Congressional hearing on MU highlights usability, costs, standards (Part 2 of 2)
Witnesses attending the Congressional Subcommittee on Technology and Innovation’s hearing on Meaningful Use on Nov. 14 overwhelmingly testified in favor of the program and called for ongoing support from the government. This article is the second installment in a two-part series about this week's hearing on Capitol Hill.
“Health IT is an essential foundational element of any meaningful transformation of the nation’s healthcare system,” said Willa Fields, DNSc, RN, professor at San Diego State University’s School of Nursing and chair of the Health Information Management and Systems Society (HIMSS).
Though there’s “still much work to be done, adoption of interoperable health IT systems continues to expand thanks to the incentives provided by the HITECH Act. We’re only two years into the program and there’s been a great shift toward EHR throughout the nation.”
The evidence suggests that “a groundswell has been achieved in the adoption of health IT and specifically EHRs,” Fields said. Without the Meaningful Use program, “the nation would not be realizing the adoption and implementation of these systems which includes the rapidly expanding ability to exchange information priavately and securely across systems and regions.”
Fields said HIMSS offers the following recommendations to improve healthcare quality while controlling costs:
- Continue strong bipartisan support for the adoption and meaningful use of EHRs;
- Support and sustain the Meaningful Use EHR incentive program;
- Direct the administration to initiate collaboration with the private sector on an appropriate study of patient data matching and adoption of a nationwide patient matching strategy;
- Support harmonization of federal and state privacy laws to encourage exchange of health information across systems, payers and vendors;
- Continue to support programs and services to educate providers on how health IT can and should be used to engage patients in their healthcare;
- Support and sponsor pilot programs addressing collection, analysis and management of clinical data and quality for reporting purposes; and
- Preclude any additional delay in nationwide implementation of ICD-10.
EHR adoption and implementation has passed the tipping point, Fields said. “There is more work to be done especially in interoperability, health information exchange and privacy and security. HIMSS recommends that in order to improve the quality of your constituents’ healthcare while also reducing its cost, Congress should continue its strong bipartisan support” of the Meaningful Use program.”
Subcommittee members asked the five witnesses several questions about health IT. For example, when asked about ongoing hardship exemptions for certain specialists Mostashari responded by saying that Stage 2 “made a number of accommodations to the reality that not all data is relevant to certain practitioners."
Stage 1 began the proliferation of adoption of EHRs, said Rebecca Little, senior vice president of health IT provider Medicity. “Without robust standards for interoperability the spread will be stifled or limited. We encourage HHS [U.S. Department Health and Human Services] to adopt standards that will support coordinated care… Occasionally, federal program rules are not aligned and providers must comply with different standards for different programs which make them less attractive. We’re pleased to see HHS proposing alignment of rules across” such programs as Meaningful Use, physician quality reporting and accountable care.
Ranking member Donna Edwards (D-Md.) asked about the recent New York Times article indicating that EHRs lead to the practice of upcoding. Mostashari responded that the article examined trends in billing up to 2010 which predates the implementation of the EHR incentive program.
Edwards also asked about rural and small providers and where they fall in health IT implementation. “One of the fundamental challenges in setting Meaningful Use policy is this is an escalator we want people to get on and continue to advance through the different stages,” said Farzad Mostashari, MD, ScM, national coordinator of health IT. The question is how fast can we push without people falling off. “We could set standards very, very high but then only a few institutions would be able to qualify and we would not have succeeded in improving healthcare for all Americans.” However, setting the standards too low does not change “the intrinsic capabilities of the system.”
The regional extension centers were specifically established to focus on small practices, primary care providers, critical access hospitals and rural clinics, he said. Those efforts have resulted in greater adoption among those providers (38 percent) compared to the national average of 34 percent.
Suzanne Bonamici (D-Ore.) asked about the stability of the health IT market. Mostashari acknowledged that the issue is of critical importance. “It’s critical that as we have technological innovation, those technologies are more usable and work for the frontline clinical staff. The usability issue is absolutely critical.” The usability of today's products is like night and day compared with those from four to five years ago, he said. “A whole host of new innovations around usability are now coming to the forum. Competition among vendors for the most useful products will yield tremendous results in the future.”
Fields agreed. Products are “more usable than they used to be and hopefully aren’t as usable as they will be.” With the federal government assisting with the cost barrier will result in increased competition, she said.
Randy Neugebauer (R-Tex.) inquired about security parameters and matching the right patient to the right record.
“The patient is the most underutilized resource in healthcare,” Mostashari responded. Patient engagement has been a high priority for the ONC, he said, which has been “pursuing standards and policy for patients to exercise their legal right to access their records online.” That access has proved to help patients keep their medical appointments, take their medicine and be more active, he said.
A lack of patient matching is a major health safety issue, said Fields. Congress prohibited the use of appropriated funds to promulgate or adopt any final standard for a unique health identifier for an individual, she said. “I plead with you to promote this investigation for a national strategy for patient identification. We have it for clinicians and insurers but not for patients and that’s where the risk is.”
Mark Probst, CIO of Intermountain Healthcare based in Salt Lake City, added that Intermountain spends about $5 million a year doing patient identification accurately. “Talk about waste in the system. That’s a significant amount of waste that we need to tackle. It’s incredibly frustrating and unsafe.”
“$20 billion in expenditures is an awfully high price tag for something that the private sector seems to be doing and offering at a much lower rate,” said Dana Rohrabacher (R-Calif.), speaking to the development of health IT standards. “It doesn’t seem that it should take that much money especially at a time when we’re trying to bring down deficit spending so we can actually provide the medicine and the x-ray.”
As an anesthesiologist, Daniel Benishek, MD (R-Mich.) expressed concern about mandating the implementation of an EHR that doesn’t work as well as the system used by the Department of Veterans Affairs. “Many systems in the private sector are expensive, costly to maintain and don’t do what we want them to do which is provide universal access to information. Why are we implementing these systems before they’re universally interoperable?” Plus, implementation costs exceed incentive payments, something the witnesses did not address in their testimony, he pointed out. "I want great medical records too but if a hospital goes broke, access to care is not there either.”
Citing the choices made when the legislation was created by Congress, Mostashari said legislators took a market-based approach to health IT rather than supply the software. Plus, the market’s offerings have greatly expanded with their own usability and cost structures. “We’re seeing that the amount of incentive payments has been sufficient to produce this great acceleration in the adoption of EHRs.”
Benishek also said that most physicians have only implemented an EHR system because of the looming reimbursement penalties. Mostashari responded that the Meaningful Use program is voluntary.
Editor
Editor Beth earned a bachelor’s degree in journalism and master’s in health communication. She has worked in hospital, academic and publishing settings over the past 20 years. Beth joined TriMed in 2005, as editor of CMIO and Clinical Innovation + Technology. When not covering all things related to health IT, she spends time with her husband and three children.