Everyone wants to stir the Meaningful Use pot

When I cook a recipe for the first time, I usually don't modify it. But the next time around, I tend to tinker with it so it's better, more to my liking. Add a little garlic, reduce the salt. It's a learning process.

I must be in good company, since it seems that everyone these days wants to tinker with the Meaningful Use program.

Of course, you have the Centers for Medicare & Medicaid Services making its own adjustments as it attempts to improve the program. Just within the past few weeks, CMS issued a voluntary 2015 edition of certification criteria as a stepping stone to keep criteria more current, and created a new hardship exemption for providers whose vendor was unable to obtain 2014 certification or where the provider was unable to implement Meaningful Use due to 2014 EHR certification delays.

But all of a sudden, everyone wants in.

And they have very specific suggestions as to how the program should operate. You have a bipartisan group in Congress that want to change the incentives and penalties as part of the repeal of the sustainable growth rate formula. The Government Accountability Office has just told the U.S. Department of Health & Human Services to come up with a strategy to improve the reliability of the clinical quality measures being collected as well as a way to monitor whether the program is meeting its goals. Then there's a group of Republican senators that are still miffed that CMS didn't extend Stage 2 of the program, another group of lawmakers that want Stage 3 to reduce or eliminate health disparities and a legislative committee asking why the program audit functions appear so weak.

It's as if they, given a chance to comment on the recipe, are entitled to spice it up to their liking. And they are.

What happened to the good old days, when critics merely wanted to halt or pause it the program?

I jest a bit. It's good for a law to evolve and become better, more palatable--tasty.

But it can be too much of a good thing. How do the participants keep track of all of the changes? And doesn't each affect the rest of the program? Do all of the changes work together?

And why does the Meaningful Use program need so much help? HHS spends a lot of time working the recipes before finalizing them. That's why ONC has two federal advisory committees--the Health IT Policy Committee and the Health IT Standards Committee--and all of their workgroups, who work very hard to assess how the program should be designed. They make recommendations to CMS, which then develops the regulations.  Then we all get to comment on them before they're issued.

This program wasn't enacted with this much controversy. So why is it becoming almost as beleaguered as the Affordable Care Act?

What went wrong here? Why does this initiative need so many adjustments, and within such a short period of time? Was it fundamentally flawed? Struggling to keep up with fast passed technology changes? Is this program as broken and in need of fixing as these developments would lead us to believe?

Or are there simply too many cooks in the kitchen? - Marla (@MarlaHirsch @FierceHealthIT)

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