I’m not deriding the stimulus bill here. Just being the devil’s advocate. Stimulus or no stimulus, looking at the modernization of antiquated systems and in turn processes could only be good for the U.S. health industry. But--and yes there’s always a “but”--are we getting too caught up in the hoopla of incentives? Do the prescribed matrices actually cover the existing challenges in patient safety and clinical quality assurance? Is the focus on cost reduction at the expense of focus on quality of care? The answer still seems a bit ambiguous. On one hand, study after sponsored study talks about the great impact on quality improvement of health care that can be directly attributed to the meaningful use reforms--and yet on the other hand one hears all sorts of rumblings in the corridors of the great Midwestern and Northeastern IDNs wherein either the meaningful use initiative is completely being discounted or is being handed over to CFOs. Don’t expect too many miracles of medicine coming out of the CFO offices.
I believe the reform has to be looked from a slightly broader perspective than simply the adherence to published matrices of meaningful use criteria. Meaningful use should be but a stepping stone on the greater journey. (God, do I never exhaust of the clichés?)
History is replete with instances where good-intentioned reforms just simply fell by the wayside because of a lack of standardization and lack of monitoring. Is ARRA, in its current format, heading down the same route?
Let me take a simple example: Having a requirement of 80 percent-plus unique patients getting at least one diagnostic indication goes only part of the way to actually creating a meaningful (no pun intended here) collaboration between various entities. The reason is because there is no standardization being proposed. One clinician could enter the indication in ICD-9, another in ICD-10, the third one in SNOMED. And don’t forget the outpatient who could still be getting his/her data coded using CPT. Yes, one will have at least one diagnostic record for 80 percent of the patient population, but will it really help the next doctor who looks up the longitudinal record for the patient and realizes that he has to understand and interpret possibly four different coding schemes? Why not make the ICD-10 transition part of meaningful use?
Don’t get me wrong. The bill is a great start, but is definitely not the panacea. A means to the end for sure but definitely not the end game. It needs to evolve or take newer versions to incorporate constructs such as semantic interoperability to facilitate collaboration between not only the providers but also the payers and pharmaceutical and medical device manufacturers, standardization of clinical communication (can anyone imagine the day when HL7 and CDISC converge?), a more interactive and possibly intrusive monitoring mechanism rather than the current periodic HEDIS reporting structure, and a standardized, mandated clinical decision support system that leverages established best practices for every imaginable therapeutic pathway (Oh, how I dream!).
Reforming a chronically moribund system such as U.S. health care system takes more than a single bill, and I hope it’s not lost on the people much smarter than me, who work inside the Beltway. But here is to a good start and many more to come …
Rajiv Sabharwal is the chief solution architect in the Healthcare and Life Sciences unit at Infosys Technologies LTD. He can be reached at Rajiv_Sabharwal01@infosys.com.
