This week, six senators released a white paper, Reboot: Re-examining the Strategies Needed to Successfully Adopt Health IT, that argues that there is no evidence that the $32 billion in taxpayers’ money being spent on meaningful use is returning the results it was designed to deliver. Although it would be naïve to discount the political motivation of the authors—all six being Republicans—they raise some of the same criticisms and concerns that I have written about in the past. They also make some claims that I feel compelled to dispute.
The senators have it right on these issues:
- The success of the EHR incentives program should not be measured by the amount of money spent, yet every month CMS issues a report boasting how many billions of dollars have been paid in incentives. This is, of course, a proxy for EHR adoption and meaningful use attestations, but it says nothing about the impact on quality or cost of care—the motivation behind supporting EHR adoption.
- The program is being propelled forward too quickly. It was the right move to delay Stage 2 for a year, but the requirements were set in stone long before a detailed evaluation could be made of the successes, challenges, and failures of Stage 1.
- Program sustainability will be a challenge. The costs of participation are increasing for providers, given the added demands of Stage 2; for example, they will have to pay for interfaces to registries and HIEs and they will need to purchase a portal, if one is not provided by their EHR. As out-of-pocket costs rise, incentives decrease. This, combined with the challenges posed by the program moving too fast, will cause many physicians to abandon participation, which will threaten the program’s ability to deliver results.
- There is no question that the proliferation of government programs with which physicians must contend has made compliance a challenge. The legislation is so complex and the requirements so cumbersome that they are diverting physicians’ attention from patient care.
I vociferously disagree, however, with the senators’ criticism regarding interoperability. Of course, we are not there yet—and clearly they are frustrated by that fact—but progress is underway toward that universally supported goal. Contrary to their claim that there are no meaningful use measures that require interoperability, there are in fact several in Stage 2, including the requirement that physicians electronically send a patient care summary for 10% of patients transitioned to the care of another physician or provider. This exchange is facilitated by the fact that all certified EHRs must communicate using the same formats.
Not only does interoperability relate to provider-to-provider communication, but it also allows for easy integration between products of different vendors, without requiring additional programming. I was recently speaking with another HIT vendor about a potential partnership arrangement, and we both talked the same language—XDR Direct for transport protocol and CCDA or HL7 in terms of content. This conversation would neither have been possible, nor would we be able to create a tight, simple interface between our products, were it not for the standards promulgated by the EHR incentive program. This kind of interoperability will ultimately be better for physicians and for their patients. The EHRA (EHR vendor association of HIMSS) hit the nail on the head: the appropriate role for government is to set the standards, but then the vendors should be free to innovate and let the market take over from there.