CMS EHR Incentives: The Dark Side

I remember exactly where I was when the term first came up, but I don’t remember what year it was. It was either HIMSS09 in Chicago or HIMSS10 in Atlanta. I can’t really remember the year. It seems that in the world of Meaningful Use ten years have been compressed into two. Surely we are at Stage 6 by now? Anyway, I was sitting on a couch in the middle of the exhibit floor talking to Jane Sarasohn-Kahn, the woman behind HEALTHPopuli, and one of the strongest voices in health care and HIT adoption. Jane keeps trying to remind us that behind health technology, incentives, and regulations there might possibly be humans, they shouldn’t be forgotten, and they deserve respect. What a novel idea. Sounds kind of radical to me. That’s Jane for you.

Anyway, I’m sitting there with Jane and she is wearing her trade-mark color, dressed all in black. We were discussing what possibly could happen with this new fangled CMS EHR incentive program that had just started peeking up over the horizon. Everything was speculation and confusion. Not only was there no Final Rule, there was not even an Interim Final Rule or meaningful use . The future for health care was bright and the HIT industry was going to lead us to the Promised Land of milk and honey. Dawn was breaking in the Garden of Eden and all of us: vendors, consultants, and people with Big Ideas were being ushered into a shiny new world. And, by the way, all stakeholders were going to be the rich rock stars of a new domain, HIT adoption. What could possibly go wrong? Then it hit us both at the same time. It was like a dark raven flew into the exhibit floor bringing snakes into this new universe of promise and hope. I was looking into Jane’s eyes when she said it. I still get a shudder when I remember the moment. She said, “What about the Dark Side?”

The US Federal Government is spending untold billions of dollars in an effort to promote the transition of our health care system from one based on paper to one based on electronic interoperable data. This massive effort is not only necessary; it is noble and ranks with other Herculean projects over the past century. The construction of the US Interstate Highway System in the 1950’s and the NASA project to land a man on the moon in the 1960’s come to mind. Hopefully, twenty years from now, citizens will look back at this effort to digitize the health care system with wonder. It is not often one gets to actually see the genesis and birth of a new way of doing things, but that is exactly where we are now. This new mode of clinical documentation and exchange will allow best practices and research to flourish in ways that can only be imagined. I cannot think of a better use of tax dollars than to remake the foundation of how health care is managed, reported, researched and delivered. Unfortunate, as there is with many noble efforts, there is a Dark Side.

The Dark Side of Meaningful Use and the incentive program is being fueled by business models and people we used to call “carpet baggers” down in Georgia. Now I’m as interested as any man in the almighty dollar and I guess in ordinary times that is pretty much OK. But these are not ordinary times. I worry when I see a gold rush. Priorities change and influence is exerted by groups that are only concerned about their interests. Maybe it is time to think about the Common Good. I haven’t heard that term too much recently. Before us lies an opportunity to help build and support the adoption of electronic health care systems that will benefit our children and our children’s’ children. There is simply too much at stake to cling to our own little private kingdoms, blog worlds and business plans. This chance must not be squandered and it won’t come again. We have one shot to pull this off. Just maybe there is an opportunity here for something really good to happen.

I have been encouraged and inspired by many of the people I have met in person or via social media involved in this movement. I see so many of these individuals emerging as credible leaders in their own arenas of technical specification, EHR usability, and process development. Thank you to all the RECs and the bloggers and Tweeters that keep us on track. Thank you to all those that work on the policy committees and workgroups. Thank you to those that submit public comment. Thank you to those who share freely and openly what they know. Thank you to those that will arise in Stage 2 and 3 and are not yet know to us. Thank you Jane, for your warning and your voice like so many others that struggle to be heard above the noise and static of the marketplace. Let’s keep our eyes on the Prize, but keep a guard posted for the Dark Side and ring a bell when it appears.

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