How far can policymakers move the ball?

What's the appropriate ongoing role for public policy in the health IT transition?

The question may seem a bit superfluous, given the fact that ONC and a host of other agencies at the federal and state levels seem to have a finger in every health IT pot. Nonetheless, even with numerous programs underway it's part of the democratic process for stakeholders and observers alike to be considering whether the public role being played is the correct one. Or, perhaps more to the point, whether policymakers are as prepared as they should be to recognize the limits of their effectiveness.

In this case, the question comes to mind given the comments of this doctor, who's pondering the real goals he and his colleagues have as they complete their practice's transition from paper to digital records.

There is, of course, the immediate upside, in terms of the potential ease of use.

"Instead of wading through stacks of unruly paper charts," he notes looking back at the day his practice went live, "my colleagues and I logged on to a sleek online portal via laptop computers to review and sign residents' progress notes. Thanks to months of meticulous preparation and the presence of onsite technical support, the day went relatively smoothly for physicians and patients."

But then he points out, "the most important reason for the switch to an electronic health record was the unspoken presumption that it would allow us to provide better preventive and chronic care for patients. At the end of the afternoon session, I asked the residents how strong the evidence is that practices with electronic health records actually improve their quality of care."

What he found in researching that question left him fairly unconvinced:

"The small number of mostly nonrandomized studies makes it hard to determine whether changes in physicians' behaviors were the result of implementing [clinical decision support systems], or if other factors were responsible. Also, the most promising studies to date were performed in large practices of employed physicians, rather than in small physician-owned practices. Finally, all but a few studies measured only guideline adherence, rather than patient-oriented health outcomes."

At the end of his comments, he rightly notes "it's not enough to just collect electronic data. For EHRs to transform primary care, we need to be able to use the data in new and creative ways, improving the health of large groups of patients -- and eventually, entire communities -- at the same time."

That's the part that leaves us pondering the role of policymakers.  We recently spoke with a federal official who laid out in broad strokes the rationale behind most of the federal programs resulting from the HITECH Act.  On one level, it's an obviously impressive effort. 

But we can't help wondering, given the above physician's musings, whether there aren't some providers who make the switch from paper only to find themselves wondering, "OK, now what?" 

To be sure, the purpose of meaningful use is to guide providers toward higher and better use of new technology, but policy moves slowly, and many providers, over time, may decide that all the hoops aren't worth jumping through.  They've adjusted to their new technology, realized a few key benefits, both for them and their patients. But maximizing their use may just not be realistic.

In short, the real question may be: Despite policymakers' efforts, will the health IT transition result in a percentage of providers getting the most of their technology while others opt for less ambitious goals?  And if so, what will be the effect on the healthcare sector, and, more importantly, what can policymakers really do about it?

Your thoughts?

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