In March of 2005, I staffed an interview between Todd Park and Steve Lohr of The New York Times in the cafeteria of the old New York offices of the “Grey Lady.” At the time, Park was heading a very small web-based start-up company that was trying to convince medical groups – and on that day, a leading national technology business reporter – that web-based “cloud” technologies would become mainstream in the healthcare IT industry and were the only logical means to get the hundreds of thousands of independent U.S. doctors and their small offices to go digital.
At the time, Lohr, one of the foremost technology reporters in the country covering IT giants like Microsoft, IBM and Intel, had just started covering Health IT upon the appointment of Dr. David Brailer as the nation’s first National Health Information Coordinator (or, as many called him back then, the “Health Information Czar”). In fact, Lohr had just gotten back from attending the annual HIMSS Conference in Dallas where he met with CEOs of “legacy” healthcare IT behemoths like IDX (now GE), Siemens, Cerner, Allscripts, McKesson and Epic.
In his first article addressing Health IT adoption in the U.S., Lohr touched on what he felt was the core challenge to achieving widespread EHR adoption: getting small medical practices to adopt and actually use these systems – something that had eluded the industry and those legacy IT vendors for many years. On the topic of getting small practices to adopt EHRs and the potential harm to the industry and the Bush Administration’s efforts if they didn’t, Dr. Brailer told Lohr, “The elephant in the living room in what we’re trying to do is the small physician practices. That’s the hardest problem, and it will bring this effort to its knees if we fail.”
Last week President Obama appointed Todd Park as the new Assistant to the President and U.S. Chief Technology Officer, with the responsibility to ensure the adoption of innovative technologies to support the Administration’s priorities including affordable health care. This got me to thinking.
Since taking office, President Obama has made some strong moves to champion the adoption of EHRs through the passing of the HITECH Act. This act, combined with the existing relaxation to the existing Stark anti-kickback laws, has actually enabled a spike in adoption of EHRs due to medical groups’ efforts to qualify for Meaningful Use dollars. But it has also had some unintended consequences that Mr. Park may now find himself in a unique position to rectify if he stays true to his support of cloud computing.
Over the last two years the number of independent medical practices, often small ones, that have become hospital-owned has more than doubled. This is a direct result of doctors selling out to their local hospital to use their legacy-based EHR (the kind made by the companies Lohr met with at HIMSS in 2005) in an effort to be a meaningful user of a clinical system and get incentive dollars. But rather than turning to more modern, web-based or cloud-computing EHRs, these doctors are now on the very systems that have been in place for decades, which weren’t adopted by the market based on actual value.
Some pundits predict and fear that this shift could lead to greater hospital vertical integration and subsequent pricing pressure on local insurers. Not such a bad thing, I guess… unless these newly owned doctors are sending more and more patients to the hospital for procedures at higher rates. So in gaining higher adoption of EHRs, do the means justify the end if the result increases healthcare costs and makes affordable care in the U.S. harder to achieve?
So how do you get doctors and practices of all shapes and sizes to adopt EHRs without the potential of driving up costs and driving down affordability? Well, any forward thinking person working in the health IT industry that I have spoken to knows that cloud-based technology is the logical solution for allowing independent doctors to go digital, get connected, and get their government incentives while staying independent.
The problem remains the same as it was in 2005 during that interview at the New York Times. The dominant health IT vendors have not truly been pressured to change their model and technology platforms from the client-server to a true cloud-based platform (some third-party hosted version of Cerner or Allcripts doesn’t count). Todd Park knows this and certainly wouldn’t have used legacy-based technology to launch the much publicized, forward-looking initiatives – HealthCare.gov and the Health Indicators Warehouse – that he effected as the CTO of the Department of Health and Human Services.
With proposed Meaningful Use Stage 2 standards just released a few weeks ago, it’s not too late to achieve what two federal Administrations have gone after while still spurring the kind of innovation and market disruption Todd Park has made his stellar career on.
Web-based technology, if widely adopted, will have a transformative impact on healthcare. Todd Park knew that seven years ago. Now that he’s our national CTO, I hope he will stay true to his vision and work to modernize healthcare through the power of the cloud.
John Hallock is Vice President of Corporate Communications at CareCloud. He joined the company in February of 2012 and is responsible for overseeing CareCloud’s communication and public relations programs with media and industry analysts while helping to promote the company’s growing product line and drive overall brand awareness. Prior to joining CareCloud, Hallock held the position of Director of Global Corporate Communications at athenahealth.