Every good parent understands the concept of negative reinforcement. If you threaten to punish a child’s bad behavior and then fail to follow through, the inclination toward bad behavior is reinforced — making future bad behavior more likely.
The same basic dynamic holds true in the relationship between the U.S. federal government and health IT industry. The government keeps imposing supposed hard-and-fast deadlines — for successive stages of Meaningful Use , for ICD-10 — and then punting when too many health IT vendors fail to do the hard work necessary to meet those deadlines, leaving their care provider clients in the lurch. Worse, the punt too often comes after repeated assurances by top officials that no further delays will be granted.
Today’s news provides us the latest example: The Sustainable Growth Rate (SGR) “patch” legislation just negotiated between House Speaker John Boehner and Senate Majority Leader Harry Reid. The “patch” includes language delaying ICD-10 by yet another year. And just two weeks ago the Centers for Medicare and Medicaid Services (CMS) quietly issued “hardship” exemptions, effectively pushing Meaningful Use Stage 2 out another year.
The bill released today was negotiated quietly (even relevant committee chairs had no scent of it), so there is still a chance that changes could be made…
For those vendors unable — or worse, unwilling — to comply, what do they learn from these repeated experiences? The same thing a child learns when a parent first tells him or her there’s no dessert if they don’t finish dinner, and then proceeds to scoop out the ice cream.
Every time the wider vendor community neglects to put in the effort to meet reasonable (and reachable!) deadlines, and is effectively rewarded for its intransigence with further delays, the lesson learned is clear: these deadlines aren’t real. They can go on selling sub-standard technology into a largely captive market, ensuring that healthcare remains stubbornly mired years behind the rest of the information economy.