We don’t win anymore in health care. After repeatedly drilling in our heads that America’s sick care system is a disaster, that those who care for the sick are incompetent and stupid, and that the sick themselves are losers, Meaningful Use was advertised as the means by which technology will make health care great again. The program has been in place for 5 years and the great promise of Meaningful Use is just around the same corner it was back in 2011. The only measurable changes from the pre Meaningful Use era are the billions of dollars subtracted from our treasury and the minutes subtracted from our time with our doctors, balanced only by the expenses added to our medical bills and the misery added to physicians’ professional lives.
Meaningful Use, a metastasizing web of mandates, regulations, exclusions, incentives and penalties, is conveniently defined in the abstract as a set of indisputably wholesome aspirational goals for EHR software and its users, which stands in stark contrast to the barrage of bad news flooding every health related publication, every single day. Health care in America used to be the best in the world, but now our health care is crippled. Meaningful Use of EHR technology will improve quality, safety, efficiency, care coordination, and public and population health. It will engage patients and families, and it will ensure privacy and security for personal health information. With Meaningful Use leading the way, health care will be winning so much that your head will be spinning. You won’t believe how much we’ll be winning.
Be afraid, be very afraid
Bombastic? Laughable? Easily dismissible by educated people? Not so fast. According to Dr. David Blumenthal, president of the Commonwealth Fund, and former National Coordinator for Health IT, “we probably have the worst primary care system in the world”. Yes, worst system in the whole wide world, worse than Niger, Malawi and Somalia. Probably. According to a hobbyist “study” that extrapolates its “results” from a handful of other studies based on an admittedly inaccurate tool intended for different purposes, 440,000 people are killed in hospitals due to preventable errors each year – “that’s the equivalent of nearly 10 jumbo jets crashing every week”. Or, with a little more math, half of all hospital deaths, and one in six US deaths, are due to negligent homicide perpetrated by psychopathic doctors and nurses.
How is that for buffoonery? I suspect that the beautiful minds appalled at populist or outright racist fear mongering rhetoric claiming that thousands of Muslims were dancing on rooftops on 9/11 in New Jersey, have zero problems with self-servingly stating that “hospitals are killing off the equivalent of the entire population of Atlanta one year, Miami the next, then moving to Oakland, and on and on”, based on equally valid he-said-she-said evidence. Both virulent strains of outlandish demagoguery are insisting that they, and only they, can keep us safe from things that go bump in the night. Supersizing the ghoulies and ghosties and long-leggedy beasties makes us more likely to relinquish control of our lives to those who might deliver us from terror.
The Meaningful Use program rests on a narrative where medicine is witchcraft, our doctors are murderers, our hospitals are cesspools teeming with death, our citizens are Lemmings unable to wipe their noses, and the machines of the illuminati are our only salvation. When the premise of an action is delusional, one cannot expect the outcomes to be anything but.
Smoke and mirrors
When you read “studies” advertising that Meaningful Use increased the rates of mammography by 90% in three months, you should assume that the only thing that was increased is the rate of ticking boxes for stuff that was not documented before, and practically no material changes have occurred. When you feel vindicated by the 99% rate of patients given a clinical summary after each visit, keep in mind that the vast majority of those summaries were posted to a portal that nobody uses, or just fake-printed to PDF, and the few actually given out were dutifully tossed in the recyclable trash bin. When you read about the billions of dollars in tax money successfully spent on Meaningful Use, you should understand that this is just the tip of the iceberg, and the indirect costs to each and single one of us are larger by orders of magnitude.
For most of us simpleton believers, who mistook fiery demagogues for brave-hearted visionaries, the disappointment is a throbbing daily humiliation, manifesting itself in polite low-energy petitions to powerful bureaucrats to take pity on us and roll back some of the most onerous aspects of the program. There are signs indicative of some forthcoming acts of mercy, but those are as disingenuous as the original false narrative of Meaningful Use. After five years of Meaningful Use of EHR technology, the initial hope has failed to translate into promised change. Or has it?
