Meaningful use debate approaches climax

Among those most interested in the result, which will come in the form of definitions approved by NCHIT David Blumenthal based on tomorrow's advisory committee meeting, is Medsphere CEO Mike Doyle (right).

Medsphere creates a hospital computing system based on VistA, originally a public record system built by the VA and now an open source project.

Doyle's fear is that the definition would specify system certification by a group close to the HIMSS trade group, called CCHIT, that might leave open source out of the running.

Those fears have abated, and he told ZDNet he is now hoping for a definition based on proof that whatever is bought is actually being used. "Knowing even 80% of orders are electronically generated" might be a good initial metric, he said.

"There are two things to watch," he added. "One is what is a certified system, and who certifies. The other is use.

"We think it's a mistake to certify features and functions," as CCHIT has suggested. "Certifying outcome data is a much more relevant standard to look at. What that will do is create innovation, because you don't have to use the same approach. You can use multiple approaches to achieve a result."

Doyle called adoption the "dirty little secret" of the health IT business. Too many systems are sitting in closets, unused, because while they meet CCHIT standards they are just too hard for doctors to use.

So for Doyle the key words in tomorrow's announcement will be Computer Physician Order Entry, and whether hospitals will get stimulus based on having the capability, or actually using the functionality.

The big objection to Doyle's criteria, I suggested, is it can delay delivery of the money.

If you're paying a clinic or hospital only after they prove the value of a system, that may mean they don't get their check for a year after buying it. Paying for certified systems up-front, through the stimulus, may look more attractive to customers.

Doyle rejected that. " <!-- @page { margin: 0.79in } P { margin-bottom: 0.08in } -->You are not going to change physician behavior with a contract. Whatever the certification criteria are and the definition of meaningful use, if you go by adoption, they can happen almost at the same time.

"I don't see a lag."