Monday, January 24, 2011

"All the World's a Stage"...Two

All the world's a stage,
And all the men and women merely players:
They have their exits and their entrances;
And one man in his time plays many parts,
His acts being seven ages…”
[As You Like It, William Shakespeare]

Oh no, as if music analogies weren’t enough, now I’m quoting Shakespeare? Actually, I’ll confess that I’ve never read As You Like It but I thought of these lines in the context of Healthcare IT and Meaningful Use (MU) Stages. The monologue quoted above goes on to list seven “ages” (which we would call “stages”) of life: infancy, childhood, the lover, the soldier, the justice, old age, dementia/death. I think HIT has gotten beyond infancy, probably into “childhood” and wants to grow more mature with each Stage (stopping well before dementia and death, of course).

The eyes of the HIT world are watching the “players” from the HIT Policy Committee, who are proposing Stage 2 MU which will start in FY2013. When it’s defined, will it be “as we like it” and will we believe it is taking us on the right path? What’s the vision and strategy to which Stage Two is a stepping stone?

Most of us indeed play many parts (roles). For instance, with respect to HIT, I ‘m a public citizen commenting on regulations, standards developer, interoperability champion, product developer, PHR user, patient, and caregiver. The dedicated people on the HIT PC also play many parts  simultaneously, which may include clinician, developer, researcher, business executive, standards developer, and of course policy maker and patient.

Before submitting detailed comments, I want to share some themes and associated issues that I gleaned from my initial reading of the 19-page HIT Policy Committee Meaningful Use workgroup’s Stage 2 recommendations.
  • There’s more recognition of the need for evidence to support objectives. A little over three pages of references are given, though I wish that there were more explicit connections between each objective and the citations. Consider that regulations that affect thousands of providers, hundreds of vendors, and millions of patients have high stakes. So it’s reasonable to expect evidence not only of benefits but of associated costs including impacts upon workflows. The public comment period will undoubtedly cause more evidence to surface (and I encourage everyone who comments to include evidence as to why you agree or disagree, not just assertions or emotions).
  • There’s a broader view of the clinical team. I see progress towards a balanced perspective with the focus on medication administration, assessments, longitudinal care plan, and care team members, though there’s a lot of room for interpretation as to what the last two mean. There’s also more clarity of clinical/discharge instructions in Stage 2. It’s good to see the acknowledgement of other professionals such as nurses, pharmacists, and therapists, in addition to physicians.
  • Patients are increasingly considered part of the team. I’m all for “engaged” patients and consider myself one. The most challenging Stage 2 objective for patient engagement may be the patient download-upon-demand feature for all EHRs. What do patients want out of the data and how does it improve their health? I’d like to see this addressed in the Evidence Base/Rationale section.
  • More and more information will be exchanged. That’s no surprise, and can be a good thing for patients and providers, if…it’s usable and relevant, as I wrote in my three part December series starting with Information Liquidity. As stated by Dr. Lyle Berkowitz who gave testimony to the HIT Standards Committee: “Data sharing alone is never enough. Dr. Reid Coleman from Lifespan had the quote of the day when he said,   ‘Data is like salt water… you need a filter to drink it’. I’d also add that it helps to have good plumbing to connect it to the right facilities, and then also to have plenty of glasses available to make it easy for people to get it to the ‘final foot.’”
The Policy Committee has a tough tightrope to walk – on the one hand they’d like to wait for more early returns, evidence of how the industry is doing adopting Stage 1; they could then incorporate those experiences before finalizing Stage 2. On the other hand, they have heard that everyone need lots of lead time to work Stage 2 into their roadmaps, and needs its requirements finalized “yesterday” or at least 18 months beforehand. So they’re trying to send a “signal to the market” but they can’t guarantee that the signal won’t change. They’ll probably receive hundreds of comments. Interesting times lie ahead!

1 comment:

  1. I am reminded of F. Emerson Andrews "Nine Ages of Man". Comparing that to stages of life, the escape from childhood to maturity comes with knowledge (e.g., from "Not old enough to know" to "old enough to know". The question is whether that transition is by an outside assessment (you are now old enough to know and will be given the knowledge), or through internal growth and development (you have learned through experience and are therefore "old enough"). I prefer the latter interpretation, and would suggest that tightrope be walked by allowing our experiences along the way to guide us.