Vendors making their final meaningful use pitch

What is becoming clear is that the stick, which many thought would only come out with the end of the meaningful use stimulus, is coming out right now.

With the final meaningful use rules now a week old, and with the initial deadlines for stimulus money less than three months away, vendors are making their final pitch for that sweet, sweet stimulus cash.

What's interesting is they are indeed having to pitch. One would think the promise of federal checks would make the go-no go decision a no-brainer. Not so. The American Medical Association is cautious, and the American Hospital Association warns many members may just say no.

An analysis from Practice Fusion, for instance, shows Texas, with a population of over 24 million, getting less stimulus than New York and Florida, which have 5-6 million fewer people. States whose leaders have explicitly rejected the health care reform seem most likely to lose out on the cash.

Practice Fusion, which offers its software as a service (SaaS) requiring little hardware investment, is also offering a white paper aimed at making the decision easier.

General Electric, meanwhile, is offering a new version of its Centricity Enterprise software, calling it Meaningful Use-ready.

Such claims need to be taken with a grain of salt. Rules for certifying software as meeting the guidelines were set along with the guidelines. So were rules for signing certification bodies. But those have yet to be chosen.

What that means is that clinics and hospitals can't make a decision that guarantees meaningful use based on features, because vendors still have to line up outside the not-yet-chosen certification authorities to start the process.

You're going to read a lot of complaints about this over the next few weeks, but the plain fact is the complaints are misplaced.

Meeting the meaningful use guidelines for 2011, 2013, and 2015 isn't going to be about the speeds and feeds of hardware and software.

They're going to be about what is done with them, giving patients better information on their health, enabling e-prescribing and information exchanges between doctors, changing the practice of medicine from one emphasizing procedures and billable events to communication and wellness.

This is the key difference between the Bush health IT policy and that of the current Administration. The Bush team wanted change to follow the technology, at a pace determined by hospitals seeking greater profit. The Obama team wants technology to measure change and transform the industry.

Hospitals, clinics and doctors still don't want to accept change. They see cost cuts cutting into their revenues, and savings coming out of their paychecks.

The hope is the hammer that forces change won't be coming from the public sector, but from the private.

Insurers are already looking to drop doctors from their plans based on costs. Groups that opposed health reform say this means fewer choices, but it also means is inefficiency will no longer be subsidized from a common pool.

This pressure on doctors' costs is necessary if small businesses aren't going to drop coverage and leave employees to the state, as is already happening in Massachusetts.

Insurers are responding to government pressure to hold down rates. Technology, and the stimulus, are carrots aimed at enabling lower costs without reducing the quality of care.

What is becoming clear is that the stick, which many thought would only come out with the end of the meaningful use stimulus, is coming out right now.