Chaos and Health IT

On the HIMSS Blog last month, I noted that we live our lives somewhere between fibrillation and asystole, a thought I had while listening to the Health IT Standards Committee (HITSC) August meeting call.

The call reported on the frenetic activity of “summer camp,” the analogy used to describe the multiple projects that the HITSC and ONC’s Standards and Interoperability Framework (S&I) were to complete over the summer in preparation for the start of rule making in the fall. Yet, in the end, there were cautions to slow down, conduct pilots, plan transitions and not rush to regulations. While final consensus deferred until the September meeting which standards, implementation guides and certification criteria to recommend to ONC for Stage 2, we can speculate about the future of meaningful use as a centerpiece of federal health IT initiatives.

Although nowhere as elegant as the human heart and autonomic nervous system, meaningful use is a dynamic system trying to adapt to controls and stimuli. We, as the users of the system, want to predict its future performance.

We have all probably seen the television commercial for auto insurance centered on a guy who brings chaos to multiple situations. For him, chaos is the unexpected, the unpredictable event.  Chaos theory attempts to make dynamic systems less unpredictable, as discussed in this month’s Standards Insight. 

So what does this have to do with health IT? 

I would suggest that our national health IT initiatives have become chaotic and unpredictable at a time and in an industry that needs predictability. Thus, in the second year of meaningful use, a program initially laid out in three stages over six years, we have an “unpredictable” reset. Actual demonstration of Stage 2 performance by providers is likely to slip one year to 2014. An observer could read this as a 50 percent variance over two cycles.

How predictable is this system?

As a strategist, I can offer the prediction that health IT based on meaningful use is in trouble; not just in the near term, but with every subsequent decision, Stage 3 becomes less likely.

Schedule adjustments for Stage 2 may be possible in a closed system, but in our complex world, another, or possibly the current, administration will confront Stage 2 issues in 2013. Then, potentially even a third administration will deal with the issue of penalties after 2017.

Meanwhile, health IT vendors and their client providers and health systems must be planning and implementing systems for the next five to 10 years, and they want and need predictability. Certainly, more regulation will not help. 

What about the inverse?

• Why not isolate the regulatory complexity within the performance incentives and payment reforms coming from CMS?
• Why not announce the intention to pay what is owed providers for demonstrating meaningful use on a voluntary basis over the next five years, but remove the threat of penalty?
• Why not encourage voluntary certification of systems’ interoperability to support internal as well as external information exchanges?
• Why not get out of the grants and demonstration business that shows temporary “progress” but will lead to failed HIEs and communities when the funding runs out?
• Why not re-energize the Nationwide Health Information Network?
• Why not make the HITSC accountable and voluntary?
• Why not provide a big picture?

None of these ideas involves a do-over or fresh start, but they do free up health IT advances from regulatory cycles and open the process to all stakeholders. In a sense, an unregulated process becomes more responsive and predictable than the current environment of uncertain regulations, capricious decision-making by unaccountable individuals and no real forum for stakeholders’ feedback.

Does any of this make sense or seem worthy of further dialogue?

Have other ideas?

Check out the full discussion of chaos and health IT and detailed suggestions for a path forward in the September Standards Insight on the HIMSS members’ page.

Your comments and input to both the Standards Insight and its companion blog entry are welcome.