Wes RishelGetting Real About the ARRA and HIT
February 18th, 2009 · No Comments
My first blogging experience was great! I was rewarded with numerous thoughtful replies. Some of the most provocative replies came in private emails. One came from my my friend and mentor, Don Simborg. He did a brilliant job of framing the question.
Now is the time, more than ever, when we must look to the future. More money is going to flood into our industry from the federal government in the next two years than in the entire history of our field. There are two extreme views of what the scenario will look like 2-3 years from now and all of our efforts need to be devoted to making the second scenario happen.
Scenario #1: (Written from the point of view of three years from now)
Disillusionment is widespread over the colossal waste of money that has occurred. $Billions have been paid to doctors and hospitals to adopt electronic health systems and the result has been a set-back for the entire industry. Nearly half of the attempts to install new systems have resulted in abandonment of the projects from lack of appropriate preparation for implementation and installation training personnel. A recent study by the Congressional Budget Office has determined that for those installations that have succeeded, CMS costs have risen 30% because of increase billings for E&M codes and other procedures. The Office of the Inspector General has determined that fraudulent claims have more than doubled. Newly enacted privacy legislation has crippled the interoperable exchange of clinical information for both patient care and research. The newly formed Health Information Technology Policy and Standards Committees are paralyzed by competing special interest members.
Scenario #2: (Written from the point of view of three years from now)
Approximately 35% of physician practices either have implemented EHRs or are in the process of implementation – a significant step toward achieving the revised goal of having every American have an electronic health record by the year 2020. Although slower and more difficult than originally envisioned in the HITECH legislation of 2009, the focus on achieving new incentives for decision support and streamlining standards for interoperability have already paid dividends in terms of measurable improvements in both quality and costs as determined by two recent studies funded by AHRQ. The newly created Center for the Study of Healthcare Effectiveness has overcome both the technical and political problems in aggregating EHR data in a safe and secure manner. The newly formed Health Information Technology Policy and Standards Committees have adopted a stakeholder representation model that requires an appropriate mix of healthcare IT experts as well as consumer advocates and is fully federally funded to avoid special interest influences.
The most important point here is that it is a call to action. We may not fully agree with the ARRA and we may fear it could go awry. But it’s the Act is the first serious shot at putting all the theorizing and piloting to work. If it fails then the either we are doomed to paper records or the healthcare market collapses to the point where Health IT becomes a reasonable self-funded business proposition. (This would not be the health-IT market collapsing, it would be the health market. Small practices and small IDNs would go the way of the family farm, the few large provider organizations would be negotiating to take on risk and have sufficient market control to realize the financial benefits of actually giving better care.)
The second great thing about Don’s approach is that it contains a pragmatic definition of success: after three years we have enough real, meaningful usage to keep the idea alive. Forget the slogans and focus on moving forward.
How do you feel about Don’s two scenarios? If Scenario #1 is a zero and Scenario #2 is a 10 where do you think we’ll be in three years? (You could conceivably reply with a number greater than 10.) Would the picture be different, two years later in 2014? What could we in the informatics community do to nudge the number up? Share what you think in the comments.
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1 response so far ↓
1 Vince Vitali February 19, 2009 at 2:22 pm
Wes:
Reading yours and Don Simborg’s replies sure takes me back! Anyway, I agree with Don’s second scenario, so I think we’ll be a #10 – not as far along as we’d hoped but making real and steady progress. The one thing that must be addressed to enhance physician use of EMRs is reimbursement reform. Throwing money at it will help but there are key policy decisions to be made to really make the investments pay off. Medicare Incentives and penalties are a good start but we need to look at how to reimburse for e-visits, e-consults, and other e-transactions. That can take significant cost out of the system.
Where I worry (and here’s the cynic in me) is we hear a lot about who wants reform, but what about those who don’t. There are plenty of companies and whole industries that are doing just fine the way things are. Will they fall in-line with the process or fight to slow it down or even derail it.
It will therefore take great leadership within a collaborative public-private model that’s well-crafted to eliminate special interest and bias. That is an incredibly tall order. But as the saying goes “If not us, who, and if not now, when?”
All the Best!