The federal strategy for health IT has evolved.
Through implementation of the Health Information Technology for Economic and
Clinical Health (HITECH)
Act of 2009, as well as long-term development and use of electronic health
systems by Department of Defense and Department of Veterans Affairs, the
federal government invested heavily in health IT adoption and electronic
information. Efforts primarily concentrated on EHR adoption and foundational
work to expand health information exchange. The successes of these initial
efforts resulted in the accelerated maturation of the health IT market towards
the widespread use of health IT and information exchange. This led to a clearer federal
understanding of marketplace strengths and weaknesses, and of the particular needs
and interests of individuals and communities.
The
ONC makes a remarkable statement while discussing a Healthcare Industry that
already receives nearly 50% support by Medicare, Pensions, and Medicaid AND
just received a $35 Billion HITECH injection that has created a bubble in the
EMR, EHR, and Healthcare Information Technology “market.” There is absolutely NO way that any entity
can glean useable market statistics from the HealthcareIT buying activity of
providers over the last five years unless Government plans to inject another
$35 Billion+ into this sector over the next 5 years.
To
further complicate any historical analysis, the Affordable Care Act has created
a fundamentally new landscape of incentives and dis-incentives in the overall
healthcare market that makes any realistic analysis of quality and cost
virtually impossible. @mcuban , billionaire investor and
member of the Emmy
Award winning Shark Tank Cast, has discussed the artificial
marketplace in healthcare over the last couple of years. Mark Cuban was a lead investor in personal
health mobility platform integration company Validic
in 2013. But, let’s pretend that we
can make an analysis.
Recently,
Congress has stated that the HITECH program was “Doomed
from the start.” because HITECH did not address areas concerning
interoperability, and data sharing. I
was involved in submitting comments prior to the passage of HITECH. The initial proposals regarding interoperability
were strong and promising; the legislation that passed congress was an
abomination that allowed the public funding of private provider follies in
health technology purchases.
The
perception of the total lack of interoperability and what vendors do to
influence government to change attitudes can be seen in what Epic Systems did
when it felt pressure surrounding its closed system architecture. Epic Systems hired a Lobbyist Bradford Card,
brother of Andrew Card (George W Bush’s Chief of staff). Bradford has virtually
zero healthcare expertise outside of lobbying for the Greater New York Hospital
Association. Yet Bradford assures the US
Healthcare system, “Epic
has been the “subject of misinformation.” His firm will work to set the record
straight. “There have been stories that
they're not interoperable, when in fact they are.” Well I can certainly sleep better at night
knowing Bradford has healthcare interoperability covered? Epic
Systems may have actually been punished for their lack of interoperability when
@Cerner recently
won the $11 billion DoD Healthcare contract. That is an example of the DoD making a
conscious decision towards interoperability by voting with their wallet. But what has ONC done for the improvement of
record sharing for the average health consumer?
In a word, Nothing! In
fact, has admitted its near total failure in leadership when, after spending
$30 billion, ONC had to admit that patients could not even get copies of their
patient records contained in EHRs that were publically funded.
In fact, the ONC in April
released a report to Congress on “health information blocking,” in which the
agency noted that “current economic incentives and characteristics of both
health care and health IT markets” discourage the sharing of health information
(http://bit.ly/1QFEZUI).
For instance,
vendors may charge up to $1 per outgoing EHR record and $5 per incoming record
in addition to connection or interface fees, noted Peter Ashkenaz, an ONC
spokesperson, in an email. Another challenge, Segal said, is finding a more
efficient way to match patients with their records. Health Insurance
Portability and Accountability Act (HIPAA) regulations prohibit the use of
Social Security numbers or other national identification numbers, thus forcing
health care organizations to match patients with records by cross-referencing a
series of identifiers such as birth date, address, and driver’s license number.
Brookings
Fellow Niam Yaraghi, however, in a blog post following up on the senators' piece,
calls their expectations for ONC unrealistic. HITECH, he says, was designed
with a lack of insight into how the healthcare market functions; because of
that, a gap persists between the program's goals and its strategies.
"Billions
of dollars were doomed to be wasted and have no tangible return from the very
first day," Yaraghi says.
What's
more, he says, blaming HITECH's failures on a lack of interoperability and
standards is "naïve." Instead, Yaraghi reiterates his previous call for
more "market-driven economic incentives" and "self-regulated,
industry-driven certification alliances" to move the needle.
"By
demanding ONC to spend taxpayers' money on designing standards and focusing on
certification, we will only be doing a big favor for EHR vendors by picking up
their R&D tab," he says.
So after
failing to help patients receive paper copies of their own patient records, ONC
has a “new” plan to involve individuals and patients:
National Coordinator for Health IT
Karen DeSalvo, M.D., told reporters in a press conference that the federal
strategy puts people at the center with HIT in a supporting role designed to
facilitate and enable delivery system reform, scientific advances like
precision medicine, as well as improvements in public health and preparedness.
The focus
on individuals is a significant change from the initial draft of the
plan which critics charged was too heavily focused on providers while giving
short shrift to consumers. However, Gretchen Wyatt, senior strategy advisor in
ONC’s Office of Policy, emphasized that with the final plan “persons are really
where we’re trying to go with the information.”
Leading
health IT groups, including HIMSS, the American Health Information Management
Association and the Sequoia Project,
have offered the Senate HELP Committee their collective recommendations on how
to proceed with its health IT work. In a letter posted
Friday they call for reforms in meaningful use and list various suggestions for
spurring interoperability. These include optimizing and levering existing
standards rather than creating new ones and support for “high-value, impactful
use cases” of health information exchange. Other recommendations: shift EHR
certification to include interoperability requirements, lift the prohibition on
creating a national patient identifier, and align electronic quality measures
across reporting programs.
Congress
may be getting primed for HITECH 2.0 as reported on September 21, 2015:
Word
around K Street is that Louisiana Sen. Bill Cassidy will introduce his bill
to spur interoperability very soon, possibly this week. Multiple lobbyists said
it could have come last week, but, of course, it didn’t. Cassidy said in July his bill would look similar to what the
House did in its 21st Century Cures Act.
If @ONC_HealthIT is really serious about individuals receiving their
health records and jump increasing interoperability, providers will only
receive financial incentives after demonstrable transfer of THEIR data to the patient (by paper, thumb drive,
CD, or to a secure patient centric system). Extra incentives can be based upon aggregation
of data transferred to the patient from more than one connected system. @ebukstel
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