Now that CMS' Andy Slavitt has spoken, did meaningful use spawn or stall EHR innovation and interoperability?
Whether meaningful use triggered a desperately-needed onslaught of healthcare digitization or effectively stifled innovation by incentivizing the deployment of kludgy electronic health records software – or both – is likely to be a matter of some debate for years to come.
When Centers for Medicare and Medicaid Services Acting Administrator Andy Slavitt announced this week that the agency intends to impart changes significant enough that "meaningful use as it has existed will be effectively over," the revelation sent a shock wave through hospital IT shops and executive suites across America.
Slavitt offered scant detail. Just about anytime a federal official does that, rumors start swirling inside the Beltway about going off script or having to walk back some of the remarks because the White House doesn't particularly like them.
But for now we're left with burning questions: Will MU be absorbed by MIPS, the Merit-Based Incentive Program? Should CIOs, IT professionals and clinicians still brace for Stage 3? What does this all really mean?
Many of those answers will arrive in reasonably short order. In years past, it would have been tempting to imagine Slavitt or CMS plotting to share more at HIMSS16, but he's already pointed to "the next few months" as a timeframe when CMS might offer more specifics.
What we won't be so certain about, however, is that looming historical question: Did the more than $30 billion federal taxpayers spent essentially digitizing and industrializing the healthcare system — an ostensibly necessary first step to enable next-generation healthcare — foster or inhibit the technological innovations necessary to get to those next waypoints?
One argument is that the program did what it was crafted to accomplish and that's exactly why the time has come to embark down a new and better avenue.
Indeed, meaningful use "served to accelerate investment in healthcare information technology systems," said Caleb Winder, managing director at Excel Venture Management. "The issues we are seeing with dissatisfied clinicians are largely a result of a belief that the EHR, by itself, would be the panacea."
Since 2009, when Congress passed and President Barack Obama signed into law the Healthcare Information Technology and Economic Clinical Health Act, the number of providers achieving HIMSS Analytics EMRAM Stage 7 rose markedly – to the tune of, oh, just about 720 percent.
"The latest data that we have shows a massive shift in the market as a result of the stimulus program," said John Hoyt, executive vice president of HIMSS Analytics, a sister company of Healthcare IT News.
Widespread EHR adoption would be an ideal problem to have if the current state of EHR usability were not so troubling.
"Six years later what the EHR infrastructure does is show doctors back what they typed in before, and some data from other systems so it's a very narrow slice," said Kenneth Mandl, MD, a professor of Pediatrics at Harvard Medical School and the Boston Children's Hospital Chair in Biomedical Informatics and Population Health, in November at the Healthcare IT News Big Data and Healthcare Analytics Forum in Boston. "The breaking of interoperability is unfortunately the standard today in healthcare."
So many EHR makers have been breathing collective hullabaloo about meaningful use certification criteria shackling them that some are even saying "don't call our product an EHR anymore."
For those vendors and, even more important, the hospitals running on their software, Slavitt's foretelling of meaningful use being "replaced with something better," and promising more details in the months ahead, brings great hope that market forces will finally be open to usher in a new era of software that is actually usable and useful.
Whether sprouting out of meaningful use's rocky soil enables those EHR makers to stop architecting software that simply meets the program's clunky criteria and finally start innovating and interoperating to the benefit of customers remains to be seen.
If that happens it will be difficult to contend that meaningful use, despite all its trials and tribulations, was an abysmal failure — but if digitizing the healthcare realm does not ultimately provide that platform and ecosystem on top of which technologists can quickly innovate, then any attempts to defend the government's work will be lonely cries.
We're on the verge of finding out.