August 20, 2010
by Jason D. Fodeman , Tevi Troy
With federal checks for electronic health records only months away, our nation's health care system is on the brink of an unprecedented digital makeover. The stage was set for this technological revolution when $20 billion in government money for health information technology found its way into the $787 billion stimulus bill. The stimulus package contains bonus payments to doctors and hospitals designed to encourage adoption of electronic health records starting in 2011. These payments are to be phased out gradually and replaced by penalties beginning in 2015. The stimulus legislation also created the Office of the National Coordinator for Health Information Technology and directed it to establish standards to attain interoperability and define key terms.
The government recently released its final definition of "meaningful use" of a certified electronic health record (EHR). Unsurprisingly, the new rule increased the expected government outlays in this area to $27 billion. On the policy front, compared to earlier versions, the final rules contain fewer requirements to demonstrate meaningful use and thus qualify for the adoption subsidies. The new regulations reduce the meaningful-use core requirements from 25 for doctors and 23 for hospitals to 15 and 14, respectively, and additional requirements can be delayed until a later stage. This added flexibility appears to have been in response to overwhelming sentiment expressed in about 2,000 comments that the initial requirements were too ambitious and needed to be scaled back. It seems as if the regulatory officials overreached and were therefore forced to reverse course.
While the scaled-back requirements are better, federal regulators are still expecting health care providers to do too much in too little time. This has the potential to undermine the administration's efforts to secure wide-scale EHR adoption.
Significant barriers to EHRs still exist, especially for solo practitioners and small practices. In addition, the government's adoption timeline remains incredibly tight. According to the American Medical Association, no current EHR system on the market satisfies all the newly established regulations, and most likely, there won't be one available until the fall. Just five months remain before incentive payments begin on Jan. 1, 2011.
An EHR system is a major financial investment. Upfront costs can range from $15,000 to $50,000 per physician and $10 million for a midsize hospital. This is in addition to annual operating fees. For such a big investment, the government should encourage doctors to shop around for the best deal and, more important, the best system for their practices to facilitate patient care. Unfortunately, a tight timeline could have the opposite effect. It places doctors on the clock and will force some to make a rash purchase "just to have something," while others may decide it's too hectic and avoid adopting health information technology altogether. For some physicians, this timetable may discourage EHR adoption, while those physicians who do buy may end up overpaying or buying something they do not like. Down the line, those unsatisfied customers may need to make costly additional purchases once new technologies become available. Worse, because doctors within a practice may differ on the value of the investment in the first place, some practices might abandon the EHR effort altogether.
On the supply side, the timeline will pressure companies to bring meaningful-use EHR systems to market as soon as possible to meet artificial demand. This may result in products being brought to market prematurely and before companies have had an opportunity to troubleshoot them completely. Ultimately, this also could prove dangerous for patients.
The government should rethink its rushed approach. Health information technology (HIT) is a tool, not a magic wand. Even Dr. David Blumenthal, President Obama's HIT czar, has written previously, "Actual evidence of the efficacy and cost-saving potential of HIT is scarce." HIT certainly does have potential, and the administration should work to maximize that potential. Yet, its actions could have just the opposite impact.
Unfortunately, Congress and the administration have decided to prioritize "getting it done" over "getting it right." Other than being able to bring those signs saying "Project funded by the American Recovery and Reinvestment Act" that pop up across the nation's highways to our hospitals sooner, there does not appear to be much benefit from this approach.
It will take much more than bombarding hospitals with extra computers and complicated, expensive software for health information technology to attain its true promise. It will require the right computers with the right software with properly trained support staff and physicians who know how to use them. All this takes time to establish and time to work out the kinks.
Unfortunately, for whatever reason, the administration is unwilling to devote the time and would prefer to roll the dice and pick up the pieces later. The administration's rush to establish an interoperable health information technology network may very well prove counterproductive. It easily could waste money, endanger patients and, possibly, do irreparable harm to the technology's reputation.
Dr. Jason D. Fodeman is an internal medicine resident at the University of Connecticut and a former health policy fellow at the Heritage Foundation.
Tevi Troy is a Visiting Fellow at Hudson Institute and served as the Deputy Secretary of the U.S. Department of Health and Human Services from 2007 until 2009.
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