On October 11th, John Boehner (R-Ohio), the current House Minority Leader—and the presumptive Speaker of the House in the 112th Congress—warned that we should not expect funding to implement health care reform if the Republicans become the majority in Congress – “They’re going to need money from us to hire those 22,000 federal employees we think it’s going to take to run this monstrosity. And I’ll just tell you, they’re not going to get a dime from us.” 

Representative Boehner went on to acknowledge that an all out repeal of the health care law is unlikely, as President Obama will still hold veto power from the White House. But even if an outright repeal isn’t possible, Republicans will still have the ability to hold up funding for many aspects of the reform legislation through the annual budget process. If Republicans take control of the House (as most polls indicate is a very likely scenario), Boehner stated that it will be the Republicans “job to do everything we can to keep it from being implemented, to keep it from moving ahead.”

So, as I see it, the choice in this election regarding health care is a clear one.  Flawed or not, do you want health care reform?  The bill has many great features—elimination of preexisting conditions clauses and recission, access to minimum coverage for the poorest Americans, etc. But, I think we all recognize that it also comes with a range of problems to be fixed.

Which leaves one question to think about: If the Republicans are in the majority, what is their alternative proposal?

One of my greatest personal and professional peeves is the “constant critics.”  These are the folks who constantly complain and critique what you do – but have no proposed solutions and rarely get things done themselves.  My experience as the founder and executive of a small business is that while it is easy to play the role of critic, it is quite difficult to develop and implement real, workable solutions.
 
These days, I consider the Republican Party to be playing the role of the “constant critic” when it comes to health care.  They had eight years when they controlled all branches of government, and did nothing.  And now that someone else has taken a swing, all they have managed to do is complain.  This “constant critic” position was perfectly captured in a piece by Grace-Marie Turner, “Putting the Brakes on Obamacare: How a Republican Congress Could Begin the Process of Repealing This Unpopular Law,” in the August 25, 2010 edition of The Wall Street Journal.  Ms. Turner outlines “the six key strategies that a Republican Congress could employ to put on the brakes.”  Her plans for health care reform? – Defund it, dismantle it, delay it, disapprove regulations, direct oversight and investigation, or delegate to the states.
 
Clever alliteration, but did you notice any solutions listed among those Republican “key strategies?”  

On December 31, 2009, the federal Department of Health and Human Services (HHS) released an interim final rule (IFR) with definitions for certified electronic health record (EHR) technology that will meet the Stage 1 “meaningful use” requirements the Medicare and Medicaid EHR Incentive Programs. Eligible professionals and hospitals must use certified EHR technology to qualify for the financial incentives described in the American Recovery and Reinvestment Act of 2009 (ARRA). HHS will adopt the IFR’s initial set of certification criteria on February 12, 2010.

Once the IFR came out, the behavioral health and human services space was abuzz discussing what was missing, what was unclear, how meaningful ‘meaningful use’ could be—you name it. The other day I came across a great feature written by John Halamka, MD, the Chief Information Officer of Beth Israel Deaconess Medical Center and Chief Information Officer at Harvard Medical School. While teaching a health care information technology (HIT) class at Harvard, he asked his class to read his EHR implementation project and then to “develop a list of barriers to EHR implementation.” The result? Ten major barriers to successfully deploying EHRs:

10.  Usability—products are hard to use and not well engineered for clinician workflow.

9.  Politics/naysayers—every organization has a powerful clinician or administrator who is convinced that EHRs will cause harm, disruption, and budget disasters.

8.  Fear of lost productivity—clinicians are concerned they will lose 25% of their productivity for 3 months after implementation. Administrators are worried that the clinicians are right.

7.  Computer Illiteracy/training—many clinicians are not comfortable with technology. They are often reluctant to attend training sessions.

6.  Interoperability—applications do not seamlessly exchange data for coordination of care, performance reporting, and public health.

5.  Privacy—there is significant local variation in privacy policy and consent management strategies

4.  Infrastructure/IT reliability—many IT departments cannot provide reliable computing and storage support, leading to EHR downtime.

3.  Vendor product selection/suitability—it's hard to know what product to choose, particularly for specialists who have unique workflow needs

2.  Cost—the stimulus money does not flow until meaningful use is achieved. Who will pay in the meantime?
1.  People—it's hard to get sponsorship from senior leaders, find clinician champions, and hire the trained workers to get the EHR rollout done. (this was the #1 concern by far)