"Meaningful use" is an elegant concept. The very words telegraph depth and purpose, and the notion is easy to understand. The implementation of this concept, however, is unlikely to be elegant or easy.
Indeed, the battle is already engaged. CMS and the Office of the National Coordinator for Health IT have received more than 2,000 comments on the proposed regulations to enhance electronic health record adoption -- often referred to in government-speak as the "NPRM" (Notice of Proposed Rule Making) and the "IFR" (Interim Final Rule).
It won't all be happy reading. Many of those letters -- from physician and hospital groups that stand to gain or lose the most -- argue politely but strenuously that the proposed rules overreach and demand too much too soon of providers.
Do they? Reading through the American Medical Association's, American Hospital Association's or American Academy of Family Physicians' submissions, one is impressed with the detailed analysis of the rules. And let it be said that these organizations fully embrace the central thrust of the proposed rules and the noble concept of meaningful use. Many cogent points are made about timelines, thresholds, numerators and denominators, "practice needs," physician workflow and demands, structural limitations, and technological "hindrances."
But the objections of provider groups to the proposed EHR rules must be viewed in the broader context that is the perennial dance between government and industry -- especially when it comes time to up the ante on getting something significant done in the public interest.
Lessons From Other Industries
Exhibit One: Car makers did not eagerly embrace new safety regulations in the 1960s in the wake of Ralph Nader's infamous findings. They complained bitterly that they didn’t have the technology and that the rules would jack up the price of cars beyond the reach of many Americans. The rules were implemented (with slight changes), and lo and behold, auto manufacturers innovated their way quickly to safer and better cars with acceptable added expense.
A similar course of events unfolded in the 1970s with the first round of environmental protection rules and the establishment of the Environmental Protection Agency. Industry (mostly large manufacturers and energy companies) screamed bloody murder at the initial rules -- again, mostly about added cost and technological limitations. Some rules were scaled back, but not overall. This battle continues to this day, of course. The relevant point here is that government, for the most part, stuck to its guns and forced industry to adapt, innovate and re-order its priorities. The result has been cleaner air and water with added cost that was worth every penny.
Airline rules from the Federal Aviation Administration have famously led to a high bar for safe air travel. In fact, just last week the FAA and other aviation regulators worldwide agreed to a new initiative to share and jointly analyze airline safety data. (Aside: Why can't we do the same in health care?)
Closer to home (health care), the significant strengthening of FDA in the 1960s and 70s, and as recently as 2007, had the drug and food industry grumbling and fighting all the way. But there is little question that our food and drugs are safer today. New CMS payment rules in the 1980s, which doctors and hospitals hated at first, strengthened Medicare and didn't, as feared, drive providers into poverty.
These successes are offset by a regulatory failure that has lessons for health care. The federal government's complex and patchwork (some would say Rube Goldberg) regulatory structure overseeing the financial industry has been ineffectual over the past 20 years. We are paying the price for that now in the wake of the 2008 financial industry implosion.
Bottom line: Businesses (including doctors' offices and even not-for-profit hospitals) are motivated primarily by financial self-interest and profit. Government exists to leaven that with consumer protection and public benefit.
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