Expect slippage on meaningful use guidelines and dates

Meaningful use is a fundamental change. The goal, once the gear is in, is to get doctors working on their businesses, not just in them. Even if everything worked by magic, that's a big ask.

This week's Health 2.0 event in Washington accidentally served as the last chance for hospitals to seek a delay in the meaningful use guidelines expected to be finalized late this month.

With even the industry's leading IT users -- Intermountain, Kaiser, and Mayo -- insisting they can't meet the requirements for that sweet, sweet stimulus cash, expect some significant watering down.

This could happen in three ways:

  1. Slip the dates -- Turn 2011 into 2012 and now everyone has an extra year to comply with what appear, on the surface, to be reasonable requirements.
  2. Cut the requirements -- Right now there are dozens of specific requirements to be met in 2011, 2013 and 2015 to get the cash. Modify those goals and more can qualify.
  3. Allow partial credit -- I first saw this offered by Dr. David Kibbe. Rather than require everything be done and working, give practices some money for getting some things going.

Having observed many IT projects from afar in my years as a reporter this does not surprise me. We all have big goals in any project. But what seems reasonable to management may seem very unreasonable to the people having to do the work.

In this case we're not just looking at programmers to do that work. We're looking to dopey doctors, people who are already up to their eyeballs in paper and patients and billing. Expecting change on top of this may be too much.

And make no mistake, meaningful use is a fundamental change. The goal, once the gear is in, is to get doctors working on their businesses, not just in them. Even if everything worked by magic, that's a big ask.

What Dr. David Blumenthal (above, at HIMSS a few months ago) is trying to do is use IT to change business models. Rather than simplifying the questions before physicians he has just added another layer of complexity.

The documentary The Vanishing Oath describes a world where insurance, malpractice, and government bureaucracy are all combining to drive doctors to hate their practices. They should, because they're spending less-and-less of their time practicing medicine, and more-and-more time trying to justify what they're doing.

The real bottom line here is patient well-being. For primary care the game is about improving wellness. But doctors don't get paid for wellness. They get paid for treating sickness, for prescribing pills and tests and procedures, for seeing people.

That's the reality meaningful use is supposed to make plain. But you don't need a computer to tell you that your dream job has become a nightmare. And for many primary care doctors that reality is all too obvious.