From its inception, the Meaningful Use program had two sets of requirements. One set defines what EHR vendors must build to stay in business, and another set specifies what doctors and hospitals must do to collect gratuity payments from Medicare. Over time these requirements sets began to diverge. Once clinicians became conditioned to compulsively collect data, overt reporting is being replaced with covert extraction through the backend (i.e. application programming interfaces, or APIs). The Certified EHR Technology mandated by the program was never intended to extend abilities of clinicians as much as it was designed to generate standardized measures of their performance. Administrators and regulators cannot control an industry from afar without incessant measurement and the power to reward and punish individual practitioners. Meaningful Use is designed to enable remote control of medicine, its doctors and the people they serve.
We are not alone
Back in 2001 our rulers identified another field where America was losing big time. Education was a disaster, a huge mess with rampant disparities and across the board low quality. Like health care, education of small children is an ideal place for intervention if your aim is to control populations and increase the value derived from each person. With overwhelming bi-partisan support the ruling class passed the No Child Left Behind Act, mandating that all children are above average by 2014. An avalanche of funding for computers, measurements of schools and teachers and incessant standardized testing of students descended upon our schools. For the last fifteen years, schools were engaged in life and death accountability games of reward and punishment, and our children became merely biometric indicators for school and teacher performance assessments.
As 2014 came and went, with many children still stubbornly below average, with multitudes of teachers still burnt out, and education morphing into a misnomer for the standardized testing doomsday machine consuming all but the rich and privileged, the federal government took a step back and passed the Every Student Succeeds Act of 2015. Leaving aside the downright idiotic terminology used for naming acts of Congress, the new legislation is reluctantly beginning a process to diminish federal control of schools. Considering the cumulative damage to our education system, perpetrated by toxic bureaucratic ineptitude which is crowding out the ability of real educators to address real problems, this halfhearted attempt may very well be too little too late.
Failure is not inevitable
I don’t know about you, but I am getting tired of having to live up to Winston Churchill’s image of America. We don’t always have to try everything else before we do the right thing. We shouldn’t have to wait fifteen years before declaring that in retrospective Meaningful Use was meaningless. We know now that it is. Removing a few reporting requirements for physicians, while beefing up patient scoring measures, is not enough. Playing with reporting periods at the last minute and granting ad-hoc exclusions to make people shut up, is not enough either. Randomly linking physician fees to Meaningful Use EHRs may be enough, but it’s beyond disgusting. The Meaningful Use program must end. Plain and simple. And most importantly, the underhanded EHR certification schemes must be halted immediately.
Standardization, quantification, computerization, gamification, engagement, and infantilization of the populace in general, do not produce better educated or healthier citizens. Education reform has failed us on a grandiose scale. Health care reform, to which Meaningful Use is foundational, is based on the same failed concepts as education reform. It will also fail in due course and spectacularly so. It is actually failing as we speak and with the exception of elite institutions, which are benefiting financially from as much health care reform as can possibly be inflicted on the rest of us, we all know it’s failing badly. 2016 presents the perfect opportunity to demonstrate to the entrenched perpetrators that in America accountability is a two way street, and value is a freely defined personal concept.
American health care has been hijacked by very bad people, and it’s time for us to quit being sad little losers who just sit there and bitch. It’s time to take our health care back and it’s high time to deliver to those horrible people the thorough schlonging they so richly deserve. It’s time to make American health care great again.
In 2016, resolve to go out and vote. Vote in the primaries, vote in local and general elections, ignore the propaganda, educate yourself and as old Harry Truman advised us all, vote for yourself, for your own interest, for the welfare of the United States, and for the welfare of the world.
glad you are seeing things differently.
The problem is the hidden agenda.
Not so hidden anymore.
Good to hear from you. I agree. Although, I don’t think we are talking about the same hidden agenda…. 🙂
I am talking of getting providers to follow direction, gather data, be good little minions, accept the edict of CMS, etc. The first data was height and weight of patients…effectively sizing the herd. The patient portals were to intimidate the providers to keep embarrassing things out of the records.
There is nothing in EMR for patients. they are full of crap. They are dangerous to patients. Do not get me started on ICD 10. It effectively censors medical diagnoses… very bad for patients.
ICD-10 is horrendous. It’s supposed to be so specific, yet I can’t find a code for latissimus dorsi tear, which has to be way more common than a Space craft crash.
