It's telling that a number of organizations-including the eHealth Initiative, the HIMSS Electronic Health Record Association, and provider alliance Premier Inc.-have issued calls for watering down or delaying the next stages of meaningful use criteria. They're concerned that too many providers will fall short as the MU bar gets raised higher and vendors won't be able to upgrade their systems in time for their clients to hit incentive deadlines.

But ... this is ignoring the reality that the incentive program was bound to create winners and losers. Some software on the market won't be able to deliver the functionality we truly need for interoperability; some care organizations are just not good at implementing or adopting I.T. But in both cases, a meaningful use program with fungible timelines, bent on making a winner out of everyone, is artificially propping up the laggards.

HHS Secretary Kathleen Sebelius said in a HIMSS conference keynote that “there are 231 companies that have certified EHR products, and two-third of those has 50 employees or less. Is the next Google in there?” If there is a Google in that group, market forces need to clear a path for its rise. Many hospitals and providers are in something akin to a suicide pact with technology they can't get rid of, but isn't going to take them where they need to go.

Better to stay aggressive and let creative destruction run its course. Some well-established I.T. vendors likely will be unmasked as having second-rate software that belongs in a landfill, and the innovative and hungry vendors will fill the vacuum. Likewise, care facilities that can utilize I.T. and actually point it in the right direction to cut costs/improve quality will prosper and grow their business by hooking in competitors and physicians who could not keep pace, from both clinical care and I.T. perspectives. That's already happening now to some extent, but it will happen a lot faster if federal officials stick to their guns.

Software vendors would fail, and some providers would suffer. But coming out the other side, health I.T. would be a battle-tested industry with leading edge technology, able to extend best practices and innovation to all corners of the market. It would be an industry that would satisfy the appetites of federal officials on the two fronts they care most about: "bending the curve" of health care costs and becoming a U.S. economic engine, selling the most globally advanced clinical software to the domestic and international markets while making a dent in U.S. unemployment.


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