EHR and Meaningful Use

The NEJM has published a short article by Blumenthal regarding Meaningful Use of EHRs.

I summarize the Table here with some comments below.
























































The key point is that the Government will be paying for this. Blumenthal states:

Through HITECH, the federal government will commit unprecedented resources to supporting the adoption and use of EHRs. It will make available incentive payments totaling up to $27 billion over 10 years, or as much as $44,000 (through Medicare) and $63,750 (through Medicaid) per clinician. This funding will provide important support to achieve liftoff for the creation of a nationwide system of EHRs.

My main concern is that anyone who has ever deployed so massive a system knows that in the commercial world it takes a long time, just look at ATMs and here we have a system with no feasibility trials, no discussions as to whether it is patient based, physician based, institution based, or Government based. It also raises a great number of privacy issues as well as legal challenges. Not that it is not a worthy and necessary effort, yet it is being done by the Government and academics, a paid of groups who have shown less than sterling levels of accomplishment in this area, namely systems design and deployment. Remember the motor vehicle office just in case.

Blumenthal concludes:

The meaningful use rule strikes a balance between acknowledging the urgency of adopting EHRs to improve our health care system and recognizing the challenges that adoption will pose to health care providers. The regulation must be both ambitious and achievable. Like an escalator, HITECH attempts to move the health system upward toward improved quality and effectiveness in health care. But the speed of ascent must be calibrated to reflect both the capacities of providers who face a multitude of real-world challenges and the maturity of the technology itself.

As part of this process, the DHHS is establishing a nationwide network of Regional Extension Centers to assist providers in adopting qualified EHRs and making meaningful use of them. The DHHS is committed to the support, collaboration, and ongoing learning that will mark our progress toward electronically connected, information-driven medical care. We hope that providers and consumers will now join us in the effort to assure that we make the best possible use of our most precious health care resource: information about the patients we serve.

There is the issue of architecture and the system engineering to achieve useful implementation and the continuing monitoring of performance. An independent group like IETF would have been much better than a Government group. The Extension Centers is a nice play on the Agricultural Extension Centers but this is not a yellowed lawn or poor corn crop we are talking about.

This may very well turn into one of the greatest lost opportunities ever all because someone wanted to score points quickly.