Adrian Gropper, contributor, The Health Care Blog

By Dr. Adrian Gropper

First Posted at The Health Care Blog on 12/12/2013

Adrian Gropper, contributor, The Health Care Blog
Adrian Gropper, contributor, The Health Care Blog

The Massachusetts Medical Society may be the first to notice that Meaningful Use EHR mandates favor large providers and technology vendors. Control over the Nationwide Health Information Network sets the stage for how physicians refer, receive decision support, report quality, and interact with patients. State health information exchanges and policy makers are caught in the cross-fire over health records interoperability. Are the federal regulations over Stage 2 being manipulated to put physicians and the public at a disadvantage?

On Dec. 7, the Massachusetts Medical Society took what might be the first formal action in the nation. A resolution stating:

“That the Massachusetts Medical Society advocate for a more open, affordable process to meet technology mandates imposed by regulations and mandates; e.g., that all Direct secure email systems, mandated by Meaningful Use stage 2, including health information exchanges and electronic health record systems, allow a licensed physician to designate any specified Direct recipient or sender without interference from any institution, electronic health record vendor, or intermediary transport agent.”

Scott Mace’s column Direct Protocol May Favor Large Providers and Vendors is the first to report on this unusual move by a professional society. Full disclosure: I’m a member of the MMS and the initiator of what became this resolution.

Meaningful Use is intended to support health reform by promoting interoperability and innovation in health service delivery. The Affordable Care Act, Obamacare, is fundamentally a free-enterprise model without single payer or even a public option. Obamacare depends on the market for eventual cost controls and sustainability. Meaningful Use is regulation designed to enable market-driven health reform by reducing interoperability barriers.

Although Meaningful Use regulations have already handed out $17 Billion to drive “voluntary” adoption of interoperable electronic health records, meaningful interoperability is still elusive. Meanwhile, the doctors are chafing about Meaningful Use intrusions and policymakers worry that the regulations will actually increase costs.


Earlier, Farzad Mostashari provided his perspective on the strategic importance of technology in this excellent interview about his new role.

The vendors and their institutional customers are interpreting Meaningful Use in a way that allows them to censor and tax physician-physician and physician-patient communications. Control over the Nationwide Health Information Network sets the stage for manipulating all of the key elements of health reform including quality, cost and population health. This is Net Neutrality on steroids.

The MMS resolution will open an important debate over the Meaningful Use regulations:

  • Are physicians, institutions, and patients all first-class citizens in the Direct-based NwHIN?

  • Can EHR vendors price messages and documents that come in via Direct differently depending on where they come from?

  • Is health care trust governed through civil federations like our credit cards or based on criminal penalties like mail fraud?

The answers to these questions will have huge consequences for all of us, way beyond the money scramble between hospitals, physicians, and global corporations. Medicine can be regulated as a profession or as a branded proprietary device. As medicine is increasingly mediated by EHRs and integrated over the Internet, the choices we make around the governance of “trust” on the NwHIN and EHR regulation will dictate the rate of medical progress itself.

With this resolution, my medical society has come down clearly in favor of physician-based trust on the NwHIN. What should the federal regulators do?


All comments are moderated. Please allow at least 1-2 days for it to display.