It could be years before patient health records flow seamlessly between hospitals, despite federal and state efforts to encourage information exchange. Earlier this week, lawmakers asked representatives from the private sector how they could speed up that process.
The federal government has invested about $30 billion in Medicare and Medicaid incentive programs that reimburse health care providers if they install electronic health records systems, and if they demonstrate that those systems improve the quality of care. Starting in 2015, eligible providers could see their reimbursements reduced -- a form of a penalty -- if they don’t demonstrate so-called “meaningful use” of their EHR systems.
During a hearing at the Senate Committee on Health, Education, Labor & Pensions, chairman Sen. Lamar Alexander, R-Tenn., asked witnesses what could be preventing hospitals and health care providers from adopting EHR systems.
So far, he noted, about 48 percent of physicians and 59 percent of hospitals have at least a basic EHR system in place. (The Defense Department is currently reviewing bids for a potentially $11 billion, 10-year revamp of its own health records, with bids from tech companies including IBM and Epic, as well as Leidos and Accenture Federal.)
For some, said Robert Wergin, president of the American Academy of Family Physicians, the reporting requirements for Medicare or Medicaid reimbursement are too burdensome. Family physicians, he said, are often working “in the trenches . . . day-to-day practice, that is really small-margin care."
He added, "In addition, physicians like me are spending far too much time typing on computers, instead of face-to-face patient care."
Alexander also asked witnesses if incentive penalties should be deferred until later.
“If we pull the penalty back, I think there’s a risk that we’ll sort of accept the status quo, and the pressure [to adopt EHR systems] won’t be there,” said Julia Adler-Milstein, assistant professor of information and health management and policy, at the University of Michigan.
Even once they’re installed, there’s no guarantee EHR systems from separate hospitals are interoperable, witnesses testified.
To encourage interoperability, the federal government should "use its authority to strengthen certification requirements to advance interoperability requirements . . . Congress should take action to delay federal penalties for meaningful use until interoperability is achieved," Wergin said in prepared remarks.
Peter DeVault, director of interoperability at Epic -- which bid on the DOD contract -- noted during the hearing that meaningful use programs should focus more on adoption and interoperability, but have ended up becoming an EHR design session by committee.
Sen. Sheldon Whitehouse, D-R.I., noted that many of the most expensive people in the healthcare system are cycling between nursing homes and hospitals.
"If you don’t capture that, and if you don’t require the nursing home to meet the meaningful use standard or cooperate, then you’ve made a really stupid tactical error in the roll-out of health information technology," he said.
But in competitive markets, hospital management may not want to share data with other systems, Adler-Milstein said -- sharing records makes it easier for patients to switch to a competitor.
“When interoperability is expensive, you have to justify that expense, and it makes it hard to justify when there are these potential competitive implications that get played in," she said.
Congress could also begin encouraging transparency in the marketplace for EHR system providers, Adler-Milstein said.
"It would be great to be able to say, 'We have a consumer report style set of information that really compares the system, compares the cost, compares the value,' " she said. "We don’t have that basic information, and therefore can’t have a robust market around these tools.”
The financial and banking industries provide an example of more effective, highly interoperable system, she added.
"There’s this national system that’s been created that allows you to put your ATM card into any ATM machine . . . in health care, we’re dealing with much more complex data . . . but we can at least see it’s possible to achieve that level of information sharing of a basic set of data."
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