Health IT mandates aren't a great idea

Massachusetts has done some, let us say, interesting things in the health reform arena of late--ranging from its ground-breaking universal health insurance requirements to new rules requiring pharmas and medical device-makers to disclose gifts over $50 made to doctors. In fact, Massachusetts has arguably broken the most ground in health system reform of any state in the union.

That being said, innovation isn't always a great idea just because it's new and different. In particular, I've got to say that I'm not sure that the state's new rules requiring hospitals to phase in CPOE and EMR systems aren't dicey. 

In fact, I'm not sure such mandates are a good idea anywhere in the country. I think I understand why policymakers are attracted to the idea, but in establishing a mandate, they're missing a few key points, including the following:

* What good is forcing a hospital to implement CPOE or EMR systems if the rest of the IT strategy doesn't support such systems?

*  How will hospitals pay for such systems without compromising vital functions already in place, or upgrades that are critically needed?

*  What if the hospital doesn't find the system that fits their needs soon enough to meet the comparatively stringent timeline for implementation?

*  Why mandate an EMR or CPOE system without setting plans for interconnecting them? After all, if you're going to force people to deploy similar systems on a similar timeline, leveraging that effort to create a health information exchange just makes sense.

While these questions were provoked by the Massachusetts effort, I believe you could raise similar concerns about any major health IT mandate coming from a state or federal legislature. And I'm not confident the otherwise forward-looking Massachusetts planners have addressed them. 

All this being said, Massachusetts could turn out to surprise us all by making a success of its health IT mandate. After all, hospital IT executives there may find ways to adapt that we haven't anticipated, and perhaps even prosper from their efforts. But until we have more data on whether the state's experiment can work, let's hope other legislators don't follow their lead anytime soon. - Anne

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