5 decisions that will determine the fate of e-health records

Experts say success hinges on the outcomes of these decisions

Former President George W. Bush urged doctors and hospitals to go digital on their own, with a few booster shots of federal help. Consequently, progress was slow. But the pace of change has been increasing since President Barack Obama has made health IT a priority and Congress put some real money on the table. Under the economic stimulus law passed earlier this year, as much as $45 billion will be distributed to health care providers who buy and use approved electronic health record systems.

The road ahead is still bumpy for EHRs, but experts say success hinges on the outcomes of five major decisions.

1. Strong standards or wiggle room?

Officials at the Health and Human Services Department have the daunting task of creating a framework for certifying EHR systems that are capable of collecting and sharing patient data in ways that satisfy the broader goals of the stimulus law. A critical question is whether HHS can strike the right balance between strong rules and flexibility.

“There is always a trade-off between innovation and any kind of a certification process,” said Wes Rishel, a vice president and distinguished analyst at Gartner’s health care provider research practice.

2. Broaden the meaning of “meaningful use?"

In the stimulus law, Congress said only doctors and hospitals that show meaningful use of EHRs can receive incentive payments. That language was meant to prevent the buying of systems that sit idle or are not used as intended. Key decisions for HHS are how broadly and stringently to apply the meaningful-use framework to meet major goals, such as cost savings, improved care and better public health.

3. Take baby steps or giant leaps forward?

To help HHS meet its fast-approaching deadlines, an advisory committee urged the agency to immediately set up a temporary program that would allow an existing organization to certify vendors’ EHR systems until more permanent arrangements could be made.

Dr. Carol Diamond, managing director of the Markle Foundation’s Health Program, said HHS should allow the same sort of flexibility for providers to meet EHR-use goals. Some are already using EHRs, but others lag far behind, she added. “We still live in the real world,” she said. “You cannot get up to speed all at once.”

4. Let the states lead the way on data exchange?

The ultimate goal of health information technology is the automatic sharing of patient data. The reasoning goes that if providers exchange patient data with government agencies and one another, analysts can identify trends and send the results back to doctors and hospitals to help them provide better care and reduce costs.

For now, a little sugar is making the medicine go down easier — such as the $564 million in state grants for health information exchanges that HHS announced in August. But the agency still has a key decision to make on the federal government’s role in creating that data network.

“You have to either grow the state exchanges that will be connected or try to seed from the top,” said Deven McGraw, director of the Center for Democracy and Technology’s Health Privacy Project.

5. Wait for broader health reforms or forge ahead?

Dr. David Blumenthal, HHS’s national coordinator for health IT, said he hopes to strike a balance between incentives and penalties for EHR use. The rules must foster competitiveness, innovation, privacy and security, among other often-conflicting goals. But decisions are also looming about how hard HHS should push for health IT in advance of more comprehensive reforms that will affect health care access and payments.

“If we do not do the work on payment reforms, we will not really reap all the value of health IT,” McGraw said.

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Reader comments

Thu, Sep 3, 2009 Robert Rowley MD San Francisco

Each of the “5 questions” described here show decision points around “go big vs. go incremental” or “safe-and-known vs. take-a-chance-on-something-new (and untested).” Health IT adoption by physicians in their offices has been hindered by (1) tremendous cost of legacy systems that had been developed in the past decade, and (2) poor usability of these systems. The results? Very low adoption, and even a trend to de-installation once implemented (see our blog, http://www.ehrbloggers.com/ for multiple articles on these matters). Can an infusion of money from ARRA/HITECH make these tanks fly? Unlikely. Fortunately, technology has evolved significantly since the legacy EHR vendors created massive, cumbersome products – there are now web-hosted, SaaS-based products emerging in the market, which overcome most of these traditional barriers. Yes, it takes some spine for government bodies to recognize and create rules that include such innovation – but we have seen the ONC’s Health IT Policy Committee do just that. They have taken a deliberative, independent approach based on principles and guidance from high-level priorities, and have derived “meaningful use” and “certification” specifications from this approach. We have been watching their deliberations, applaud the work they have undertaken, and are hopeful that the result of this whole process will, in fact, positively influence the emergence and adoption of good-quality health technology. The result will certainly be beneficial to health care delivery in this country.

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