve listened to the first meetings of the Policy and Standards Committees and to the NCVHS sessions where policy wonks waxed on about the potential of healthcare IT, and I couldn’t tell you who is doing what, when and how. I can’t tell you how Kathleen Sibelius, David Brailer, John Glaser, the Policy Committee, the Standards Committee, NIST, NCVHS, HITSP, CCHIT and whoever else will actually come up with any plan that doesn’t leave a large majority of small hospitals and practices scrambling to find money and resources that don’t exist. To be honest, I don’t know how that many individuals and organizations come up with any coherent plan at all.

While project-management professionals would never have come up with HITECH, big vendors certainly would have.

Q: “But if the big vendors wrote the legislation, wouldn’t they have asked for the money up front so they could get paid?”

A: “Maybe. But which version of legislation do you think would be an easier sell on Capitol Hill. And who really cares where providers find the money? They beauty is … they’ll have to!”

HITECH is inevitably going to turn all the major vendors into something Epic has worked over 20 years to become: order takers. Gone are the days of hospitals issuing RFPs, then putting vendors through their paces to earn the business. AH (After HITECH), hospitals will be lucky to get their phone calls returned, as vendors will have more business than they can handle. BH, there were plenty of implementation failures already, many due to the vendors, many also due to the hospitals that failed to commit sufficient resources or lay the groundwork. Epic, you see, is one company that understood it’s better to walk away from a deal that lacked sufficient commitment from the other side than preside over a failed implementation and the attendant bad press which would follow.

AH, vendors will be stretched even thinner as they try and lap up all the business puddles across the country. But an implementation that is poorly staffed on the vendor side, combined with clients that are only doing the implementation because they are required by law will see failure rates skyrocket. The vendors may have gotten what they wanted, but may not want (or be able to handle) what they get.

Q: “But what about all the practices and organizations that have implemented HIT successfully?”

A: “Organizations that have successfully implemented HIT, obviously, had leaders that drove the change, found the resources, and did it on their own timeline. With HITECH, none of those things will be put into place, yet we expect the same outcomes.”

The big vendors pushed and, I am convinced, were involved with the writing of this legislation — that’s the only way it makes any sense. Vendor revenues are going to skyrocket in the next 24 months whether healthcare IT improves or not. Hospitals and physicians will be on the hook for making these things work to earn their money back, while the vendors only have to make the sale and suffer NO government penalties for a lack of subsequent use. So where is the incentive for them to improve their products?

Absolutely all of the impetus to funnel money into R&D is gone. The only incentive now is to put all resources into sales and implementation. The systems, as a result, will not improve.

I am a patriot. I love our country, its history and our democracy. I think our government represents the best system man ever devised. However, this is one case where I feel sick to my stomach about the effects of that democracy, about the laid-bare relationship between money, lobbying and legislation. But the fact that I’m sick over it isn’t all that important. The fact that it’s more likely sick people will be injured by jammed-in and little-understood technology than bad handwriting is important. I recently told a room full of venture capitalists that this is one industry where they should not look to make a fast and loose buck, because someday they will be in that hospital bed.

Somehow, we’ve got to slow this train down, convince those in the driver seat to set the bar low. Joe Bormel’s option number three is a good start. During a Brookings Institute policy discussion this week, Blumenthal said, “This is not about IT,” and, he hopes, “not about the money.”

Unfortunately, by my reading, HITECH has always been all about the money.


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