COMMENTARY:
Health IT not only benefits patients, but will offer healthy return on investment
Health IT offers healthy return on investment, Chip Kahn says
It is clear that access to objective medical information about a patient is critical to physician and provider decisionmaking at the point of care. Health information technology, specifically electronic health records, can be the conduit for making the right information available at the right point during a patient’s episode of care, whether in the emergency room or upon admission to a post-acute facility. Health IT also can provide other opportunities to enhance care, including reductions in duplicative testing or better management of patients with chronic disease.
There is clear consensus on at least one point—having the right information in the right place at the right time results in better care for patients.
I sat on the American Health Information Community advisory group, the precursor to what is now the Health IT Policy Committee, from 2005-08. During this time, the George W. Bush administration, recognizing the foundational importance of health IT, clearly was trying to bring about the widespread diffusion of health IT through encouragement, focusing on standards development and experimentation in information exchange, thereby planting the seeds for the Nationwide Health Information Network. Despite very good intentions in those years, however, there were few market forces and no financial incentives or regulatory motivation to move our healthcare system toward adoption on any large scale.
In February 2009, Congress passed the Health Information Technology for Economic and Clinical Health Act, or HITECH, to jump-start demand sufficient for a robust market to drive vendor product development and innovation. The HITECH Act was constructed to achieve three main goals: move past limited demonstrations to spend real money on an infrastructure for nationwide interoperability; create strong financial incentives to spur adoption and use of EHRS; and set hard targets in the form of penalties for noncompliance.
Congress clearly wanted to move the healthcare system forward on health IT adoption, but the details of how to do so under HITECH’S newly constituted Medicare and Medicaid EHR incentive programs were not made public until 10 months later, on New Year’s Eve 2010.
To receive incentive payments under these programs, eligible providers (clinicians and acute-care hospitals) are required by statute to demonstrate meaningful use of certified health IT. Meaningful use was designed to focus not on whether every hospital room or doctor’s office had a computer plugged in, but instead, how that technology is being used to care for patients.
We learned tough lessons in the first year of implementation of EHR incentive programs. On one hand, HITECH incentives have been a game-changer. On the other hand, the high cost of adoption in terms of capital expenditure and workflow disruption, and limited capacity on the part of vendors, showed that the healthcare system, in large part, was not up to the immediate ambitions of HITECH as defined by HHS in its Stage 1 meaningful use regulations.
Providers have only so much bandwidth. A hospital system can accelerate its adoption to a point, but capacity to implement new systems safely on a highly compressed timeline is finite. The aspirations and visions exceeded the reality—today’s healthcare delivery system is built largely on a system of moving parts, with limited synchronization, not a command-and-control structure. The lesson was clear: If HHS was going to make this program successful in our market-based system, it needed more than the carrots and sticks in the legislation, as essential as they are. HHS also needed to undertake an ongoing effort to build a meaningful, enduring partnership with providers.
Now, two years later, HHS just initiated the regulatory process that will take us to the next level of health IT adoption by proposing requirements for providers to reach Stage 2 of meaningful use. These Stage 2 standards would begin in 2014 or later, depending on when the eligible professional or hospital first attests to meaningful use Stage 1.
At first glance, it appears that regulators are taking their role in this new partnership seriously by attempting to respond to feedback from the field over the past year, largely around flexibility, timing and burden. For example, in this round of regulations, HHS is seeking to redefine “certified EHR technology,” which effectively would eliminate a burdensome, costly requirement that providers purchase technology they aren’t using currently to satisfy meaningful use.
But in a system as complex as healthcare, the devil is always in the details. By the time the incentive payments stop flowing, billions of dollars in public funds will have been invested wisely to stimulate the adoption of electronic health records. Realistically, though, the federal payments constitute only seed money; the incentives are not enough to pay the entire cost of EHR adoption, in terms of the startup costs and the heavy maintenance and upgrade costs that are sure to follow.
So, in the end, it is likely that the legacy of this program will include some return on investment to the government, but the greater legacy likely will be the system setting a new standard of care—one that breaks down silos and does the right thing for patients as the benefits of these investments accrue over time.