Panel weighs pros and cons of meaningful use, needs more media attention

Paul C. Tang, MD, vice president, CMIO at the Palo Alto Medical Foundation. Image source: Palo Alto Medical Foundation

BOSTON --The news media are not paying enough attention to the vital health IT components of healthcare reform, said Paul Tang, MD, vice president and CMIO of the Palo Alto Medical Foundation in Calif.

Tang joined John Halamka, MD, chief informatics officer (CIO) of Beth Israel Deaconess Medical Center in Boston, and CIO at Harvard Medical School in Boston; J. Marc Overhage, MD, PhD, CEO of the Indiana Health Information Exchange; and Micky Tripathi, PhD, president and CEO of the Massachusetts eHealth Collaborative, in a panel discussion at Massachusetts Gov. Deval L. Patrick's health IT conference last week.

The proposed criteria for meaningful use are “tools for the government to help improve healthcare nationwide,” said Tang, who cited four in particular:

1. Requiring EHRs to be certified “levels the playing field” for both vendors and providers because everyone will know what is required.
2. EHR objectives that are directing everyone toward health outcomes, rather than just being a replacement for paper, are ground-breaking.
3. The requirement for exchange of information is one area where commercial infrastructure isn’t there yet, and that’s one area where government can help, he said.
4. Clinical quality measures: “There are plenty of quality measures, but we have very few clinical quality measures,” said Tang, “because most data has been claims data, [which is] not as much about quality as we’d like.”

Meaningful use criteria were never intended to be “a money-for-software program,” and are directed toward health outcomes, he said. “One of the pieces that this legislation has done is mobilize everyone in the same direction. Getting vendors pointed in a single direction, aligned with the needs of patients and providers, has been tremendously useful,” said Tang.

With regard to standards, “policy drives technology,” Halamka said. “The genius of [the HITECH Act is that it] tells us what we want to do.”

There are some challenges to standardizing the exchange of healthcare information, he said. For example, the e-prescription process doesn’t include scheduled controlled medications like Valium—prescriptions for those are still paper-based, Halamka said.

In addition, “the nature of the data we’ve recorded may not be good enough” – it’s hard to pull quality measures out of non-vocabulary-controlled, unstructured text. “This is the tough part: Getting the data structured,” he said, and the HIT Standards Committee is working a variety of these issues.

Much has been made about how different healthcare is from other industries, said Tripathi, but there are similarities as well. At the turn of the last century, the telephone was a new technology, but by 1901 there were already two million phone users in the U.S. and public and private investment combined was $500 million, he said.

“At the beginning, things are expensive, there are many companies…I would argue that’s where we are in healthcare IT," Tripathi said. “It takes time for technologies to settle. It feels unbelievably messy at the beginning.” Unlike other industries, however, healthcare is still very fragmented, so “we need different levers to push [EHR adoption] forward,” he said.

One way: “Follow the money,” Tripathi said. “The vast majority of [funding] is going to individual physicians and hospitals...[it’s] a subsidy for an investment they’ll have to make to stay in business.”

Regional Extension Centers (RECs), based loosely on the model used for the federal Agriculture Extension program in the 1920s and 1930s, will provide some guidance and then allow “labs of democracy to work,” he said. RECs will provide market information that has been unavailable in the past, including “who are the organizations and EHR vendors that are getting physician buy-in?” said Tripathi.  Having that information available to the market will have a lot of impact in the short term, he said.

“Think about email,” Overhage said. The first electronic message was sent in 1970. When email systems were up and running, the question became “How do you exchange email between all these different networks? But today it’s ubiquitous.”

The core challenge today is similar: “How do we achieve network value for EHRs? Information lives in silos.”

“Data doesn’t spontaneously appear in EHRs. We can’t afford the inefficiencies it takes to bring data into EHRs from silos,” Overhage said.