It’s tempting to amuse oneself about healthcare IT by juxtaposing it with a more or less dusty fixture of pop culture. For instance, you can sing the Bob Seger song “Beautiful loser,” and substitute the words “meaningful user” to parody things, but there are huge problems with healthcare IT, and they’re not particularly funny.

For instance, the head honcho at the Office of the National Coordinator appeared on Capitol Hill last week and gave the Senate Finance Committee a glowing report on healthcare IT adoption. However, Farzad Mostashari informed the committee (only after someone asked) that 10,000 providers had dropped out of the meaningful use program, a seemingly small number when compared with the 300,000 providers that had enrolled.

The problem? The taxpayer has coughed up $15 billion in incentives to those 300,000 providers, which is an average of about $50,000. Take those 10,000 departing providers and multiply them by $50,000, and you have something like half a billion dollars down the rabbit hole.

As the saying goes, a million here, a million there … who says Senator Dirksen is irrelevant?

Even the providers that are still on board are carping about meaningful use standards, however, a sure sign the HITECH Act was ambitious beyond rational thinking. Sen. Orrin Hatch recently proposed that ONC slow down on the meaningful user program, but he wasn’t the first. A group of six senators made the same suggestion in April.

Let’s not forget that more providers will dump the whole meaningful use thing when the ICD-10 squeeze starts to feel like a python, and you have the makings of a bona fide exercise in absurdity, even by government standards.

Do as I say, not as I do

The workflow debate is still cruising along, with ONC’s Mostashari repeatedly asserting that providers will have to adjust their workflows to the software rather than the other way around. At a July 9 briefing in Washington, he said of existing workflow patterns: “If you merely pave over the cowpath, you have a streetmap that looks like Boston,” which sounds like a great description of the government's approach to interoperability.

Mostashari also compared this workflow dilemma to factory workflows upon the introduction of electricity. I reminded him that the typical doctor has much more influence over the HIT workflow debate than the typical 19th Century factory worker had over his working conditions. Mostashari heard me, but was undaunted. He remarked that the government is “only about 5% of the way through” the process of forcing a change of workflow onto practitioners.

Apparently Mostashari hasn’t heard about the influence MDs have on policy in this town. I wonder whether he likes his humble pie served a la mode.

The final ingredient: Interopera-bull

This interoperability discussion has wandered like a deranged ruminant for nearly a decade, and now we hear that the market, not government, will determine what constitutes interoperability. Seems to me we could have left it up to the market back in 2005, when HHS secretary Mike Leavitt first started yakking about it.

Still, government’s concession on the interoperability clanger serves as a nice denouement for what has been much ado about not very much so far. The taxpayer is on the hook for $15 billion to date, and another $15 billion or more to come. It strikes me that even our government could have found a more meaningful way to squander $30 billion.