The New England Journal of Medicine, long known for providing a forum for the discussion of complex and thorny healthcare policy issues, has surpassed itself in its latest issue, dated September 7, by showcasing what might be the ultimate point-counterpoint of contrasting views of the meaningful use program under the HITECH (Health Information Technology for Economic and Clinical Health) Act.
In last week’s issue, the esteemed NEJM published facing Perspectives (op-ed articles) by, on the one hand, a team of the four most recent past National Coordinators for Health Information Technology; and on the other hand, two exceptionally well-known national healthcare IT leaders. Thus, on p. 904 began “The HITECH Era and the Path Forward,” authored by Vindell Washington, M.D., Karen DeSalvo, M.D., Farzad Mostashari, M.D., and David Blumenthal, M.D.; and beginning on p. 907, readers were offered “The HITECH Era in Retrospect,” authored by John D. Halamka, M.D., CIO of Beth Israel Deaconess Hospital in Boston, and Micky Tripathi, Ph.D., president and CEO of the Massachusetts eHealth Collaborative.
This face-off of healthcare IT policy titans did not disappoint. On the one hand, the two teams did present somewhat contrasting perspectives on the meaningful use program; on the other hand, there was a surprising level of consensus on some of the fundamentals, as well as on some of the particulars, in their arguments. Let’s look at both, and then analyze the confluence of perspectives.
First, Drs. Washington, DeSalvo, Mostashari, and Blumenthal provided a broad overview of the history of the meaningful use program under HITECH. There’s no need to reproduce that summary here in full, though certain passages are worth quoting.
For one thing, the former National Coordinators note, eight-and-a-half years after the Congress passed, and President Obama signed, the HITECH Act, as part of the ARRA (American Recovery and Reinvestment Act of 2009), “Today, almost all U.S. hospitals and nearly 80 percent of office-based practices use certified EHRs [electronic health records]. A majority of providers can share health information between systems, and 87% of patients report having access to their electronic health information. More important, of nearly 500 studies examining the use of health IT functionalities required for what the HITECH Act designated as “meaningful use,” 84 percent showed that deploying this technology had a positive or partially positive effect on care quality, safety, and efficiency.”
Still, the National Coordinators write, “Obstacles emerged with the rapid deployment of technology and the development of new sources and uses of health data. Primary policy goals were to foster health IT adoption and stimulate the economy. The ONC [Office of the National Coordinator for Health IT], for example, was originally structured as a coordinating entity rather than a regulatory agency, and HITECH only slightly adjusted that profile. Participation in the EHR incentive program and the vendor-certification program is voluntary. Other challenges included congressional expectations of rapid allocation of HITECH funds and development of IT programs. A short timeline meant that some organizations simply expanded existing, proprietary EHRs; the design was hampered as clinical documentation requirements were in competition with billing and compliance needs.”
Importantly, the former National Coordinators concede, “Health care providers, especially physicians, have borne the brunt of this transformation. Many are frustrated by poor EHR usability and the lack of actionable information generated by these systems. In part, such limitations are attributable to the decision to allow proprietary standards and data blocking in the market, which has led to suboptimal data sharing.” So what’s the answer? “As former national coordinators for health IT,” they write, “we believe that the culture surrounding access to and sharing of information must change to promote the seamless, secure flow of electronic information. Both patients and providers want health information to be sharable between systems. Relevant policy work has involved educating clinicians, technology developers, and patients about common misperceptions associated with privacy protections under the Health Insurance Portability and Accountability Act (HIPAA). It has also focused on empowering patients through efforts such as the Blue Button Initiative, which allows patients to view and download their personal health information.”