Congressional hearing on MU highlights usability, costs, standards (Part 1 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.

“Effective utilization of information technology in the medical field has the potential to fundamentally change healthcare in our country,” said Rep. Ben Quayle (R-Ariz.), chairman of the subcommittee, opening the hearing. “IT will be a critical component of our future healthcare system.” EHR incentive program payments have totaled more than $7.7 billion and it’s estimated that the Centers for Medicare & Medicaid Services (CMS) will pay out a total of $20 billion.

Given the significance of the spending, “it’s vital that taxpayer dollars are spent effectively in ways that lead to reduced costs and better healthcare down the road,” said Quayle. “Nearly four years after the HITECH Act was passed, taxpayers should know what we have to show for it.” Although EHR adoption has increased, Quayle said he has serious concerns about the progress of greater interoperability.

“It is crucially important that health IT is used to improve care without burdening certain providers with requirements that divert valuable time and resources, and to ensure that information technology in the healthcare industry is used to reduce costs and improve care.”

“We’ve made remarkable progress in health IT in a relatively short time since the HITECH Act’s passage,” said Farzad Mostashari, MD, ScM, national coordinator of health IT, citing the doubling of the number of office-based physicians who have adoption an EHR system and the three-fold increase in EHR adoption among hospitals. “Achieving Meaningful Use is meant to be hard but achievable. We need to strike a balance between the urgency of modernizing our healthcare system and the pace of change that can be absorbed by providers and IT vendors. Each stage is designed to build increased functionality and interoperability to improve patient care, enhance care coordination in population health, increase patient and family engagement and protect patient privacy and security.”

A solid roadmap and adequate timeframe are key to successful HIT implementation, Mostashari said. When drafting the initial set of Meaningful Use criteria in 2009, “there was simply no consensus” so he and his team took the initial steps toward interoperability by focusing Stage 1 on functionalities that support the consistent electronic capture of data and its effective use within practices.

“Over the past two years, we’ve worked with industry to accelerate the painstaking work of building consensus on these technical standards that were required,” he added. Stage 2 “for the first time, defines a common data set… It’s worth emphasizing that patients will have the ability to securely access the same information as the need arises. Our progress on the road to interoperability has been steadfast.”

The goal is developing a nationwide health information network that is reliable, usable, interoperable and secure, said Charles H. Romine, PhD, director of the IT Laboratory at the National Institute of Standards and Technology (NIST). “NIST has been hard at work fulfilling the mandate of making our system safer, more effective and more affordable through the use of health IT,” he told the Subcommittee.

For future stages of Meaningful Use, NIST is providing technical leadership in evolving standards for interoperable EHRs, as well as medical devices, genomics, imaging and text retrieval and analysis.

Essential to the success of Intermountain Healthcare is the efficient use of IT, said Mark Probst, CIO of the healthcare system based in Salt Lake City and widely recognized as a top provider of quality care. “Progress has been made but it is only a beginning,” he said. “We must commit ourselves as a nation to set a clear roadmap and support and exchange infrastructure and the adoption of standards that will make it easier to share information.”

Probst compared the U.S. healthcare system to the Australian railroad which developed with varying track sizes and then required standards and extensive retrofitting to make the tracks usable by all trains. “Existing health IT systems also were built one by one and applied differing standards. While that is effective for each institution, heroics are required to share even basic data between them.” 

Applying standards is really hard, Probst said. “We now have our own Australian railroad. Fixing it will require leadership and investment.” If an appropriate infrastructure can be defined and implemented, “innovation in health IT will skyrocket. Health-related data will be more secure. Costs for technology and access to knowledge will be significantly reduced and quality care across the country will be improved. If this is done, all ships can rise.”

Rebecca Little, senior vice president of health IT provider Medicity, said that her company provides the “intelligent plumbing” that allows EHRs, lab services, pharmacies, hospitals, doctors’ offices and other providers to connect to one another. Medicare and Medicaid costs are unnecessarily greater when a lack of innovation leads to bad outcomes or repetitive testing or procedures, she said. “The results can translate directly into lower healthcare costs. In total, poor medication adherence results in 33 to 69 percent of medication-related hospitalizations at a cost of roughly $100 billion per year.”

“Once connections are established and patient data begins to flow, other health information technologies can be put to work to turn that data into useful information for physicians and patients –saving lives, reducing medical errors and substantially lowering costs.”

For continued coverage of the hearing, please see Part 2 of the story in tomorrow's e-newsletter from Clinical Innovation + Technology.