Getting the balance just right between asking too much or too little of healthcare providers will be the key to the success of the government's meaningful use initiative, says David Blumenthal, MD, national coordinator of healthcare IT and chief architect of the three-stage program that ties implementation of electronic health records to millions of dollars in government incentives.

Getting the balance just so is enough to keep him up at night, as the country moves from a largely paper-based healthcare system to one that is all digital, and eventually interoperable.

Blumenthal talks with Healthcare IT News about his work, about what keeps him going and about what comes next on the hilly road to meaningful use.

What has been the hardest part of the job for you so far?
The hardest part of this job changes over time. The hardest part at this point is to reach the nation’s providers – the doctors, the nurses, other health professionals, the hospitals – and convince them that this is the right time to move into the electronic era. I’m convinced that it is. But that conversation – that dialogue – bringing home that point is hard in an environment where there are so many competing pressures, there are so many economic disincentives, there are technical issues to overcome and things are changing so fast. People think about the electronic health record and its capabilities in terms of technology that existed three or five years ago. The market is just exploding with new options. I think creating the optimism and the sense of inevitability is a big task that is essential to our success. So I think that’s been the hardest thing I’ve faced. In the coming year – over the next several years – it will be the interoperability challenge. Before you can create interoperability, you have to create operability, and that’s the first thing we’ve been working on.

What keeps you up at night? What do you worry about most?
I worry that we will ask too much of providers – or that we will ask too little. I’m worried that we won’t get the balance between what we need to accomplish in a relatively fast time frame and their capability to deliver. So, when I hear that rural hospitals feel they can’t manage the transition to meaningful use, that keeps me up at night. When I hear solo practitioners say, ‘It’s just too hard, I can’t manage it,’ that keeps me up at night. So I worry about whether we’ve found the balance between the vision and the practical. That’s what we do here every day of the week. We try to find that balance, and you never know whether you’ve got it until the dust settles.

[More on meaningful use: Healthcare IT chief takes on meaning of 'meaningful'.]

When will the dust settle?
We will have a good idea of whether we were successful in this first stage probably by the fall or winter of this year. We’ll watch and see how many providers have volunteered to become meaningful users – have succeeded to become meaningful users. We have to succeed in the first stage in order to build the next stages. So we will know in about nine months to a year whether we got this first stage right.

Are you feeling optimistic?
I am feeling optimistic. We’ve got a surge of registrants for meaningful use. We’ve got a strong expression of interest from the community as a whole. Many will find this a tough list, and we understand that. We appreciate the intent. We appreciate the interest. We want to make it possible for everyone who intends to succeed to actually be successful.

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