For whom the HITECH Bill Tolls?

As part of a sweeping effort to address the woes of the current US economy, the government has placed $19 billion on the table for HIT, aimed at containing healthcare costs and creating new jobs. The ultimate instruments for implementing this HITECH bill are America’s physicians and there is much confusion and apprehension in the physician community regarding the net effects of this bill on doctors in particular and healthcare in general. The HIT stimulus effort will not reach its stated objectives without voluntary adoption by our doctors. The government and the HIT community must find a way to draw physicians all over this country into the process of defining and implementing the stimulus package.

In very broad terms, interoperability standards will be defined, Electronic Health Records (EHR) technologies will certify compliance with the standards and physicians will be provided financial incentives to acquire, and meaningfully use, those EHR technologies. The assumptions are that use of these standardized EHRs will reduce costs by reducing medical errors, reducing duplication of tests, improving quality of care and encouraging evidence based clinical decisions. Jobs will be created as the EHRs are deployed across the nation. Experts are already at work “on the Hill”, in the White House, in the boardrooms of HITSP, NIST, CCHIT and other acronym organizations. Technology vendors are feverishly doing their part, from creating websites devoted to the HITECH bill, to making products available at Wal-Mart, to sudden revelations that HIT is really their main business. Everybody is actively involved in making this bill a success.  Well, maybe not everybody.

There are tens of thousands of physicians out there, mostly practicing in 1-2 doctor clinics, from Wichita, Kansas to Troutville, Virginia, where waiting rooms are packed with seniors pushing aluminum walkers with yellow tennis balls on their bottoms, some holding Ziploc bags full of medication bottles for Diabetes, Hypertension, COPD, Hyperlipidemia and worse. Doctors  are seeing 30-40 patients every day in an insane hamster-wheel race that repeats itself day in and day out. That is where health care is being administered in America.  Most of these doctors cannot spell CCHIT, but thanks to the mainstream publicity of the HITECH bill, they are aware that the government will be giving them some money if they buy a certified EHR.

Will the acquisition of a certified EHR increase efficiency so more time can be spent with each patient without loss of revenue? Will it allow reimbursement for much needed coordination of care? Will it make preventive care easier to administer? Will it save time? It’s always about time…. Yes, “time is money”, but time is also quality of care for patients and quality of life for doctors.On the other hand, will this new certified EHR slow doctors down? Will the high learning curve result in significant  productivity loss? Will the computer devalue the personal relationship with the patient? Will the physician be required to collect data for unclear reasons and no reimbursement? Where is this liquid data going to end up? Who will be analyzing it? Will it be used to further cut reimbursements? Is it even worth the hassle? The incentive payment doesn’t even cover the outright price of a Wal-Mart EHR, not to mention all the hidden costs and disruptions to practice.

The question really is, will doctors buy into a process in which their voices are not being heard?

Interoperability is a worthy goal, and ability to measure outcomes is a must. Ability to move data across systems has benefits that physicians can and will embrace if placed in the proper context. Doctors transfer data every day using very basic and common tools: fax machines and telephones. Moving data across the internet should only make the process more efficient if the new technology does not impose an onerous burden on doctors. But if we are to improve healthcare, we must be able to measure its outcomes. One cannot improve that which cannot be measured. Doctors will see the benefits of creating a “clinical information highway” that allows for collection of evidence to be used at the point of care. However, physicians must be empowered to shape this information exchange channel and not just be asked to patiently bear the costs of building it.

At the risk of sounding childish and naïve, I am going to address someone that will never read this article: Mr. President, this administration was elected by the American people on the promise of Change and participatory government, by the people, for the people. Surely America’s physicians are people too. Why not take this decision process on the road? Town hall meetings could be an option. I’m sure the same people that ran the most sophisticated grassroots campaign in history can find a way to engage our doctors in this crucial decision making process.The real experts on healthcare delivery are not “on the Hill”, or in boardrooms of IT vendors and organizations. They are in Wichita, KS and Troutville, VA. They are busy seeing patients while  public policy pundits and IT experts are deciding what tools doctors should use to deliver healthcare to this nation. Moreover, physicians have ultimate spending authority over most of our exploding healthcare budget and physicians can make or break this initiative by choosing to adopt HIT or not. Costs will not be contained without physicians’ cooperation. Jobs will not be created if doctors refuse to purchase HIT tools. Their voice matters because they will be the ones paying the highest toll for this clinical information highway.

My sincere gratitude to David Kibbe, MD for much needed edits and suggestions.

Margalit Gur-Arie is COO at GenesysMD (Purkinje), an HIT company focusing on web based EHR/PMS and billing services for physicians. Prior to GenesysMD, Margalit was Director of Product Management at Essence/Purkinje and HIT Consultant for SSM Healthcare, a large non-profit hospital organization.

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Summer FrandsenStef HartBarbara PowerRam DurisetiMatthew Holt Recent comment authors
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Summer Frandsen
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Thanks for the review! Your post of your initial troubles and then solutions were really helpful and I think I may go out and purchase this grill/smoker! Thanks again!!!!

