When it comes to the federal meaningful use program, keep your eye on the prize—not the incentive dollars, advised Doug Fridsma, MD, former director, office of science and technology in the Office of the National Coordinator. With complexity rising and dollars declining, the greater objective in your deployment of health IT should be preparation for payment reform.
Recently named CEO and president of the American Medical Informatics Association, Fridsma was a member of a panel addressing “The Future of Federal Information Technology Incentive Programs” at the annual meeting of the Radiological Society of North America in Chicago on December 3.
Fridsma provided an insider’s appraisal of the program to date, real-world perspective on what to expect next and recommendations for the radiology community on making the best of it all. His first piece of advice: Recognize that the incentive moneys were front-loaded.
“We have this paradox in that increasing requirements that come from stage 1, 2 and 3 are actually met with decreasing dollars,” he said. “It is important to recognize that, because it affects how people are going to do the business decisions around stage 2 and stage 3.”
Another cloud on the MU horizon is the current leadership challenge, with executives departing—including Fridsma—at a critical time both politically, with a presidential election cycle approaching, and operationally, with the increasing requirements of the program. “It is going to be a challenge for ONC to get ahead of the curve to be able to lead a lot of this, and that is why I think that CMS and some of these other programs are going to be important to pay attention to,” he said.
For a bellwether of where the meaningful use program will go in stage 3 and beyond, look at choices around the government’s $11 billion acquisition of a next-generation EHR. The quantity of interactions that healthcare has with veterans and the requirements that emerge from that EHR acquisition will impact development of all other EHRs, Fridsma predicted.
“I think it’s important to pay attention to that, because there are a lot of dollars going into it,” he said. “There is a requirement within that acquisition that it align with meaningful use, and certification and many of the other things that we have been talking about within the health IT policy community.”
Health records or bridges
Because the HI-TECH Act was a $23 billion segment of a $900 billion stimulus package, the emphasis was on technology adoption. “I tell you that from experience, having had the vice president call and say, ‘Unless you can spend this money, we are going to send it to build bridges, because we need to get the money out there in the economy.’”
Yet interoperability continues to be a source of frustration for many users of health IT. Stage 1 was more about adoption than interoperability, and stage 2 was more about exchange than interoperability, Fridsma said. “Exchange is really just moving the information around,” he noted. “Sending a PDF image from one place to another is about exchange, but you may or may not be able to use that information that is being exchanged.”
Moving forward, the work of interoperability will be driven by specific goals and private industry rather than government prescription, Fridsma predicted. “Interoperability is hard in the concrete, but it is impossible in the abstract: Interoperability has to be grounded in a thing you want to do,” he said—such as creating recognition that you are using decision support with ordering. “That is something concrete.”
Creating interoperability around specific needs is still hard, but it is possible, Fridsma said. “We have this abstract notion that what we want is interoperability, and all of these systems are going to play with one another, and they all are going to talk with one another—it is almost impossible,” he said.
This is why Fridsma predicts that payment reform will drive further health IT policy decisions. “To succeed under payment reform, including ACOs, medical homes and value-based purchasing, knowing your patients in the data will be critical,” he said. “I’d like to see a world in which you get paid because you have good informaticians, not because you have good accountants. The way you manage risk is by making sure you understand the risks that you have and making appropriate decisions based on that.”
Getting to interoperability
Between budget constraints and the political headwinds of a presidential election,