Heavy-hitters such as the American Medical Association, the American Hospital Association, the MGMA, Healthcare Information and Management Systems Society, and others had argued for further delay along common lines: too many vendors were not ready to meet the deadline, and their doctor clients shouldn't be punished for that. MGMA even framed the problem in a letter to HHS, referring to postponed “software upgrades,” “lengthy wait times for installations and training,” implementations that “can take a year or more…,” etc. The assertion was undeniable, but the conclusion was wrong.
Nearly a decade and a half into the 21st century, why do so many 20th-century problems still plague health IT? Yearlong software implementations? We can download highly complex software into the palms of our hands, with “implementation” times of literally less than one minute!
One reason: when the government decided to wade into the health IT market with tens of billions of dollars to advance meaningful use, it set the bar way too low, placing obsolete technology platforms on taxpayer life support.
Worse, by putting its stamp of approval on dinosaur technologies, the government did a disservice to the doctors it was trying to help. They reasonably assumed that “certified” software would do the job. That assumption was wrong with regard to a lot of products marketed as “meaningful-use certified.”
It is unfair those doctors stand to be penalized for vendors' failings if they choose not to change vendors, but calls for delay are still wrong. Here's why:
Some vendors, and their doctor clients, are ready for stage 2. The necessary technology exists and is available. About 40% of participating providers successfully attested to meaningful use in year one, stage one. By contrast, among athenahealth's participating providers, more than 96% successfully attested and other vendors on cloud platforms are seeing similar results with no software delivery and installation queues or lengthy implementations. Government should be encouraging the use of technologies that do the job, not lowering the bar to accommodate technologies that don't.
Extensions and delays mean another year of wasted taxpayer money and an anchor on innovation. It is an undeniable fact that some meaningful use-certified products might never be ready for stage 2, much less stage 3. Those products are being subsidized by government to the tune of $40,000 per doctor. Delaying “judgment day” for those laggards will just extend those subsidies. That does nobody any favors; least of all the doctors struggling to meet standards that their vendors cannot meet. Lowering standards effectively weighs an anchor on progress as healthcare struggles to catch up to the rest of the information economy.
Delay is a disservice to doctors. It is the laggard vendors, many of whom made explicit promises—verbal and contractual—to their clients who should be punished, not the doctors who pay them. Fortunately, doctors have the ability to see justice done. “Rip and replace” is an uncomfortable term, but in many cases it is an overdue measure.
Meaningful use is just a proxy for progress, not the definition. Doctors saddled with technologies that cannot meet standards for meaningful use are not merely falling short of those standards; they and their patients are falling behind as healthcare moves into the 21st century.
Further delay of meaningful use will only exacerbate the deficiencies in today's health IT, to the detriment of doctors and patients alike. Health IT won't catch up by slowing down.
Dan Haley is vice president of government and regulatory affairs at athenahealth.