Oh, okay then… I stand corrected. We’re on the same page 🙂
The progress of a country largely depends upon the healthcare standards of the the country. One needs to connect the emerging technology with the healthcare sector.
I’m not so sure voting will get us there unless those elected are willing to go after MU in the same spirit they go after the IRS or Planned Parenthood. It’s really those type of tactics that erode at and force otherwise unaccountable bureaucracies to change. MU is tax payer fraud ushered in by severe incompetence. Many of the terrible decisions made are going to indefinitely hinder progress. Even the IRS can be reformed with some adjusted tax code and appropriate resource management. MU needs to be completely thrown in the garbage. It is a disaster. Fire the designers. Close the department. Stop saying the words. It’s really that bad. Take a bulldozer to the building it was conceived in and then repeat the process for the PCMH ilk.
“MU is tax payer fraud ushered in by severe incompetence”
Although I have posted multiple articles (many here on THCB) arguing that Meaningful Use is counterproductive, it is inappropriate to make the above statement. The vast majority of the people who have been involved in creating Meaningful Use sincerely believed that Meaningful Use was a potential solution to a serious problem (the quality /cost of our healthcare system.) In hindsight, that solution did not work. This does not mean that they all had ulterior motives for creating Meaningful Use. To demonize people with whom you disagree is grossly inappropriate. Despite the fact that many politicians think “demonization” is they way to advance one’s agenda, I would hope that physicians (who were trained to rationally look at and analyze data) would maintain a higher level of discourse and avoid demonizing people with whom they disagree.
Hayward Zwerling, M.D.
I don’t think fraud is too far off. I have personally heard 3 presidents in a row make the case for developing interoperability and reduced costs. MU has produced neither. Mostly it has accomplished data mining, and set up a system of sanctions against physicians, as though they were some sort of enemy state.
I don’t know if the MU crowd is sincere or not. Are you suggesting there is no problem in their organization with revolving door politicians with ulterior motives? How did they insulate themselves from the rest of Washington?
As far as demonization goes, physicians have been framed as greedy, over coding, disorganized and incompetent…until it comes to crashing jumbo jets full of patients into the ocean every single day with medical errors.
I appreciate what you are saying, but I did not set this tone. I don’t see polite letters from Medical Societies producing any effects. And at what point does patient care become so jeopardized that it becomes reasonable to part from “professionalism”? (Whatever that means.) Lots of docs are cracking and have had enough of the nonsense.
You have been touched by it as well: Which is why you opted to “kill” meaningful use in your blog, rather than politely caress it to powder.
Sincerity (or lack thereof) is irrelevant. Reformers have a primary goal (dream, ambition, vision) and what they’re willing for society to sacrifice to reach that goal. It is the primary goal of the EHR, and the motivations behind that goal, which trouble me.
She is trying to wake up the frogs who don’t have any recall of the days when Medicine was relatively free of all this social engineering….and retained its’ status as a respected and trusted profession.
” if a frog is placed in boiling water, it will jump out, but if it is placed in cold water that is slowly heated, it will not perceive the danger and will be cooked to death.”
Perfect tone for a blog….adds to the conversation…..and the message needs to repeated on other venues with different tone(s).
I think informed voting can go a long way to solving the underlying problem. There are now multiple pending legislations in front of various committees in Congress that pertain directly or indirectly to Meaningful Use. These things are generated by lobbyists and our elected representatives tend to make decisions based on their campaign funding needs, and often their personal pocketbooks. At State levels legislation is most often written by lobbyists and rubber stamped by legislators who have little understanding of what’s in it, and without much public scrutiny.
Once legislation is passed, it takes very little effort to find bureaucrats for hire to implement anything (the revolving door set), and if the subject is complex, it’s pretty easy to find true believers as well.
Voting for people who exhibit different character traits, people who support campaign financing reform, people who lead by example, may be a good start, and not just for Meaningful Use.
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Well said. Time to make health care great again. But, Who am I supposed to vote for again? Doesn’t seem Ike the right or left understands this. You wouldn’t happen to be running, would you?
No, I am not. However I think we should all make a concerted effort to have those who are running educate themselves first and express an opinion regarding health care, other than the customary canned platitudes such as “I will repeal Obamacare on my first day” or “I will tweak the Affordable Care Act on my second day”…. or whatever….
