Obama’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.
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,
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.