Meaningful Use Phases 2 and 3....

In a March 16 blog posting entitled "Not so Fast," Joseph Conn summarizes the perspectives of those who suggest that MU 2 and 3 goals are simply too agressive.

I expressed my concerns about the challenges of this task shortly after HITECH's passage in a Health Affairs piece called "One Step at a Time."

I ask a rhetorical question. What is there were no Phase 2 and Phase 3 MU criteria, rewards, and penalties? Do we have sufficient momentum and guidance through health reform and quality legislation to "pull" desired goals through rational local responses rather than "push" goals through federal action?

Most everyone agrees with the goals espoused in MU 2 and 3, but many differ as to the pace an method. In light of the maturity and pace of standards development and the imperatives to achieve interoperable functions in anticipation of new reimbursement approaches and care delivery models, is it heretical to suggest that Phase 2 and 3 MU incentives (and penalties) be dropped altogether. One could argue that we will of necessity achieve these aims even without subsequent MU because ONC's great efforts to far have created sufficient momentum to realize a "tipping point."

What does history teach us? Pharmacy claims transactions were mandated through the 1988 Medicare Catastrophic Coverage act. These practices grew and evolved even after repeal of the Act. They simply made too much sense. They were, in essence, a precursor to RxHub and e-prescribing.

Perhaps we've got enough momentum to focus on the goals and not the methods. Perhaps its time to move the conversation out of Washington and back into communities where practitioners and vendors can discuss business and care needs at the local level. It's the same conversation, but it will be "owned" by the stakeholders - something that federal efforts strive for.

So, what happens if the Nation keeps standards and infrastructure development but lets care reimbursement and quality agenda drive innovation and adoption rather than by adding additional stress and complexity through Phase 2 and 3 MU?