The Stimulus Package and Health Data Exchange

CapitalObama’s stimulus package allocates
tens of billions for healthcare IT, and that much expenditure by the 
Feds won’t happen twice; thus, we should ensure these stimulus funds
address key health information infrastructure needs. The package dangles
incentive payments in front of hospitals and physician offices to adopt
electronic medical records (EMRs) by 2011, as well as penalties if they
fail to use them by 2016. Providers will hopefully benefit from EMRs
through improving effectiveness and efficiency within their organization.
For the health system as a whole, however, the promise goes beyond gains
within practices to encompass improved teamwork among providers and
with patients. It is on this latter promise—system improvements through
sharing medical records—that I’d like to focus here.

The vision is for a community-wide
information system that allows Marie, a diabetic who is allergic to
penicillin, to show up unconscious at any emergency room, yet get care
from doctors who know her special medical needs.  Further, Marie’s
treatments in the ER are known immediately both to her family physician
and to her specialists. The full team—primary through tertiary care—have
access to complete medical records available in real time, integrating
their separate decisions through shared information. This vision promises
improved care quality through comprehensive and transparent information,
and it will reduce redundant diagnostic testing.

Does the stimulus package adequately
promote this vision? What we’ve seen so far disappoints.

The bill
states that, to be qualified for incentive payments, an EMR must be
“capable” of data exchange. If this only means that a qualified
EMR has the appropriate technical interfaces, we’ll get approximately
nowhere. Technology is not the main roadblock for community wide exchange
of health information, as technical solutions have long been available.

Instead, data sharing’s main roadblocks
are in building viable organizational and revenue models to support
it, then generating universal participation. Building a voluntary, integrated
approach across over a half million independent businesses would be
an overwhelming task even if resistance from key players were minimal.
However, resistance to integrated data exchange is strong, buttressed
by concerns such as resources required, litigation fears, potential
embarrassment of exposing internal errors, and competitive impulses
to hold tightly to internal data.

>Establishing viable business models,
then generating participation, are the main roadblocks that the stimulus
money should address. The payments should be structured to incent key
players to first create and then use community data sharing exchanges
in health care.

I propose that “capable” be specified
to mean actual transfer of data into a health data exchange by some
date, say, July 2012. The act seems to assume that, if health exchanges
are built, all players will come. I doubt it strongly: Of exchanges
built to date, few have had providers pounding the doors to join.

Of course, few such data exchanges
are currently in operation and even fewer have viable long-term business
models.  Thus, in addition to the subsidies, one would need to
both pare back expectations for data exchanges initially and to invigorate
their development with legislation and funds.  The stabilization
plan has funding for data exchange startup, as well as a regulatory
structure for defining certification. However, possible sources of ongoing
operational revenue, such as payment by participants on a utility model
or through taxation, will likely need further enabling legislation.
Data exchanges are not expensive to run, but they will provide a public
good and, like all public goods, unfettered markets won’t fund them

Reduced initial expectations for data
sharing can help ensure that “good enough” happens. David Kibbe,
in a
February 13 THCB article
offers data exchange solutions that are limited, yet still provide valuable
services and are more readily implemented.

Now that our government is putting
up tens of billions to stimulate health information technology, let’s
leverage it to clear away the main roadblocks to community-wide sharing
of health data. Should we fail to take advantage of this one-time opportunity,
we’ll right back to hoping against reason that over a half million
independent, competing parties will collaborate effectively despite
the disincentives and complexities. Instead, let’s ensure that the
funds stimulate health data sharing for our common good.

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6 replies »

  1. Security for EMR is a major concern. EMR solutions providers must adhere to strict guidelines. Doctors and practitioners must take this seriously and thoroughly investigate security of their data before implementing a solution. This is where value provides can help physicians.

  2. I am pretty excited about this – partly for the health of the country, and partly for personal reasons. My girlfriend has a rare (well, rare-ish) heart condition that requires constant meds flowing through a drug pump. She’s got a Med-Alert bracelet, but that tech doesn’t feel adequate to us, so we pretty much stopped traveling in case she developed problems on the road and we couldn’t communicate with her docs at home to instruct the local hospital. We started using HealthVault and see huge promise in that, and I sure hope that we see more and more people start to sign up in the future.

