The resignation of David Blumenthal, MD, last week as national coordinator for heath IT provides an important opportunity to right a meaningful use (MU) ship out of control.
As I wrote in The Most Powerful Person in Healthcare IT, I believe that ship is out of control because the crafting of MU has been taken over by passionate individuals more devoted to the special interests they represent than the practicability of requirements they're putting into place. I believe that for MU to be a success, it must not only be looked back upon as a great carrot which enticed many down the electronic medical record (EMR) path, but actually (for most) paid out the pot of gold they assumed would be at the end. In a program like this, you should get more than a gold star for your efforts.
What is really needed in the next coordinator is someone who, through his or her real-world experience in the trenches, can apply a line-item veto on the wish list spewing forth largely unedited from the HIT policy committee.
"But Blumenthal was in the trenches," you say with indignation.
Yes, to some degree, he was. But it was in a velvet trench with room service. Blumenthal repeatedly spun the same yarn at event after event to prove his EMR bona fides to the industry. He would say that, one day, "An EMR landed on my desk." He would go on to talk about how it was a bad fit at first, that he had little aptitude or interest in the technology initially, but then went on to overcome that trepidation and fall deeply in love with his one-time nemesis. Great story -- touching and appropriate for some, but not all.
You see, most EMRs in this country have been, or will have to be, implemented by three individuals -- the hospital CIO, the large physician practice administrator, and the independent doctor. For none of those three does an EMR "land on their desk" unless they put it there by:
1. Determining they need one;
2. Formulating a budget;
3. Hitting the market to evaluate options;
4. Making a selection;
5. Contracting for it, including capital outlay and ongoing maintenance;
6. Implementing it or having the vendor do so; and
7. Training and using it.
While the administrator and independent doc have never implemented a hospital-based EMR, many hospital CIOs have implemented -- or overseen the contracting for and implementation of -- ambulatory EMRs. Under the Stark relaxations, a large number of hospital organizations around the country have learned all about the ambulatory EMR market, vetted the vendors, developed a short list, investigated integration pain points, implemented them, and contracted for training. Hospital CIOs have been deeply invested in these programs, as the ramifications of a rupture with local independents -- and the subsequent disruption of the patient flow they provide -- would be financially disastrous.
Hospital CIOs also know how hard and far they can push their vendors. Over years of working together, they understand why there are limits to customization and why even small tweaks to software can have significant ramifications on their end, such as when clinician workflow must be realigned or revised.
For all these reasons, I nominate a hospital or health system CIO as the next national coordinator because they sit at the nexus of all the parties effected by MU. I want someone sitting in that chair who will have to deal with the programs they oversee. I want someone with real skin in the game.
Long ago, an EMR landed on David Blumenthal's desk. For the next national coordinator, I want someone who's done the dropping.