Carrots and sticks and EMRs

The danger is that community projects become community fiefdoms, dueling power centers driven by the ambitions of their vendors, and if rivalries are implemented in code then someone who moves from, say, Atlanta to Portland may have a long wait for their EMR data.

With the tech-heavy stimulus package nearly passed through Congress it's time to consider how it can be implemented. (The blog post from which the picture is taken was on another subject entirely. But I liked the drawing.)

The bill's direct language implies a mix of carrots and sticks. Implement and you get a tax credit. Fail to implement and your reimbursement rates decline.

The concept of carrots got a boost with news that smokers may actually quit if you offer them cash. But sticks are necessary to enforce deadlines, which is really where criticism of the package comes from.

Still, the devil is in the details. And it's the detail work that begins now.

A gang of 50 EMR experts, including David Kibbe (friend of the blog), David Kelleher, and John Halamka  of Harvard, along with with the eHealth Initiative and others, have already sent a letter urging that regional extension centers like the Massachusetts eHealth Collaborative be given the lead in doling out the dough.

Regional centers can be very effective in getting small practices over the hurdles involved in EMR implementation, they write, but there is a very important word missing from the letter.

Standards. Even interoperability among health networks is not mentioned. Given the history of many signatories in pushing for both this may be an oversight, a point that is assumed.

The danger is that community projects become community fiefdoms, dueling power centers driven by the ambitions of their vendors, and if rivalries are implemented in code then someone who moves from, say, Atlanta to Portland may have a long wait for their EMR data.

Technical coordination among community or regional projects is thus essential if standards and interoperability are to be maintained throughout the adoption process.

Beyond that, health IT advocates need to acknowledge they will be fighting a rising tide of misinformation, even demonization, as the Administration moves forward with its health reform agenda later this year.

Even though the goals of the insurance industry, especially on things like comparative effectiveness, are in harmony with the Administration's ideas, you can expect a lot of talk about socialism, communism, and compulsion from opponents, which can be reflected on the ground in resistance to IT.

It's possible insurance carriers will be co-opted in this fight, with business and the government moving forward together, isolating opponents to the populist extremes. But the underlying political fight is a swamp EMR advocates don't want to look at.

What such advocates face for the next several months are a ton of alligators, but at least now they have the money to make a stand against them.

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