Meaningful Use or Meaningless Bureaucracy?

After two weeks away from the office, I’m back in the saddle in Redmond.  As much as I tried to pull the plug over the Holidays it was pretty hard to avoid the Christmas Eve health (insurance)  reform antics gong on in Congress.  If that wasn’t bad enough, the Office of the National Coordinator (ONC) on December 30th released a 556-page document providing interim final rules on meaningful use and qualified electronic health records.  Reading even a summary of of the rules gave me a hangover greater than anything I’ve experienced on New Years Day.  Is it just me, or are we only making everything about health, healthcare and the practice of medicine in America even more complicated and confounding than it is already?

I mean no disrespect to the politicians, industry executives, thought leaders and others who are doing this important work.  But has anybody really stepped back and asked, “What is it exactly that we are trying to improve and how can we make getting and giving healthcare less complicated,  more affordable, and more satisfying”?

I see glimmers of hope in some of the proposed rules.  For instance, as a consumer I like the idea of being able to get a copy of my medical record in a timely manner.  I applaud directives that take a more proactive, preventive approach to health.  I really, really want my medical information to be stored electronically and shared (by my permission) with anyone who needs it.  I want my doctor to be focused on providing safe and effective treatments when I’m ill and recommending things I can do to stay healthy when I’m not.  But 556 pages of rules defining meaningful use of electronic records!

I think I have a far better than average grasp of contemporary  information technology, electronic health record solutions, and hospital IT systems than your average Joe.  Yet even I cannot help but feel overwhelmed when reading the ONC rules.  As an average doctor in America, how many additional full-time staffers would I need to implement, let alone keep track of all this stuff.  Would I be incented by an additional forty to sixty thousand dollars to my cumulative Medicare or Medicaid reimbursements to even bother with any of this?  It might be easier to just withdraw from those programs as so many doctors have already done.  Then who will care for our seniors and the medically underserved?

I can’t answer for my medical colleagues.  I’m not in practice anymore.  But if I was still in practice, I’m pretty sure these new rules would push me over the edge.  And that’s coming from someone who actually enjoys using technology!  And while we in America mire ourselves in all these new regulations and directives, will the rest of the world continue to innovate with much simpler, more pragmatic approaches to health IT?  That has been my observation as I’ve traveled the world.  Sometimes we are our own worst enemies. 

Bill Crounse, MD    Senior Director, Worldwide Health     Microsoft

Technorati Tags: ONCHIT,ONC,meaningful use,healthcare reform,Microsoft,EMR,PHR,health IT,care quality,patient safety,innovation

Comments

• Anonymous
  January 04, 2010
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• Anonymous
  January 04, 2010
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• Anonymous
  January 04, 2010
  Thank you, Laura (and Arvind) for your thoughtful comments.  I suspect there are tens of thousands of clinicians who will whole-heartedly agree with you.  For all kinds of reasons, the practice of medicine has become extraordinarily complex.  Properly designed technology could help ease the pain, but arbitrary rules and regulations on how it must be used will only inhibit its adoption. Bill Crounse, MD

• Anonymous
  January 04, 2010
  I felt compelled to add 2 cents here as well.  I consult in Health IT and wrote an EMR, which is now in mothballs as it was too much for me to keep up with as things evolved, but as a partner in consulting, I too had to ponder the complication with software that is arising. When the consultants who are there to help and aid somewhat start seeing the same issues, where are we going from here?  I agree too there was a lot of hard work that went in to bringing the ONC recommendations about, and I think back to watching the PBS documentary, "Money Driven Medicine" and listening to the interventional cardiologist  stating he just wants to practice medicine.   In other words he's on camera showing you "a day in the life" of what I consider one of the most highly technical/clinical occupations in healthcare as they save our lives. I also think back to the "Common User Interface" and wonder why it never picked up more steam, as I think any physician would dearly welcome walking into any hospital and being able to know where to find and access information with standardized screens with not having to again learn a multitude of user interfaces like we have today.   I had one MD tell me he had to learn 5 systems to get through his residency, and kudos to him for that effort too.   Also the Wall Street Journal was kind enough to put an article out that basically told where to go to find the "meat and potatoes" in the 500 plus word document. I too hope this does not prove to be too over whelming for the physicians we need.   Technology is moving so rapidly with advancements in all areas of healthcare that I might also guess there will be considerations enter the picture within the 60 day commenting period that we may not be aware of today.  

