Remember: ‘It’s a marathon'

By Bernie Monegain
12:52 PM

It’s hard to tap the brakes – even ever so slightly – to an initiative like the government’s meaningful use program. The plan is so long overdue, it’s made remarkable progress, and one is loathe to slow the momentum – perhaps fearing that what Uncle Sam giveth under the HITECH Act, Uncle Sam could also taketh away, especially in these times rife with political volatility.
Providers and vendors have told the federal Health IT Policy Committee that advises the Office of the National Coordinator for Health IT and the Centers for Medicare and Medicaid Services there is not enough time to develop the new functionality that will be required for EHR software in Stage 2. The final rule is expected in mid 2012. Hospital executives have told the same panel that implementation schedules for new enterprise applications usually take longer than planned and almost always take a lot longer than the timeline given for meaningful use.
At the same time, new care delivery methods, such as accountable care organizations, will rely on the adoption of advanced functions and features of Stage 2 meaningful use that are being drafted now, including health information exchange.
“This is a compromise,” said Paul Tang, MD, CMIO at the Palo Alto Medical Foundation in California at a May meeting of the workgroup, where he put forth the idea of delaying Stage 2 by a year. Tang is the workgroup chairman and vice-chair of the Health IT Policy Committee. (In the interest of full disclosure, he is also a member of the Healthcare IT News Editorial Board).
As Tang explains it, a delay would not affect the overall meaningful use program. “It only affects one group, the group that comes in in 2011," he said at a meeting of the workgroup.
“We want to step back and see what we can do to maintain the momentum and progress made, and now more than ever with the pressures of ACO models and new payment mechanisms that may be in our future and the national quality strategy,” Tang said. 
Susan L. Davis, president and CEO of St. Vincent’s Medical Center, a 473-bed community teaching and referral hospital that is a member of Ascension Health and of St. Vincent Health Services, with 61 eligible hospitals, indicated at a May 13 meeting of the workgroup that Ascension Health would welcome a delay.
“Implementation schedules for new enterprise applications usually take longer than planned and almost always take a lot longer than the timeline given for meaningful use,” she told the group. Forty of the 61 Ascension Health hospitals had experienced delays with Stage 1 meaningful use, she added.
“As you, members of Meaningful Use Workgroup, move forward in your recommendations for future stages of meaningful use, Davis said, “we ask that you carefully and considerately take into account the real world experience with Stage 1. It is our belief that any additional requirements need to be few in number, build on existing capabilities and be very carefully thought out to achieve their goals.”
We concur. A well considered delay in Stage 2 meaningful use would not merely be playing it safe. Given the concerns over whether the technology itself would be up to the functionality and usability required, it’s the wise course – the right choice for all concerned, especially the patient. And, if crafted carefully, delay need not dampen the enthusiasm for the work already under way. As the country’s health IT chief Farzad Mostashari, MD, said recently: “It’s a marathon.”