Sen. Warner: 'We need to put our foot on the MU accelerator'

The imbalance in Medicare is going to continue to grow, said Sen. Mark Warner (R-Ga.) at the Office of the National Coordinator of Health IT’s annual meeting on Dec. 14, referring to the discrepancy between what individuals pay in to the system compared with the value of the services they receive. “The question is going to be whether we have the personal and political will to take this enormously powerful tool of health IT and allow it to be transformative.”

Further pushing on Meaningful Use [MU] needs to happen “not at some mystical point in the future but right now. Meaningful Use is great but without interoperability you are not creating the comprehensive promise” we’ve all been assured of.

The HITECH Act, part of the federal stimulus plan, was initially thought to include about $27 billion in health IT but now ticks north of $30 billion. “That’s some serious dough,” said Warner. “Here we are four years after stimulus and while progress has been made, we need to put our foot on the accelerator even more. We recognize that it requires all of us to get into our discomfort zone if we’re going to get this done.”

There are three critical steps to advancing health IT, Warner said:

1. Clear interoperability requirements amongst EMR systems. Stage 2 is a step forward because “we’ve got to have an audit trail so this is not just an aspirational goal but something we can make sure is accomplished and measured.”
2. Accelerate MU in a way that doesn’t divert from that goal. “It has to be tied into clear interoperability standards,” he said.
3. Establish a long-term strategy for health IT and determine how to align incentives inside the healthcare system to make sure health IT works right now.

A self-described “telecomm guy,” Warner said there are lessons healthcare can learn from the telecommunications industry. “Back in the 1980s, projections were that at the end of 35 years, 1 percent of Americans would have cell phones. Thirty years in, there are north of 300 million phones in the U.S. and over 6 billion in the world. That explosion took place because before we built out all of the cool apps, the FCC set very strict standards for interoperability so that all systems developed could talk to each other.”

Warner discussed four challenges to interoperability:

1. The enormous number of legacy systems.
2. HIPAA requirements, “while terribly important, make this exchange of information more difficult because of appropriate privacy concerns.”
3. “Even if we can get around the HIPAA challenges, we have an enormous lack of economic incentives for those who are currently collecting data to share it.”
4. The rapid changes in medical technology and procedures and the associated complexity in billing.

The healthcare industry needs to focus on compatibility with “crystal clear front-end requirements for systems,” he said. “It’s not enough to be able to send secure emails. We need to figure out how to get equipment to allow for searches and transactions for exchange of information between different vendors.”

It’s easier for financial companies to aggregate data, Warner said, because there are more restrictions on patient data. While access to those data is an important privacy safeguard it also restricts some potentially useful uses of data which may help improve outcomes and lower the cost of treatment.

“Even if we could reach a consensus on how to best protect privacy, there’s no economic incentive” to do so, he said. Business models are centered around proprietary data. Because of the “uncomfortable space, the [Centers for Medicare & Medicaid Services] has to accelerate its work.”

Many industries make their money not on the actual product, but on the associated accessories and billing, Warner said, including for such products as cell phones and credit cards. "This practice is exponentially more challenging in a field like healthcare, he said. That is yet another challenge "to having a truly robust, interoperable system."

“I absolutely believe that interoperability has to be the standard,” Warner said. “We’re $10 billion into this $30 billion investment. It’s easier to get Republicans and Democrats to agree than it is to get software engineers to agree on a common system. Someone has to say perfect is the enemy of the good and this is the standard.”

Warner wrapped up his talk by channeling Ronald Reagan: "Trust but verify.”