Maybe the medical associations can make themselves useful for a change and reach out to candidates to do a little education & inquiry, and barring this unlikely scenario, maybe all of us should trigger a mighty letter writing campaign to force the subject to the fore… Just a 2 cents idea….
unfortunately, I think the politicians pick the side that fits with narrative they’re peddling. The bigger ? Is why the policy ‘experts’ in our profession let us down by buying into hopelessly simple check a checkbox solutions that do more harm than good.
There are no good political options arrayed in front of us that demonstrate any understanding of anything that matters. I think we have to work on changing the narrative. Your efforts in doing this are to be commended!
I think many, particularly those who work for large systems, have honestly bought into the “standardization” narrative. It’s very seductive to think that you can treat people like you treat cars, aircraft or cheesecake (witness the glut of articles on what health care can learn from XYZ industry).
Others, being human, may have vested interests in the tech industry, as is evident from the multitude of advisory boards, consultants and such for the Silicon Valley industry, and yet others are supported by health reform grants/financing from both government and tax exempt organizations. It’s a mixed bag of misfortunes…..
Are you arguing against medical science? Or just against Process “QI”?
Neither. I am objecting to the feedlot method for raising productive workers/consumers. It doesn’t work well for the cattle folks either, but they never had a voice in this arrangement. As long as we still do, I intend to use it.
“the feedlot method for raising productive workers”
LOL. I’m using that one. With attribution, of course.
all yours 🙂
For those who have not seen this… “25 Reasons It is Time to Kill Meaningful Use”
The Massachusetts Medical Society on Meaningful Use
Great stuff, Dr. Zwerling. Thanks for the links.
“The discoveries of healing science must be the inheritance of all. That is clear: Disease must be attacked, whether it occurs in the poorest or the richest man or woman simply on the ground that it is the enemy; and it must be attacked just in the sane way as the fire brigade will give its full assistance to the humblest cottage as readily as to the most important mansion….Our policy is to create a national health service in order to ensure that everybody in the country, irrespective of means, age, sex, or occupation, shall have equal opportunities to benefit from the best and most up-to-date medical and allied services available.”
Typical bombast from a pissed off doctor or ayn rand disciple. So MU is not so great, but what is the answer? Our health care system still stinks, costs too much and you have no solution. Don’t complain unless you have any reasonable ideas.
She’s neither and she does have a solution:
“We’re mad as hell and we aren’t going to take it any more”.
Isn’t it funny that we can’t differentiate between the “far right” and “far left” anymore? Maybe it’s because the division today is mostly vertical. The horizontal thingy is dead.
“Individualists of the world, UNITE!” – Ayn Irony-Free-Zone Rand, circa 1940
Exploited workers of the world, Unite! – someone else, much earlier than that… 🙂 It’s the implementation that needs to be blended.
Sometimes we go so far left and so far right, we meet in the middle.
Yes, it occurred to me that this thing is not flat either….
Ralph Nader: Unstoppable
Almost exactly what you are talking about.
We need a Bull Moose 🙂
watching Mike Huckabee using the same horizontal/vertical argument on CNN right now…. there is hope 🙂
There are numerous problems with this program.
The first is the amount of time and money stolen from patient care to document.
The second is the focus of doctors from the patient to the computer.
The third is similar to what we see with educational reform. Some kids/patients are not going to do well no matter what we do with them. Many are so beset by social problems that we have little or no control over.
The fourth is the definition of “value”. What is it? How do we get it?
The fifth is the sweeping of private practice physicians into large hospital based practices which only serves to dilute services and relationships even further, and only increases costs instead of decreasing them.
I’m not sure the framers of these rules are as much bad people as they are totally and infuriatingly misguided. But, I could be wrong.
Perfectly stated. It’s that mythical road to hell and its peculiar pavement…. 🙂
“The Meaningful Use program must end.”
I am reminded of “Restrepo.” We sent a bunch of young troops to a FOB astride the Korengal Valley in Afghanistan, got ’em thoroughly shot up, with a good number dead, then just packed up and left, with the young captain declaring, “yeah, it was worth it.”
But, once The Donald is President, trust me, it’ll all be Terrific.