COM­MEN­TARY:

Health IT not only ben­e­fits pa­tients, but will of­fer healthy re­turn on in­vest­ment

Modern Healthcare - - MODERN HEALTHCARE - Chip Kahn Chip Kahn is pres­i­dent and CEO of the Fed­er­a­tion of Amer­i­can Hos­pi­tals, Washington.

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.

Hav­ing the right in­for­ma­tion

in the right place at the right time re­sults in bet­ter care for pa­tients.

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