AMDIS: Bumps in the Road to Healthcare Reform
The following, written by Peter Basch, MD and Michael H. Zaroukian, MD, PhD, is an excerpt from content published on the website Doctors Helping Doctors Transform Healthcare:
There has generally been broad consensus that widespread adoption of EHRs is a necessary, if as yet imperfect, step in the evolution to better, safer and more affordable care. While there have been challenges to the logic and effects of the HITECH Act and the Centers for Medicare & Medicaid Services’ EHR Meaningful Use Incentive Program that have catalyzed greater EHR use, stories recently published in two high-impact newspapers raised additional serious questions about the conventional wisdom that EHR use will help contain increases in healthcare costs.
The first, published as an op-ed piece in the Wall Street Journal, takes the position that there is no evidence from four to five decades of research that EHRs save money, and that the current policy to use financial incentives to accelerate EHR adoption is misdirected. The second, a report published in The New York Times, does not question the rationale behind the policy; instead, it presents the startling and disturbing finding that whatever policymakers were hoping for, there is evidence that doctors and hospitals with EHRs are using them to bill for more and higher complexity services–and are thus increasing costs. Worse, The New York Times article suggests that much of the higher billing may be due to widespread electronic ‘science fiction’ in which doctors electronically record findings without actually ascertaining them, while their EHR coding software actively encourages documentation resulting in unethically and even criminally inflated bills.
Our initial reactions to these two pieces were mixed. We were troubled by the possibility that EHRs could be directly and significantly contributing to billing fraud, a criminal activity that hurts everyone. On the other hand, as practicing primary care physicians with longstanding informatics leadership roles and experience in our respective organizations and professional societies, we have presented and published data from our own practices showing cost savings and quality gains from EHR implementation and optimization. We have seen EHR coding decision support software from multiple vendors designed to facilitate appropriate billing rather than fraud. We have reviewed enough of the primary literature over many years of research and have deployed enough of it in our own practices to believe that well-designed, -implemented and -optimized EHR systems used by trained healthcare professionals in a “meaningful” way can support improvements in healthcare quality and value.
In light of our experiences, we wondered how a recent study could yield such strong and conclusive evidence that the WSJ editorialists could reasonably conclude that the “savings claimed by government agencies and vendors of health IT are little more than hype.” We were also curious to understand the evidence base behind the claims in the NYT report that there may be a widespread problem with EHRs encouraging doctors to document work they did not do to inflate their bills, and then using their EHR coding software to discover and document in a manner that would support fraudulent billing practices.
The product of our reflections about these issues is a six-part blog post that can be found on doctorshelpingdoctorstransformhealthcare.org. We invite others to add their comments, questions and suggestions for moving the conversation forward to ensure that the increasingly widespread adoption of EHR systems and associated health IT results yields its intended goals of improving the quality, safety and value of healthcare.