I have a bit of a paranoid streak.  Not of the foil hat-wearing variety (at least not yet), but I do look for places where organizations may be playing a little fast and loose to meet their objectives.

So now that the definition of Meaningful Use has settled and we know the key components to making it a reality – such as how certification programs will work – my brain has immediately wandered off to find opportunities for strategic abuse.  Now that we’ve got the rules, you can be sure a few people are looking to play hardball.

Let’s begin with the vendors.

• Vendors will force upgrades. Even if you believe the software you installed will meet Meaningful Use requirements, you need certified software for it to count.  Vendors will need to certify a particular version of their software and can extend that certification for future versions.  Expect most vendors to certify only their current version — this will push customers to install their current version, possibly requiring additional licensing and servicing costs.

• Vendors will force software bundles. How software versions are bundled is a strategic decision for vendors – the certification regulations don’t require vendors to certify the minimum components or modules needed to meet each certification objective.  If you don’t need your core EMR vendor’s e-prescribing module?  Too bad.  If it’s part of the package they certified, you could be forced to buy it in order to get the certified product.

That’s not to say health systems aren’t also looking to use Meaningful Use to create both differentiation and barriers to competition.

• Expect large health systems to qualify for Health Information Exchange objectives by sharing data within their own health system. These organizations can use this both as a competitive differentiator with patients and a barrier making it harder for them to look to competing facilities for services.

• Stark laws (medical anti-kickback laws) were amended to allow hospitals to offer low-cost or free Meaningful Use certified EHR systems to physicians.  This was intended as a way to encourage EHR adoption – a great goal.  The change now is that, as a reward, providers get up to $44,000 from the government!  Suddenly, this starts to sound like a kickback again.

So am I just being paranoid or concerned without cause?  On the other hand, is this just the tip of the iceberg?  Do you see other ways  organizations can use the new rules to quash the goals of collaboration, sharing and healthy competition?