The Office of the National Coordinator deserves credit for managing to pull together, in less than two years and with a small but apparently tireless staff, a plan for rolling out a system of electronic health information sharing across the country.
While the plan has passed muster from a cross-section of provider groups, payer organizations and think tanks, it does have its detractors, mostly those who think it is overly complex, gives short shrift to public health priorities and lacks reliable methods of measuring its success.
All the same, ONC's meaningful use strategy would probably get mostly "right track" numbers if a survey was done today of its primary target: physicians in small-to-medium-sized medical practices who don't have what amounts to a health care Internet connection to the outside world.
Imagine if your office was approached in 1995"the equivalent of the technological era in which most practices operate today"and was offered federal financial support to set up a local area network, an Internet connection and a suite of office applications.
In exchange you would be required to attest to your ability to track the business's transactions and financial affairs using a series of electronic spreadsheets, and send them via email to various business partners. I think most would take the plunge.
Of course today's meaningful use incentive plan offers doctors not only steep discounts on basic hardware and software but"as our story in this issue of Government Health IT points out" a small army of experts who themselves have been offered incentives to ensure clinicians can operate and understand the technology they are buying.
Those who balk at the offer will ultimately have to pay penalties in the form of negative adjustments to their Medicare and Medicaid reimbursements. I suspect there will be some willing to pay the price for not having to get on the bus. But they will not be the providers that most patients will be flocking to five or 10 years down the road, when a generation of consumer and professional class users of mobile phones and e-readers have taken ownership of the middle and upper tiers of the medical profession.
The practices with improving market share"and health outcomes"will be those who dove into the meaningful use experiment and took advantage of the bargain it offered to test electronic health record systems and to use them to coordinate and compare treatments with at least a sample group of patients.
The providers who made a concerted effort to use the tools available to them through the federal health IT incentive program will have the best chance to get out in front of a fast moving wave of new health information analytics, decision support and management technologies that are likely to leave those who fail to participate at an expensive and unhealthy disadvantage.
