A few weeks back, on the heels of the House of Representatives’ Energy and Commerce Committee’s Subcommittee on Health’s hearing on the transition to ICD-10, I noted how the debate over the transition wasn’t as one-sided as that panel had made it seem. Indeed, there is a clear division between the pro and con ICD-10 crowds, with both sides getting ample representation in the industry from publications such as ours.
Yesterday, I figured we’d see a similar division—albeit, one that would be more evenly represented—when the U.S. Senate’s Committee on Health Education Labor & Pensions (HELP) held a hearing this week on the effectiveness of the meaningful use program and the current health IT infrastructure. I was wrong.
Everyone, from Democrats to Republicans and even those aggressively advocating for the adoption of EHRs, agreed that the meaningful use program is in need of a fix. The debate really is over the degree of this fix. Some say it should rebooted entirely, others are more careful with those kinds of assertions. The hearing ended with Senator Lamar Alexander (R-TN) and others suggesting a continuous meeting of stakeholders on how to enable the adoption of interoperable, usable electronic health records (EHRs), rather rely on the meaningful use mandates.
After this, Senator Alexander asked the four panelists—from a variety of healthcare backgrounds—how they would enable and not mandate. I found myself agreeing with Robert L. Wergin, M.D. president of the American Academy of Family Physicians (AAFP) who represented the provider side and Peter DeVault, director of interoperability at Epic Systems Corporation who represented vendors.
(Sidenote: The fact that a vendor and provider association representative are in firm agreement at all, shows you how there is much more acceptance of the notion that meaningful use needs improvements to drive interoperability and innovation.)
Both Dr. Wergin and DeVault asked for an end to the “data dump” approach, lambasting artificial incentives, prescriptive measures, and an “all or noting” approach. Wergin shared a story on how he had to ask two patients to email him a question at the eleventh hour to reach meaningful use incentives. To add on to his point, is this really what we wanted health IT systems to accomplish when meaningful use was enacted? It really defines the term checking-the-boxes.
If an educational framework had made a child this lazy with his homework, wouldn’t you think something was wrong?
The Health Information Technology for Economic and Clinical Health (HITECH) deserves credit for spurring adoption of EHR systems. This was pointed out by Senators Al Franken (D-MN) and Patty Murray (D-WA). It’s easy to forget that the state of EHR adoption in this country was abysmal not too long ago. But now it’s time to evolve the regulations to allow for interoperable, usable systems.
Coincidentally (or maybe not coincidentally), the Brookings Institution, a Washington D.C.-based nonprofit research organization, released a brief this week that provided a nice overview of the problems with current health IT policy and possible solutions. For anyone that wants to read an agenda-free examination of this issue, I highly recommend it.
The authors touch on many of the issues outlined in the hearing: meaningful use is too prescriptive, the uniformity of requirements is unrealistic for how care is delivered, there are gaps in effective interoperability, and more. They say that meaningful use should focus on value and outcomes rather than health IT processes. As the authors note, this is likely to be the case in Stage 3, however as they say, that’s a few years away from actually happening.
“There is a missed opportunity in the meantime to use MU incentives to encourage the adoption of health IT capabilities that enable both quality improvement and better measurement of outcomes of care directly from electronic data systems,” the authors write. They add that meaningful use penalties for specialties would be avoided in this scenario, since performance outcomes would be tied to their area of clinical practice.
Another fix recommended by the Brookings authors that I love is similar in spirit. It would create interoperable standards around outcomes and not mandates. More than just linking to outcomes though, they say the Office of the National Coordinator for Health IT’s Interoperability Roadmap should focus on driving interoperability through actual business cases, including the cost and coverage of interoperability.
This addresses one of the core challenges of interoperability, outlined on the Senate panel by Julia Adler-Milstein, Ph.D. assistant professor of Health Management and Policy at the University of Michigan’s School of Public Health. Dr. Adler-Milstein correctly noted that as of right now, there is no business case for interoperability. Vendors and providers don't have the incentives to do that right now. Brookings says the roadmap and other policy measures should address that and fix it.
There is a lot to sift through both with that paper and what was said at the Senate hearing. The lack of usability of these systems was hotly debated as well. One thing is clear though, no one is satisfied with the status quo. It’s time to fix meaningful use and put healthcare on a new track.