When I started to read about the potential – and now, real – delays in Stage 2 of Meaningful Use, my first reaction was that this is not the right approach. We need to keep the momentum going. We need to get our health records into a digital format in order to get to the next level. The next level, in my view, is getting patient data to us – the citizen-patient – and to our providers in an electronic, secure, timely, easy-to-use, and accurate manner.
I am impatient.
Back in May 2011, John Halamka, MD, CIO and a professor at the Harvard Medical School in Boston (and, co-chair of the Health IT Standards Committee plus being an just an all-around guru) , suggested a two-part roll-out of Stage 2: Stage 2A and Stage 2B (Halamka: No summer break for standards work). The approach:
“Say we have a year period to report on meaningful use Stage 2. Instead of a year, let’s make it 90 days. We will buy ourselves nine months of extra time to implement new technologies so that Stage 2B will begin nine months after Oct. 1  and that is a reasonable timeframe [for allowing] vendors the opportunity to create and install software that would support the new technology requirements of Stage 2.”
Seems like a reasonable approach. One stage, two steps.
However, in July 2011, the ONC backed a delay (Mostashari backs stage 2 delay to 2014). As the ONC Director stated:
“In consideration of these points and the concerns expressed by multiple stakeholders, we agree with the logic of delaying the start of stage 2 of meaningful use for a period of one year for those first attesting to meaningful use in 2011. We also agree that it makes sense to maintain the current expectations for those first attesting to meaningful use in 2012 so that all providers attesting to meaningful use in 2011 or 2012 would attest to stage 2 in 2014.”
I understand the tight timeframes and the crammed, risky schedules. I have been through the “big bang” implementations of the Y2K era, so I understand many, connected project plans and the risk in coordinating and meeting aggressive deadlines. I also understand that assertive goals help move major initiatives forward.
I understand the other perspective, too. Bernie Monegain, Editor, Healthcare IT News, is right, as the title of his editorial indicates – Remember: ‘It’s a marathon’. Yes, getting to full Meaningful Use is a marathon; however, completing a marathon in a competitive manner requires high goals, tons of work, and ambitious benchmarks.
The question requiring an answer may be: Is Meaningful Use a rolling program or an incented mission?
Neil Calman, MD, president and CEO of the Institute for Family Health, an HIT Policy Committee member, stated it very well:
“This program is not a subsidy program. We have a responsibility to use these funds as incentive dollars. If we’re not accelerating the process, then we don’t need to put all these dollars on the table.” (HIT Policy Committee recommends delay for Stage 2 MU)
Finally, someone else who is impatient!
I agree with Dr. Calman. HITECH should not be viewed as a subsidy program. It is an incentive program. Incentives encourage and reward people and organizations for faster achievement of big missions, big initiatives. Meaningful Use spells out the objectives and the consequential rewards; the design is for high mission and worthy incentives.
Although momentum is rolling behind the delay, I believe the added time for Stage 2 will slow down progress and turn Meaningful Use to a government program rather than a health care mission. We need to act like we are on a mission rather than implementing yet another program.
And, I do believe it is a mission.
iPatients are impatient, as we should be!
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