EHRs: HHS walks a tightrope

The department needs to set the bar low enough to get broad adoption and high enough to achieve its goals for improving quality.

If using electronic health records is the future of health information technology, getting there will require some degree of technological innovation, just about everyone involved agrees.

However, the Health and Human Services Department, which has $17 billion in economic stimulus money to distribute to doctors and hospitals for digital record systems, must walk a tightrope. If HHS rewards EHR adopters for the current generation of systems, that might lock in existing technologies for years. However, If it sets overly ambitious rules for next-generation systems, too few hospitals and physicians might jump aboard.


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HHS needs to set the bar low enough to get broad adoption and high enough to achieve its goals.

Early signs suggest that the department aimed high, but not too high, when it unveiled nearly 700 pages of regulations Jan. 13 for choosing and using EHR systems. It took a risk that might pay off, though there might still be modifications. And it will be months before the outcome is known.

“HHS had a terrific challenge to set the bar at the right height, and I think they did it well,” said Dr. Manuel Lowenhaupt, national practice leader for clinical transformation at Accenture. “They are asking us to demonstrate capacities, not to have everything working perfectly.”

HHS' regulations outline a vision of a national infrastructure in which records systems collect and exchange medical data for the purpose of improving the quality of care. That means standardization and interoperability, in many cases for the first time.

If approved, the rules would allow for a more modular approach to certifying systems — such as independently certifying an e-prescribing system rather than as part of a comprehensive system — which has left the door open for some innovation, said Dr. Mark Leavitt, chairman of the Certification Commission for Health Information Technology, a nonprofit group recognized by HHS to certify digital records systems.

Of course, regulation is still regulation. “There is no getting around the fact that 700 pages of regulation is a frictional drag on innovation,” Leavitt added.

To a degree, HHS’ hands were tied by Congress, which wrote the stimulus law to motivate the adoption of digital health records. That would tend to favor the existing generation of software.

Next-generation digital health records systems will make it easier to transfer data from one provider to another, said Dr. John Loonsk, chief medical officer at CGI Federal. And those capabilities are important to achieving HHS’ goals for quality improvement.

“Some clinical outcomes will not be achievable until electronic medical records are more networked, interoperable and mobile,” Loonsk said. “But until more physicians use electronic medical records, we are stuck in a chicken-and-egg situation.”

Several industry executives say they see niche opportunities for innovation — for example, in applying versions of the Veterans Affairs Department’s VistA health records software in the private sector and developing open-source solutions, interoperable interfaces and connections.

“In my opinion, there will be tremendous innovation,” said Peter Durlach, senior vice president at Nuance Communications, a maker of speech recognition products. “On the community side, there is a lot of room for innovation. The record systems don’t talk to each other.”

Whether Google or Microsoft will enter the electronic medical records field is a wild card, Durlach added. Both have set up private health data storage systems for consumers, but they are not generally part of a system that doctors and hospitals use.

Although HHS has not yet required doctors and hospitals to exchange data through its Nationwide Health Information Network, the trend is moving in that direction, said Melissa Chapman, vice president of health solutions at Agilex Technologies, an IT solutions firm.

If Congress passes broader health care and payer reforms, that will push the envelope on innovation in health IT much further. The burst of stimulus spending could be just a blip in comparison to changes to come.

“HHS certainly is pressuring us to innovate,” Durlach said. "But it won’t really be pressure until the payer side is addressed. If you have great data, it will make a huge difference when you start changing what you pay for.”

NEXT STORY: Measuring quality

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