http://www.politico.com/story/2014/10/health-care-data-records-112039.html?hp=l13
Few motives to fix busted health data
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Someday, doctors will have our data at their fingertips and will use it to prevent drug reactions, nip diabetes and cancers in the bud and lengthen our lives while preventing unpleasant and costly hospital stays.
But for most doctors, that free-flowing information highway is a beautiful dream that doesn’t pay the bills.
Many hospitals don’t have any incentive to improve the clunky $30 billion federal electronic health records program: They still make most of their money by filling beds. Most doctors still get paid through procedures and visits.
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So a new 10-year plan for fixing the system from the Office of the National Coordinator for Health IT may have a hard time getting off the ground.
“From the business perspective, there’s no financial benefit for the majority of hospitals and physicians to be interoperable,” says Steve Waldren, director of the Alliance for eHealth Innovation at the American Academy of Family Physicians. “If we don’t change the business end of it … it’s just checking a box.”
Lobbying efforts have yielded a bill that would slow down federal requirements — and patient-centered care in the process. It could be taken up in the lame-duck session or added to another bill that directly addresses the interoperability issue next year, Hill staff say.
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“It may already be too late,” says Thomson Kuhn, a researcher with the American College of Physicians. “Short of some crazy scheme to make a change at the end of the year I just don’t see how we’re going to get what we need. And at that point they’ve killed the program.”
To address that issue, the Office of the National Coordinator’s plan is likely to require EHR vendors to include software interfaces that will make it easier for smooth communication across health care systems. But it may not work unless the economics of medicine shift in a way that forces doctors to require shared information to function.
The HITECH Act of 2009 was designed to let health care professionals use information to improve care and reduce spending and shifting their economic motivation to keeping people healthy, rather than charging for individual treatments.
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Five years later, most doctors have electronic health records (EHRs) — that’s where most of the money was spent — but doctors and nurses are unhappy with the time-consuming clumsiness of the software, much of which wasn’t ready for the medical profession.
The records are difficult to use, reduce interaction with patients and cost a fortune. And for the most part, they haven’t made information sharing easier.
There are some places — a growing number, in fact — where interoperability makes business sense. In Massachusetts, for example, many health systems such as Partners HealthCare have more than a third of their patients in value-based care systems built on the state’s network of health information.
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Some patients in these systems already are benefiting from “wrap-around” care that relies on good data, shared among medical professionals.
Such success stories have popped up around the country in tandem with growing consolidation of health networks and the Affordable Care Act-fostered creation of accountable care organizations — in which doctors are nudged toward focusing on patients, rather than procedures.
In such organizations, information sharing among doctors and hospitals is vital. Shifts in the Medicare payment schemes for doctors next year could also force the medical profession into more reliance on sharing.
“Value-based care may not succeed with good information, but it can’t succeed without it,” says Josh Seidman, a former HHS health IT official who is now a vice president at Avalere Health.
To date, though, most hospitals and provider networks aren’t financially motivated to freely share their patients and data with others. It will cost money to get their computer to share data. Providers, having already spent plenty, aren’t enthusiastic about spending more to meet the demands of the federal incentive program.
- For some, accepting a penalty will beat buying new software, which they will need to upgrade again for the next stage of the program in a few years, says Rob Tennant of the Medical Group Management Association.
- A retreat from the beautiful dream: It’s enough to make some health visionaries sick. One of them, a former official who was involved in creating the incentive program, sniffs that providers have themselves to blame.
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- “A lot of people made bad choices,” he said, speaking on condition of anonymity. “They didn’t do half as much research before buying their EHRs as they would getting a new car, and they’re paying for it.
- “The people complaining now are the ones at the trough — the vendors and doctors and hospitals. They gladly took the money, but when it comes time to step up or take the penalty, they say, ‘Let’s drop out of the program.’ It’s always, ‘Slow it down, dumb it down, give me money, don’t take anything away.’”
- The biggest provider complaint about the current stage of the incentive program is its requirements that doctors share summary-of-care documents and get a percentage of their patients to receive or send health data through secure portals.
- They often must shell out tens of thousands of dollars to software vendors to set up portals to transmit data across health care networks or even outside their offices. Their patients aren’t interested in accessing their records, they add — how can the government penalize them for what their patients won’t do?
- Republican members of Congress are skeptical of the federal program’s top-down requirements, and equally incensed by its slow advance.
- Rep. Phil Gingrey (R-Ga.) epitomizes this contradiction. This summer he threatened to investigate Epic, the leading EHR vendor, because he said it had taken billions in federal money to create information silos. A month later, he supported a bill put forward by Renee Ellmers (R-N.C.) that would slow down the meaningful use program, giving providers — and vendors — more time to learn how to share.
- Some Hill staff who track the issue think the answer is to relax federal standards while focusing narrowly on freeing the information — a position that federal health IT advisory committees share.
- “It’s hard to argue with physicians who say their systems aren’t ready, so they shouldn’t be penalized,” said a Hill staffer. “But the administration has to make this happen. … Every year we don’t have interoperability, public health issues go unaddressed and that’s unfortunate.”
- A parade of witnesses appearing before the House Energy and Commerce Committee this year as part of its 21st Century Cures Initiative have stressed the importance of free-flowing health data — not only for patient care but also for research leading to cures.
- “If we had a truly networked health care system, it would allow us to gather data on patients treated with drugs on and off label to see what kinds of adverse events are occurring,” said William Hanlon of drug testing company Covance, in testimony last month. “It could have huge benefits for clinical trials.”
- Energy and Commerce staff say that information sharing will be part of legislation they expect to put out early next year.
- The Health and Human Services Department is feeling pressure from Congress — in multiple directions. CMS has delayed the incentive program twice already in response to provider unhappiness. At the same time, ONC has taken a harder line on enforcing interoperability.
- Earlier this month, HHS official Kelly Cronin noted that some EHR vendors were charging up to $20,000 to create computer interfaces for users to access out-of-network laboratories. She suggested her office might pass along such information to the Federal Trade Commission, to investigate as obstructions to free trade.
- HHS’s health IT coordinator, Karen DeSalvo, has indicated that her agency may toughen its stance.
- “[The Office of the National Coordinator] believes the market has not solved this problem on behalf of the American people,” she said in an interview. “Patient data is a public good so there has to be a public involvement in making sure everyone … has the data available in an appropriate way.”
- The version of this story has corrected the spelling of Thomson Kuhn’s name.
- Read more: http://www.politico.com/story/2014/10/health-care-data-records-112039.html#ixzz3HN1pB9eO