  3. My comments or questions are related to Human Services
    Message………………………….. I am hanging onto God’s promise of Healing. In todays world only the Rich have the privilege of Medical Attention. Life today reminds me much of a MOVIE I ONCE VIEWED YEARS AND YEARS AGO CALLED “SOY LENT GREEN”…here I am decades later starting to relate to the subject matter of that movie. I am a victim of the latest Corporate Manipulation. Recently I had to endure an emergency surgery for a Cancerous Tumor in my Colon. I was truly blessed to have no cancer cells spread to other organs as of yet, but it is imperative that I continue having preventative treatments to make sure their is no recurrence. HOWEVER I AM UNABLE TO SEEK FURTHER MEDICAL TREATMENTS at the present time because my EMPLOYER has employed the use of manipulating the system as a cost saving tactic by laying off employees to only REHIRE US ALL BACK on a part time basis without reinstating our much needed medical benefits. THIS IS A CRUEL AND INHUMANE ACT as well a financial burden to all the tax payers due to nearly a $75,000.00 or more Medical Bill that I just incurred, that will have to be paid by the STATE via Social Programs because my Medical Insurance was TAKEN AWAY. For my particular situation…I was denied though any further assistance for Medical from the State and now I am left to simply HOPE FOR THE BEST without any possible means to PAY CASH to see a DOCTOR. The Casino I am employed by is in LAUGHLIN and they own several other properties that they have executed the same CRUEL PRACTICE. One sad story I want to relay is FEB 2009 we lost a co-worker to Cancer…Debbie was one of the unfortunate employees that was used as a COST SAVING Maneuver, she cancelled her scheduled DOCTORS APPOINTMENTS after being let go and then rehired without benefits being reinstated…..SHE DIED due to her condition then became TOO ADVANCE FOR A CURE. SHAME ON ALL THE Businesses and Corporations that play RUSSIAN ROULETTE WITH THOSE WHO HAVE BEEN LOYAL AND HARDWORKING TO MAKE THEM RICH! ….p.s. I hope the media has the
    Courage and Integrity to consider this subject worthy of discussion….I realize the possible fear of loss of advertising revenue would prevent those whose concerns are for MONEY NOT THE HUMAN RACE…I will continue to contact every source that may have the HEART it will take to create POSITIVE CHANGE FOR OUR SOCIETY. Sincerely, Susan Johnston of Bullhead City, Arizona….
    Name…………………………….. Susan Johnston
    E-mail Address……………………. johnette86442@yahoo.com

  4. For all of the money the gov’t is allocating to individual entities and health systems, it could have created its own web-based system and allowed the entire system to use it. No need for interfaces or incentives in that scenario. Instead, the IT industry will be profiting wildly from fragmentation, maintenance agreements, etc.

  5. There is no doubt about the fact that EMR will be a good thing for the medicine…for patient, for the government….
    There may be those not so happy who have made money on duplicate testin, etc. But then they are not the one who we should we worry about.
    That challenge on EMR is not about its philosophy or need. The challenge is about the quaility of EMR products that are in the market, their completeness, and their ability to deliver the promise.
    If after 10+ years of effort by people, we have the quality problem….
    Should we rely on them making it better
    Should we implement the product which we belive are not good
    Are these product good enough
    and of of course, should we wait to fix the gaps before implementation
    These questions would help decide the strategy to use the allocated 10 billion dollars.

  6. The legislation that encourages the development of electronic medical records (EMR) is in fact encouarging, not disappointing. It will ultimately result in: “improved care quality through comprehensive and transparent information, and it will reduce redundant diagnostic test”.
    I work in the IT field for the http://www.HealthMegaMall.com (sells some 120,000 hospital supplies and medical products) and we are involved in system development everyday. We have streamlined our systems and improved our Privacy Policy and other assets over the past eight years. This could not have happened without the benefits of time which enabled us to improve and observe and listen (to our stakeholders).
    With respect, you want to see a new, well-behaved child in the family but this legislation is the equivalent of a first-ever attempt at invitro fertilisation with the hope that it will make pregnancy possible and nine months later…. you may see a child! The Government is treading carefully lest they create a monster or a useless swine with a flu!
    They are inexperienced in managing policies related to EMRs. And all the other players and stakeholders including the general public and healthcare providers have limited knowledge of what this all really means to them and how it will impact them. Institutions need time to plan and create these systems. The players need time to select their various service providers and those providers need to develop their capabilities and security mechanisms. The professional Boards need to create their own statements on ethics and operational guidelines. Rushing the end goal now – attractive as it may seem – may result in the total failure of the undertaking.
    As such, I feel the Government is for the first time in a long time taking a correct approach: “Aim, Ready, Shoot” rather than “Shoot, Aim, Ready”.