Stef Hart
Guest

Good Morning, To some degree I am in agreement with all of you, but I do not think we appreciate the fact that we finally have a President who is doing what he said he would do as far as health care reform. The primary reason for the nationwide implementation of Health Information Systems has to put an end to the 100,000 persons killed each year by doctors’ prescription scribble which that and along with the creation of extra jobs for the health industry(I believe along with infrastructure,manufacturing,/and new energies)were the basis of his campaign but his stimulus and budget.… Read more »

Barbara Power
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Barbara Power

It is well known and acknowledged that our health care system is in disarray. This is not due to IT or lack thereof. To overlay our existing chaos with any IT model, no matter its promises, will not help. If we separate this enormous effort from the parallel effort of health care reform then we will, with certainty, lose ground, lose time, and lose billions. When any high cost initiative is put on the table, an important question to be asked is: who gains the most? This question needs review from the 100,000 foot level down to the provider’s office–with… Read more »

Margalit Gur-Arie
Guest

Ram, I don’t think there is consensus in the physician community and I don’t think there needs to be in order for physicians to get involved in this process. I can definitely see the wishes of specialists possibly conflicting with the Primary Care agenda, but that’s just fine. Nobody can object to the need to collect and analyze data (with full physician/patient privacy provisions). The debate will be over interpretation of such data and its a necessary debate. I would prefer a debate led by medical professionals instead of a debate led by insurers,IT vendors and all those HIT organizations.… Read more »

Ram Duriseti
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Ram Duriseti

What if we start at the end? What if we define the holy grail of what HIT technologies are supposed to be? What if we identify the goals, agree that they are worthy, and only then build the IT tools to get us there. Posted by: Margalit Gur-Arie __________________________________________________________ You hit the nail on the head. There is one problem: is there such a consensus in the physician community? You cite cost-effectiveness as one goal. I couldn’t agree more. However, are physicians, especially procedure oriented specialists, going to accept data-driven recommendations when they argue against major revenue generating procedures? My… Read more »

Matthew Holt
Guest

err…John, if you think Google won the lobby battle over HITECH you really don’t understand US politics!!

Merle Bushkin
Guest

Your call for a dramatically different approach to healthcare IT couldn’t be more timely! If we’re not careful, we will waste the $19 billion designated for healthcare IT in the ARRA legislation just as we seem to be doing with payments to AIG and the banks. Like you, last October I offered my suggestions in the following letter to the Obama Transition Team but no one seems to be listening. I post it here in the hope that it enhances the dialog and perhaps even influences the legislation and programs being proposed. I apologize if it sounds like a commercial… Read more »

Gary M. Levin M.D.
Guest

This has been a good summation of the task at hand. Surely physicians should not be asking to be invited to the table to discuss their serious concerns about the processes they use to deliver health care. I would suggest, perhaps even demand that every specialty society and the AMA be represented at these ‘quasi-governmental’ organizations’ (which have more eponyms than letters in the alphabet).The unfortunate thing is that our ‘government’ listens to these ‘voluntary organizations’ which are largely supported by the self interests of the information technology industry. With the recent ‘promises’ of federal largesse the feeding frenzy has… Read more »

Carl Parisien Natick MA
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Carl Parisien Natick MA

Carl Parisien Natick MA good article thanks for the post, I think physicians should make the call.

Margalit Gur-Arie
Guest

Maybe, just maybe, we are thinking in the wrong terms. When EHR technology is mentioned, we all naturally think about existing products in use today. As Deron S writes, obviously what is out there today is not doing much for the physician. Today’s “EHR” at its best is a productivity tool, mostly for office staff and rarely does it add value for the physician. What if we start at the end? What if we define the holy grail of what HIT technologies are supposed to be? What if we identify the goals, agree that they are worthy, and only then… Read more »

MD as HELL
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MD as HELL

Medical records contain lots of errors. Thanks to the federal desire to slow the doctor down, todays EMR cannot legally store a master list of facts about each patient. Each patient’s history must be regathered and reconstruted by each new provider to justify a new patient level five E & M charge. In my own hospital’s records there are many patients whose records contain bad information. Hopefully the winning national platform will only store facts, rather than opinion in it’s database of each patient. Just because I think you are a narcotic addict fraudulently seeking pain medicine for your chronic… Read more »

BenefitStudio
Guest

Assuring patients of the privacy and security of their medical records will be difficult to accomplish. Although there are many hurdles to overcome, by reducing medical errors and improving quality of care in the long term we will enjoy a much better healthcare system.

Deron S.
Guest

“Will the acquisition of a certified EHR increase efficiency so more time can be spent with each patient without loss of revenue?”
Margalit – The answer to that question is no. EHR makes a practice more efficient (i.e. staff not running around looking for paper charts) but it does not free up much provider time to see more patients. From a healthcare system stanndpoint, EHR is a good thing. At the physician level, the benefits are minimal.

Dr.Rick Lippin
Guest

I’ll repeat a previous sentiment expressed by me on other THCB posts on HIT Of course users must be consulted/surveyed before a top-down system is “shoved” into their practice setting. Furthermore the culture of the practice settings must be studied by social scientists to permit succssfull embedding and implementation of any HIT system with some allowable modifications to match the practice setting and practitioners without losing the core interoperable data set. But I doubt if that will happen because we tend to still be stupid enough and immature enough as a nation and as a profession to deify technololgy with… Read more »

Randall Oates, M.D.
Guest

It is necessary for doctors to buy in (i.e. endorse) the plan ONLY if the desire is for the plan to meet with success. Otherwise, we can follow the U.K path to a failed NHIN.