A health care Marshall Plan — $50 Billion stimulus to get electronic health records (EHRs) in every doctor’s hands or $50,000 to each physician -– what an incredible marketing job.
Detroit, are you listening? Stop whining to Congress that you need a bailout. Tell them you want to be the new alternative energy Manhattan Project, get the money, and then keep building SUVs and flying around in corporate jets.
To Congress, Daschle, and Obama, please don’t do this. Our industry, health care, combines the worst of the Big Three automakers with the worst of the hubris, dishonesty, and failure of the public trust of Wall Street. Please do not bail us out.
The health care information technology (IT) industry is a close analog
of the auto industry circa the 1970s. A few large players who build
big, expensive systems on outdated technology platforms dominate the
industry. There are some Toyotas, Hondas, VWs, and BMWs in the mix, but
the big players dominate the industry forums, standards organizations,
and mindshare of the institutions – our academic medical centers and
large health care organizations. They sell the institutions Cadillacs
and Lincolns with big fins that wallow and weave as you drive down the
road and they offer the rest of us Pintos and Vegas – smaller versions
of the big systems that unpredictably catch on fire.
Unlike other industries, however, (again, listen up Detroit) there is a peculiarity to health care IT relative to government regulation. The large health care IT companies love regulation and they love government mandated standards. You might wonder, no other industry has government setting standards, why health care?
It’s simply because HITSP and ONCHIT, the organizations set up by industry and the government to mandate standards, are controlled by the large archaic systems vendors. Standards selected and set by these organizations are unnecessarily complicated, expensive to implement, and protective of the big players. They stifle innovation and like the Big Three automakers, keep health care IT completely out of step with the general computer industry. Health care IT and HITSP standards are at least a decade behind the open data standards and open-source progressivism of the general computer industry.
In a nutshell, do not pour more money into this industry without completely rethinking how we drive innovation. Currently available EHRs from the major, CCHIT certified vendors will not save us money. Any assumptions about improvements in quality or patient safety will be offset by an across the board loss of clinical efficiency, a loss of productivity and a counterintuitive increase in the number of personnel, and increased clinical and administrative errors due to system and user interface complexity.
Across the board the decisions by CCHIT have narrowly defined the criteria that constitute a ‘certified’ EHR. They have made the hurdle artificially high and they have made the process as well as the required standards expensive for smaller innovative vendors to comply with and time consuming to implement. EHRs are not the solution, and this is very sad for me to say having devoted most of my professional life to them.
Apologies that this is out of left field but please spend our taxpayer dollars on the following:
A) Allocate $25 million and fund five efforts at $5 million each to build a scalable, XML, and cloud-based claims adjudication, public health, and quality reporting system to replace the entire archaic mainframe systems at CMS. Make the winning solution open source, implement it for Medicare and the CDC, and offer it free to every state Medicaid program and all the commercial payors. In addition make public and open source all Medicare and state Medicaid payment adjudication rules and payment edits. If you want to regulate something, make disclosure of adjudication rules and payment edits mandatory for all public and private health plans and PBMs.
B) Allocate $12.5 million (five efforts at $2.5 million each) to build an XML and web-based, completely secure and confidential patient registration, master person index, eligibility management, claims submission, and explanation of benefits/remittance system that interfaces seamlessly with Item A, above. Involve the patient privacy experts integrally in the selection of the winner and make the winning entry open source and free to all physician practices, hospitals, nursing homes, and ancillary facilities.
C) Allocated $10 million (five efforts at $2 million each) to build an XML and web-based, completely secure, confidential, and digital signature-based integrated ePrescribing and order entry (CPOE) system. Make the winner open source and mandate that all physicians, all hospitals, all institutions, all laboratories, all pharmacies, and all ancillary services use this integrated and uniform prescribing and order entry system for all inpatient and outpatient transactions.
D) Allocate $10 million (five efforts at $2 million each) to build an XML, open source PDF, and web-based, completely secure and confidential results reporting system. The winner would be open source, it’s use mandated, and must generate identical report formats for each type of result independent of source – in other words the onscreen and print based display of a urinalysis, culture, and sensitivities; an imaging report; and all other results would be uniform across the country and across practices, labs, radiology groups, and institutions.
E) Allocate $12.5 million (five efforts at $2.5 million each) to build an XML and web-based, completely secure and confidential clinical and administrative decision support engine that operates seamlessly with C and D, above. Make the winner open source and the solution has to provide open source authoring tools so that academic, public health, and institutional sources can publish plug-and-play guidelines, protocols, and recommendations for cost and clinically effect and evidence-based prevention, diagnosis, treatment, and patient safety.
A, B, and E will save a phenomenal amount of money for providers, payors, and the entire health care system, and C, D, and E will do more for patient safety than all the EHRs in the world. That’s for $70 million — not billion — and remember, the ‘experts’ and the established vendors will say this can never be done for this little money. I’ll take that challenge.
Let the existing health care IT vendors build charting systems, scheduling systems, and implementation platforms for the above technology. They’ll make plenty of money and unlike the Big Three might actually survive.
Rick Peters is an emergency physician, founder and former CEO of the EHR vendors Oceania (now Cerner) and iTrust (now Medplexus), and the PBM PTRX. He has been integrally involved in health care standards and health care consulting.