• Anonymous
  January 04, 2010
  Few if any doctors will read the 566 pages (the summary table p103-108 is good enough for anyone that is interested). We need to get over the number of pages as it has no real meaning. Most physicians will rely on their certified vendor and the functionality already available in their EHR. No vendor will long stay in business if they don't have the functionality or they don't help their clients. many of the 25 criteria are laughably simple - have a problem on the problem list. Document allergies. Come on its not that hard!

• Anonymous
  January 04, 2010
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• Anonymous
  January 07, 2010
  Dear dr. Crounse. Thank you for asking this question in such a sharp way. I believe that the steps US is making in the first round of improving information technology use in healthcare are not even enough to reduce the gap between US and the rest of the world. I was on an industry panel working on definitions of "meaningful use" and when I questioned why don't we push harder to deliver more benefit to patients, the answer was that what we proposed is already way too much for US policy makers. If we add just a bit more to the scope - we risk being denied flat... This reminds me of "no child left behind" initiative: when it was discovered that too many kids are failing tests - we lowered the thresholds to meet the goals, rather than investing in our kids. Maybe there is a wide-spread misunderstanding about the goals of healthcare? Healers and early physicians used to be paid only while their patients remained healthy. If a doc read 500 pages instead of healing people, is he doing what he is supposed to? Eventually the life-time medical record of each of us will be recorded on an implantable chip and there will be no question who you are, what are your allergies, blood group, medications, how to transfer the information to point of care, who has access to it, etc. It will be all there, at patient's and his doctor's disposal, the most up-to-date gold copy of all clinical info. We could do it today if we wanted. I am strong believer in socialized medicine. You don't call your insurance company to get an approval before calling fire department when your house is on fire! There is no extra layer of money-takers between you and this life-saving service. Physicians should not worry about services covered by patient's insurance when they make treatment choices. They should concentrate on delivering the most benefit to the patient, not to the "system". The reimbursements should be based on only one thing - the clinical outcomes. Nothing else matters. You cure people faster and fuller, with less complications, so they are back contributing to the society - you get paid! Prevention should be given much more attention than today. To rephrase - I think we are solving the wrong problem. We are attacking a symptom, instead of looking at the root causes of systematic failure. The loyalty of care-givers should be with patients and auto-magically everything else will be solved. Over-regulating simply inflates the middle-man layer, taking resources away from "workabees" of healthcare. This is strictly my personal opinion! Take it as that. Thank you, Tibor Duliskovich dr.

• Anonymous
  January 10, 2010
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• Anonymous
  January 10, 2010
  Thanks for all the great comments.  I'm totally on board with the assertion that it should be doctors and patients who determine what is meaningful.  But in healthcare, there is a disconnect between those providing the services, those receiving the services, and those who are paying for the services.  If people could walk into a grocery store and take whatever they wanted for free, the steak and lobster would probably fly out the door.  In our US health system, everyone wants the best services, most advanced technologies, and latest drugs so long as someone else is paying the bill.  The challenge in healthcare is creating balance and properly aligned incentives in the system.  Some would say the best way to do that is to let market forces prevail.  Others say, we need a more socialized healthcare system.  Clearly, there are drawbacks to either model. But I don't think anyone wins (except perhaps lawyers and consultants) when we add more complexity to a system that is already too complex. Bill Crounse, MD

• Anonymous
  January 10, 2010
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• Anonymous
  January 13, 2010
  Dr.Crounse, your verbiage is welcomed and echoed. Personally, dealing with the Medicare and Medicaid bureaucracy and re-reimbursement, negates and government money for me.

• Anonymous
  July 01, 2010
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