Time to Reassess MU

Some of us have been publicly calling for relief in the timelines of the Meaningful Use program since it was created by ARRA in 2009. The recently proposed program changes are thus welcome.  Do they go far enough?

Since 2011, I have proposed that a full reassessment of the Meaningful Use program be considered. The recent adjustment to the Meaningful Use program in response to challenges that organizations are facing suggests that there may be a greater willingness than in the past to consider alternatives.

Stage 1 of Meaningful Use was a prudent way to ensure that payments were only made for purchased health technology that was being used to treat patients. With that foundational success nearly behind us, we should reassess how to build on it. Is there a better way to achieve the triple aim than by requiring vendors to code boxes, so that providers can check boxes, and CMS can audit reports, to verify the right boxes were checked, supported by adequate documentation? This tightly prescribed box management directs resources away from innovation and ultimately delays achieving our national goals.

If we refocus on what we want, better personal care and a healthier population at lower cost, then we might identify a better path than Meaningful Use. Perhaps it is time to look outside the boxes.
One path to better quality and lower cost increases transparency around cost and quality. Unfortunately, one entity can quote one set of quality metrics while another quotes a different set. It’s hard to make valid comparisons when we don’t have an easy way to use comparable data. We need consistent definitions of both cost and quality if we want to be able to compare them among different healthcare organizations. Why not redirect the efforts of ONC and its public committees to this effort?

We also should reassess the quality metrics that we use. Changes in populations can impact results of the current quality metrics more than improving individual patient health status. We need metrics that look at more dynamic measures in individual patients over time. Improvements and deteriorations measured over the time each patient has been a member of the reported population might help to mitigate the impact of patients moving in and out of a service area. We also must move away from metrics that allow individual providers and healthcare organizations to say “my population’s sicker.” We need to build the underlying illness into the metric. Monitoring individual changes over time does that.

Once we can make consistent, replicable, normalized information available for public comparison, self-interest will motivate everyone to find innovative ways to improve care that go well beyond checked boxes. We will stimulate hundreds or perhaps thousands of experiments to better use the technology foundation we have put in place. Right now, the demands of the current box management mean that vendors and providers have neither the time nor the resources to innovate, and government must perform costly audits that create no true value.

My proposed path builds on our technology foundation in a way that might get us to the triple aim faster and cheaper than pursuing Meaningful Use Stage 2 and beyond. What path do you propose?