A Time for Boundless Energy and Optimism

2012 has been a challenging year for me.

On the personal side, my wife had cancer.   Together we moved two households, relocated her studio, and closed her gallery.    This week my mother broke her hip in Los Angeles and I'm writing from her hospital room as we finalize her discharge and home care plan before I fly back to Boston.

On the business side, the IT community around me has worked hard on Meaningful Use Stage 2, the Massachusetts State Health Information Exchange, improvements in data security, groundbreaking new  applications, and complex projects like ICD10 with enormous scope.

We did all this with boundless energy and optimism, knowing that every day we're creating a foundation that will improve the future for our country, communities, and families.

My personal life has never been better - Kathy's cancer is in remission, our farm is thriving, and our daughter is maturing into a fine young woman at Tufts University.

My business life has never been better - Meaningful Use Stage 2 provides new rigorous standards for content/vocabulary/transport at a time when EHR use has doubled since 2008,  the State HIE goes live in one week, and BIDMC was voted the number #1 IT organization the country.

It's clear that many have discounted the amazing accomplishments that we've all made, overcoming technology and political barriers with questions such as "how can we?" and "why not?" rather than "why is it taking so long?" They would rather pursue their own goals - be they election year politics, academic recognition, or readership traffic on a website.

As many have seen, this letter from the Ways and Means Committee makes comments about standards  that clearly have no other purpose than election year politics.   These House members are very smart people and I have great respect for their staff.    I'm happy to walk them through the Standards and Certification Regulations (MU stage 1 and stage 2) so they understand that the majority of their letter is simply not true  - it ignores the work of hundreds of people over thousands of hours to close the standards gaps via open, transparent, and bipartisan harmonization in both the Bush and Obama administrations.

I spoke with the authors of the Wall Street Journal article "A Major Glitch for Digitized Health-Care Records" and discovered that their issue was not interoperability standards but a lack of usability in non-standard EHR user interface design.  When a clinician goes from Epic to Cerner to Meditech and tries to perform the same task (e-prescribing, managing a problem list, or looking up a lab), the learning curve can be steep.   The authors and I reviewed the Consolidated CDA specification that is required by Meaningful Use Stage 2 and they are completely satisfied that interoperability standards gaps are no longer a rate limiting step.

Many reporters have asked me about the New York Times article "Medicare Bills Rise as Records Turn Electronic"

I've said three things:

1.  In the past, paper documentation lacked details to accurately document acuity.  As we make the multi-year journey from simple EHRs that support electronic billing to complex EHRs that include decision support, interoperability, and patient/family engagement, there will be an interim period when increasing detail in documentation results in higher acuity, which results in increased reimbursement.  

2.  These trends long pre-date the health IT incentive program.  Meaningful Use re-orients the healthcare IT industry away EHRs supporting billing to EHRs which focus on prevention, care coordination, population health management.  It is these functionalities that will both enable, and be incentivized by the shift in payment policies towards value, and away from volume.   In a healthcare reform world, clinicians will be paid for wellness not sickness and the EHR will help them increase efficiency, safety, and quality, which will be required for reimbursement.

3.  As quoted in the Center for Public Integrity's Cracking the Code series, Donald Berwick said he believes that only a small portion of the upswing in coding is the result of fraud. In most cases, he said, the hospitals have learned “how to play the game,” and are targeting the vulnerabilities of the Medicare payment system.  “If you create a payment system in which there is a premium for increasing the number of things you do or the recording of what you do, well, that’s what you’ll get”.

As the cartoon above illustrates, our current society tries to find fault in everyone and everything. Social media and our increased connectedness has turned criticism into a spectator sport.

If everyone could align their efforts into an agenda of optimism, we'd all be better for it.

I may be asking too much to expect positive energy and optimism from Congress, the Wall Street Journal, and the New York Times, but as 2012 has proven to me, anything is possible if you try hard enough.