Health IT: Suc­cesses and missed op­por­tu­ni­ties

Modern Healthcare - - COMMENT - By Chip Kahn Chip Kahn is pres­i­dent and CEO of the Fed­er­a­tion of Amer­i­can Hos­pi­tals based in Wash­ing­ton.

Pres­i­dent Barack Obama’s Jan­uary 2009 pledge to “com­put­er­ize the na­tion’s health records in five years” largely has come to fruition. More than 4,000 hos­pi­tals and nearly 300,000 “el­i­gi­ble pro­fes­sion­als” have re­ceived Medi­care and/or Med­i­caid in­cen­tive pay­ments for in­vest­ing in cer­ti­fied elec­tronic health records and meet­ing “mean­ing­ful use” func­tional re­quire­ments in the 5½ years since the pas­sage of the Health In­for­ma­tion Tech­nol­ogy for Eco­nomic and Clin­i­cal Health Act.

Taken on their own, th­ese EHR adop­tion statis­tics make a strong case for the suc­cess of the pro­gram. That’s one side of the story. The other side of the story is that HITECH was big­ger than the mean­ing­ful use and the EHR in­cen­tive pro­grams. The law en­vi­sioned build­ing a na­tion­wide in­ter­op­er­a­ble in­for­ma­tion su­per­high­way, en­sur­ing pa­tient in­for­ma­tion gets to the right place at the right time to en­able bet­ter de­ci­sion­mak­ing at the point of care.

In­stead, more than five years and hun­dreds of mil­lions of dol­lars in grants and seed money later, we have lit­tle more to show than the equiv­a­lent of a few dis­con­nected in­ter­states and county roads and a health IT land­scape shaped by cer­tain missed op­por­tu­ni­ties.

This prob­lem is the fail­ure to achieve “macro” in­ter­op­er­abil­ity—the move­ment of pa­tient in­for­ma­tion out­side the walls of a fa­cil­ity. Macro-in­ter­op­er­abil­ity is hap­pen­ing in pock­ets of the coun­try, but cer­tainly not on the scale Congress en­vi­sioned when it passed HITECH.

The law’s ini­tial vi­sion was de­pen­dent on three fac­tors: tech­nol­ogy, aligned in­cen­tives and a cul­ture that en­ables in­for­ma­tion to flow. Yet in­stead of en­abling th­ese fac­tors to flour­ish, we al­lowed them to at­ro­phy, due largely to what ul­ti­mately is a cul­tural prob­lem— a fun­da­men­tal dis­trust of ex­ter­nal in­for­ma­tion among providers and clin­i­cians—that su­per­sedes any pol­icy lever the law cre­ated.

The bar­ri­ers that have stood in the way of macro-in­ter­op­er­abil­ity are well­doc­u­mented. Dur­ing the frenzy to get prod­ucts to mar­ket to meet reg­u­la­tory dead­lines, we failed to ad­dress in­ter­op­er­abil­ity among cer­ti­fied prod­ucts.

We also failed to pre­vent business prac­tices run­ning con­trary to the spirit of HITECH, such as closed ven­dor net­works and costly trans­ac­tion fees to move in­for­ma­tion. The bot­tom line: We have not aligned ven­dor in­cen­tives with provider re­quire­ments.

Fur­ther, mean­ing­ful use’s my­opic fo­cus on EHRs means that na­tion­al­level dis­cus­sions about in­ter­op­er­abil­ity ef­fec­tively ig­nore the mul­ti­tude of med­i­cal tech­nolo­gies within a fa­cil­ity that gen­er­ate crit­i­cal pa­tient data, in­clud­ing de­vices, mod­ules and other dig­i­tal in­stru­ments. When you ask hos­pi­tal chief in­for­ma­tion of­fi­cers what mat­ters to them, they talk about th­ese tech­nolo­gies and their lack of plug-and-play con­nec­tiv­ity with EHRs, even though this prob­lem of “mi­cro-in­ter­op­er­abil­ity” con­tin­ues to be omit­ted from the grow­ing num­ber of frame­works and roadmaps fo­cus­ing on how to achieve a con­nected health­care sys­tem.

De­spite our EHR suc­cesses, most hos­pi­tals are a “Tower of Bab­ble,” with nu­mer­ous mod­ules and de­vices un­able to talk to each other with­out costly in­ter­faces, over­lays, or, in many cases, a nurse or other health­care pro­fes­sional serv­ing as a trans­la­tor, man­u­ally trans­fer­ring or tran­scrib­ing data from one sys­tem to another.

It is sober­ing to re­al­ize that hun­dreds of mil­lions of dol­lars were spent ex­per­i­ment­ing on how to get pa­tient X’s in­for­ma­tion from Ohio to Florida, yet we can­not con­vey data from a dig­i­tal blood pres­sure cuff into an EHR three feet away with­out some type of work-around. This re­flects yet another missed op­por­tu­nity to invest in solv­ing a con­crete con­nec­tiv­ity prob­lem that adds cost, re­duces ef­fi­ciency and di­verts the fo­cus of clin­i­cal staff away from pa­tient care.

We are at a crit­i­cal junc­ture in the au­to­ma­tion of our health­care sys­tem. The win­dow to earn in­cen­tive pay­ments for EHR adop­tion is clos­ing, and the fi­nan­cial penal­ties for non­com­pli­ance are real. In th­ese tight fis­cal times, it is dif­fi­cult to imag­ine where the fund­ing will come from to ro­bustly ad­dress any one of th­ese missed op­por­tu­ni­ties, ab­sent the pri­vate sec­tor ris­ing to the oc­ca­sion.

HITECH’s stated goals in 2009 of re­duc­ing er­rors, bring­ing down costs, en­sur­ing pri­vacy and sav­ing lives are still the right goals for pa­tients, providers and the health­care sys­tem as a whole. Yet, ab­sent in­ter­op­er­abil­ity, macro or mi­cro, their prospects seem shaky at best.

As we look to the fu­ture—to Stage 3 mean­ing­ful use and even­tu­ally a post-HITECH world, it is crit­i­cally im­por­tant to con­tinue striv­ing to re­al­ize the law’s larger vi­sion for health in­for­ma­tion tech­nol­ogy. At the same time, one “les­son learned” should be never to un­der­es­ti­mate the value of tak­ing a con­crete step, such as mov­ing in­for­ma­tion from a dig­i­tal blood pres­sure cuff into an EHR a few feet away.

In­ter­ested in sub­mit­ting a Guest Ex­pert op-ed? View guide­lines at mod­ern­health­ Send drafts to As­sis­tant Man­ag­ing Ed­i­tor David May at dmay@mod­ern­health­

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