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Now That We Know

July 14, 2010
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After months of delay, the Centers for Medicare and Medicaid Services (CMS) in the Department of Health and Human Services (HHS), and the Office of the National Coordinator (ONC), on Tuesday announced the final rule on meaningful use under the HITECH (Health Information Technology for Economic and Clinical Health) Act, via a live and telephonic press conference in Washington, D.C. And, contrary to rather a large volume of Chicken Little-like predictions made before that event, the sky did not fall.

Indeed, the reasonableness of the stage 1 (2011) requirements under meaningful use for hospitals and physicians to receive funding under the federal stimulus program seems to have taken many by surprise. Whether the Chicken Littles and the Cassandras of the healthcare industry should have been surprised or not is perhaps a separate issue. But HHS Secretary Kathleen Sibelius made it clear that she, David Blumenthal, M.D., the National Coordinator, and others, were well aware of the levels of anxiety and concern out in the industry as they prepared the final rule, noting that HHS had received more than 2,000 comments on the interim final rule. The message: We listened.

And the result? A significant set of modifications of the requirements for both hospitals and physicians, under the final rule. For example, the interim rule’s 23 core requirements for hospitals are now 14, plus five to be chosen from a menu of 10 additional goals. For physicians, the earlier 25 criteria have been trimmed to 15 core requirements, plus five out of a menu of 10.

And the requirement for percent of prescriptions that must be ordered electronically went from 70 percent to 40 percent for 2011. Meanwhile, CPOE has been set at 30 percent for both hospitals and physicians, a level that sounds about right to me.

The underlying issue here is one of balance and proportionality. ONC/the feds had the tricky task of how high to set the bar on the requirements for HITECH. Had they set the bar too high, particularly with regard to the 2011 requirements, they could have created a cascade of negative impacts, up to and including the vast majority of hospital organizations and eligible physicians failing to meet the requirements, and ultimately perhaps huge setbacks to the industry’s achieving the goals the feds were seeking in the first place.

On the other end of the spectrum, setting the bar too low would potentially have caused an intensive dilution of the momentum towards automation that the federal government had been hoping for to begin with. And it might well have caused its own kind of disillusionment, as change advocates and change agents in healthcare might have seen a deflation in the sense of forward momentum for the automation that everyone agrees must occur in order to improve patient safety, care quality, clinician effectiveness, and cost-efficiency in U.S. healthcare.

And let’s face it: there is no ideal, foolproof way to do this stuff. What’s being attempted here is an unprecedented clinical transformation of the U.S. healthcare system, in order to jump-start the crucial modernization and systematization of patient care processes in healthcare through the requisite automation. Both the scale/scope and timeframe involved are completely without precedent; as a result, it would be surprising if this were not a challenging set of goals to work towards.

The bottom line? What happened on Tuesday set a positive capstone on the first phase of a multi-phasic process that is transforming our industry in the here and now. And now that we know what will be required, at least during the first stage of this process, we can all move forward, supporting each other along the way. Will the path forward be difficult and challenging? Absolutely no doubt. Will every hospital and physician eligible for the federal stimulus funds receive them? Absolutely not. But we’ve got our marching orders now, and, by and large, they are reasonable, doable marching orders. So it’s time to march forward, and make the best of a challenge-opportunity that’s never presented itself before.

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