One of the things that strikes me most about the meaningful use juggernaut, now that we’ve all had a chance to analyze and ponder the final rule since its release on July 13, is this: there is a strong undercurrent in the industry of an attitude that feels something like, “OK, just tell me what the heck to do so that I can check off the boxes, get the money, and move on!” It’s not that this is even a dominant sentiment; but it does give me some pause, for several reasons.
Let’s go back to the basics: as part of the overall effort to stimulate the healthcare industry, along with every part of the U.S. economy (and let’s face it, at something around one-sixth of the economy, the healthcare industry is definitely one that should be stimulated, if one wishes to stimulate the overall economy!), Congress passed ARRA in February of last year, and included what was at the time projected to be about $19.1 billion in stimulus to the healthcare industry through, HITECH, whose outlays (now estimated at perhaps up to twice as large a total, if all goes as expected) were intended to push the industry forward on automation. And automation—especially its largest component, the development of the fully electronic health record—is something that is pretty much non-partisan as a goal, and also pretty much universally acknowledged as a worthy objective for our industry.
But once the HITECH legislation was signed into law, of course it had to be articulated by a rules- and regulatory-based process, and since then, understandably, everyone’s gotten very focused on the details of that process and by its implications. So far, so appropriate. After all, there is a lot riding on all this, given that the carrots turn into sticks soon after 2015, so that even those healthcare organizations whose leaders are choosing right now not to heed the call to action will face inevitable reckonings down the road, based on the choices they make in the present. And, too, many healthcare organizations have already made considerable progress in terms of outcomes measurement, reporting, analysis and feedback for care delivery process improvement; so the leaders of those organizations are having to make some hard choices about how to respond to meaningful use requirements that are compelling a reordering of how they pursue their paths forward towards patient safety, care quality, effectiveness, etc.
But in the rush to “git ‘er done” (if I may invoke here that now-famous phrase from well-known entertainer Larry the Cable Guy), I’m seeing in some quarters both a loss of focus on the broader, 40,000-feet-up perspective on all this—that the point of this entire, industry-rattling exercise is improvements in care quality, patient safety, efficiency, and cost-effectiveness, improvements that pretty much everyone agrees need to be made; and also a desire, as expressed by some, to try to compress everything into neat “step 1, step 2” formulas.
So the release of CSC’s new report this week, “Hospital Quality Reporting—The Hidden Requirements of Meaningful Use,” authored by Jane Metzger, Melissa Ames, and Jared Rhoades—comes at a particularly interesting point along our collective journey. As Jane Metzger shared with me earlier this week in our industry-exclusive interview immediately prior to the release of the report, she and her colleagues at CSC share strong concerns regarding the ability of CIOs and other healthcare IT leaders to grasp the full complexity of the 15 quality reporting measures articulated in the final rule. Because, of course, those “15” measures are really almost more like symbolic hand-gestures for a series of intensely complex processes whose true requirements are exponentially greater and more intensive than the number 15 can convey.
Just looking at the report’s analysis of the provision of VTE prophylaxis offers one example among many of just how this is so. On the surface, the question of whether VTE prophylaxis has been provided to a patient sounds very straightforward; but in practice, the underlying questions and data demands are staggering. And when one looks at all the data reporting requirements, the picture that emerges is equally daunting.
The reality here is that fulfilling this one element of the meaningful use requirements—not to mention all the others—is going to be tremendously more difficult than many CIOs and other healthcare IT leaders realize at this particular moment in time. And as CIOs and other leaders wade into this swamp of complexity, I believe strongly that it will not be the lure of the money to be handed out that will help them and their organizations get through the next few years (though, conversely, the potential for reimbursement cuts after 2015 could provide quite a strong motivator, on some levels!), but rather the consensus inside their organizations that moving forward on all this work is what they should be doing on principle, under the banner of improved patient care, efficiency and effectiveness. Because, frankly, the average attending or affiliated physician simply won’t have the sense of immediacy around potential funding cuts after 2015 to motivate her- or himself to participate in the complicated and time-consuming processes around clinical IT implementation, utilization and optimization, to make this happen otherwise.
Will there be inevitable moments of discouragement and setback? Of course there will. But, as our coverage of the pioneer healthcare organizations out in the field has continued to uncover, those organizations whose leaders have convinced their colleagues to march under the banner of improved patient care, have made the kinds of progress that will be required to make a success of the whole HITECH/meaningful use mandate. And frankly, without the inspiration that improvement-focused efforts can provide, it does all become a mind-numbing slog through a swamp of endless details and overwhelming complexity.