I was very pleased to see that U.S. Senator Lamar Alexander is recommending the delay for Stage 3 of Meaningful Use, since it would drive the entire system to its knees. We all agree that the industry needed to change. This has been a bi-partisan initiative that started with President Bush and his appointment of David Brailer as the National Health Information Technology Coordinator back in 2004. For the past decade, this effort has been continued by the Meaningful Use program under the ONC.
I am not criticizing the initial goals of Meaningful Use (Stage 1 – Data Aggregation & Data Access; Stage 2 – Healthcare Information Exchange and Care Coordination; and Stage 3 – Outcomes Improvement). Rather, my extreme disappointment is directed to the fact that we did not pay attention to the first pillar – Data Aggregation and Data Access – to achieve outcomes improvement, which cannot be accomplished without clear and aggressive guidelines on interoperability requirements. Instead, the effort was directed to the implementation of EHRs for data entry, which created silos around few vendors. Of course, the consolidation and collaboration of healthcare providers that resulted from the Affordable Care Act (ACA) exposed the failures of Stages 1 and 2 around interoperability.
If the right level of interoperability is not established early in the program, then the healthcare system cannot easily migrate to Stage 2 – Healthcare Information Exchange and Care Coordination. Why? Because the only data available is now centered around very limited interoperability standards of C-CDA & HL-7 and to the Fast Healthcare Interoperability Resources (FHIR) – which, due to its many shortcomings, should really be called SHIR for Slow Healthcare Interoperability Resources.
Rather than immediately addressing the issue of limited access to clinically relevant data, the ONC came up with a 10-year road map that brings the industry to where it needs to be toward the end. To top it off, the push to Stage 3 – Outcomes Improvement – would force a value-based reimbursement model without giving caregivers access to clinically relevant data to make informed decisions – again exposing the limited success of Stage 1.
It seems as if developments are now moving at “Washington Speed” – driven by political elections and not by the original mission and vision of the Meaningful Use program. It is time for the government to start listening to the providers and patients, not the vendors. This could be a win/win situation – providers and patients know what is good for the industry, and can help get the politicians the votes they need.