Meaningful use essentially digitized the healthcare system arguably faster than any other sector of the U.S. economy. But as with so many federal government programs, laws, rules and regulations, that is not even close to suggesting the endeavor was an indisputable success.

Could the total $37 billion paid out thus far, according to newest summary report CMS posted, have been spent more wisely? Did the program succeed or fail? Perhaps the most critical question right now is: looking to the future what should the federal government’s role be?

“We believe that now is the time to step back and recalibrate the role of the federal government on the basis of lessons learned,” John Halamka, MD, and Micky Tripathi wrote in an article in the New England Journal of Medicine. 

Both Halamka, CIO of Beth Israel Deaconess Medical Center, and Tripathi, CEO of the Massachusetts eHealth Collaborative, have been involved with the Office of the National Coordinator for Health IT’s work fostering the meaningful use EHR incentive program.

Tripathi and Halamka put forth four suggestions for the government’s role moving forward: dramatically simplify the Merit-Based Incentive Payment System to focus on interoperability and streamline quality measures; overhaul EHR certification to focus exclusively on interoperability; encourage interoperability by action not by regulation; and, lastly, incentivize the use of application programming interfaces such as FHIR.

Halamka and Tripathi acknowledged that meaningful use “accomplished something miraculous” in digitizing the healthcare system since HITECH Act passed in 2009. But that rapid transformation also created burdensome regulations and usability, workflow, innovation, interoperability and patient engagement deficiencies.

“We lost the hearts and minds of clinicians. We overwhelmed them with confusing layers of regulations. We tried to drive cultural change with legislation. We expected interoperability without first building the enabling tools,” Halamka and Tripathi wrote.  “In a sense, we gave clinicians suboptimal cars, didn’t build roads, and then blamed them for not driving.”

Former national coordinators Vindell Washington, MD, Karen DeSalvo, MD, Farzad Mostashari, MD, and David Blumenthal, MD, wrote in a companion NEJM article that physicians wound up shouldering much of the burden.

“Many are frustrated by poor EHR usability and the lack of actionable information generated by these systems. In part, such limitations are attributable to the decision to allow proprietary standards and data blocking in the market, which has led to suboptimal data sharing,” they wrote. “As former national coordinators for health IT, we believe that the culture surrounding access to and sharing of information must change to promote the seamless, secure flow of electronic information.” 

There are no easy fixes when it comes to culture change, in general, and the health IT realm, interoperability specifically, is no exception.

The former national coordinators called for national standards, APIs, both market innovation and government policies, the emerging Public Health 3.0 model, and various stakeholders continuing to work together.

“The HITECH era was an important catalyst for EHR adoption, and the industry benefited from government intervention,” Halamka and Tripathi wrote. “If the post-HITECH era can return control of the agenda to customers, developers, and multistakeholder collaborations, we should be able to recapture the hearts and minds of clinicians.”

Twitter: SullyHIT
Email the writer: tom.sullivan@himssmedia.com