Compliance and Process Improvement are Opposites, no matter how hard you try to make compliance “meaningful”

HIMSS13 iconI’m attending the HIMSS’13 conference in New Orleans this week, a huge assemblage of health care IT people and the bewilderingly diverse collection of technology vendors that sell to them.  The first meeting I attended was billed as a “town hall” meeting by the Federal Government’s “Office of the National Coordinator” (ONC).  The session was heavy on self-congratulatory enthusiasm, even including a demonstration of an ONC team cheer — and I mean that literally.  The session was very light on the type of challenging discussion connoted by the “town hall” concept.  No time for any questions from the microphone.  Just some time towards the end for some selected questions written on small cards, all of them softballs.

I don’t want to be too harsh on the ONC crew.   They are clearly talented, well educated and working hard for government salaries.  They clearly are inspired by the cause of improving health care.  And they are sincere in their belief that requiring or incentivizing compliance with a minimum standard set of technology capabilities is what we need.

In my experience, that is a very natural belief system for people in government agencies, accreditation organizations, philanthropic organizations, health plans, and many healthcare information technology vendors.  I admit to being guilty of going down that road myself.

But, I see it as an honest mistake.  In my experience, people within health care provider organizations are easily convinced that pursuing compliance, no matter how small the penalties and rewards involved, always seems like the most urgent priority.  It’s a mandate, so it gets to win in any internal prioritization debates.  And, that compliance mandate travels up the food chain to all the product management executives of health information technology vendors.   I used to be one of those too, and admit to making such arguments.  As a result, the compliance features occupy all the available near-term slots in the product roadmap, and the innovations have to wait until a future phase that never arrives because there is fresh batch of mandates coming up quickly on the heels of the last batch.

In the ONC town hall session yesterday afternoon, the ONC leaders seemed to acknowledge that the results of earlier phases of “meaningful use” incentives had been somewhat superficial, not anything that led to transformative change yet.  They emphasized that this is a long term journey, and that we need to have reasonable expectations and be patient.  But, they failed to recognize that the superficial nature of the response by vendors and providers may be due to the very fact that it was a compliance response, rather than an internally-initiated agenda driven by the process innovations the technology is intended to support.  Rather, they just looked forward with eagerness and cheerful enthusiasm to the next round of meaningful use standards that will continue the journey.

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