Six Republican Senators are asking the healthcare community for input on “recalibrating” health information technology policy, arguing that there are several problems with the current trajectory of the meaningful use program.
In a white paper titled “Reboot: Re-examining the Strategies Needed to Successfully Adopt Health IT,” the senators argue that the federal health IT program has been hindered by a lack of progress on interoperability, billing increases sometimes associated with EHR adoption, oversight and patient privacy concerns, and financial sustainability beyond the federal incentive payments for providers buying IT systems.
“We hope stakeholders can provide information about the areas of concern we have identified, any additional areas of concern, and potential solutions to improve HITECH implementation,” wrote Senators John Thune of South Dakota, Lamar Alexander of Tennessee, Pat Roberts of Kansas, Richard Burr of North Carolina, Tom Coburn of Oklahoma, and Mike Enzi of Wyoming, in a letter broadly addressed to the American healthcare community.
With $35 billion allocated for incentive payments and grants in the American Recovery and Reinvestment Act and about $12.7 billion paid out so far, “Congress has the fiduciary responsibility to ensure that these taxpayer dollars are being used to efficiently accomplish the end goal of reduced healthcare costs through the appropriate sharing and use of health information,” the senators wrote in the white paper.
[Commentary: 5 obvious cases against suspending meaningful use payments.]
They cited concern that the Centers for Medicare and Medicaid Services (CMS) "does not yet seem to have an adequate plan to achieve secure, meaningful interoperability.” While lauding the Office of the National Coordinator for Health IT and CMS for delaying Stage 3 meaningful use rule development, the senators said that the program in Stage 2 “continues to focus less on the ability of disparate software systems to talk to one another and more on providing payments to facilities to purchase new technologies.”
The “failure to systematically and clearly address meaningful groundwork for interoperability at the start of the program,” they wrote, “could lead to costly obstacles that are potentially fatal to the success of the program.”
Among other concerns, the senators cited so-called “code creep,” increased billing that some have said actually reflects more accurate accounting of services rendered. The senators also cited something they and some others consider more problematic: habitual copying-and-pasting of patient data, by some clinicians possibly weary or inexperienced with computers, which could lead to potentially serious medical errors.
“The ability to quickly and easily generate documentation data deserves careful scrutiny as both a benefit and a risk of increased use of health IT,” the senators wrote. “Without proper oversight it is especially concerning, particularly in light of the way the Medicare system currently uses claims data instead of patient outcome-based information to reimburse providers and monitor global changes in clinical patterns and practices.”
Overall, there is a “need for more rigorous data analysis of Stage 1 before moving forward into Stages 2 and 3,” they wrote. “Congress, the administration, and stakeholders must work together to ‘reboot’ the federal electronic health record incentive program in order to accomplish the goal of creating a system that allows seamless sharing of electronic health records in a manner that appropriately guards taxpayer dollars.”