Tech

Post-HITECH HIT: Still Waiting

flying cadeuciiWhen it comes to health information technology in the United States, are you an optimist or pessimist?

Do you think it’s likely people who want health information will soon have routine, seamless digital access to it?

Most physicians and hospitals have at least some sort of electronic health record, yet big adoption gaps remain among physicians as just over half now have electronic health records. We can declare success and move on, right?

Hardly.

Most of us still cannot get health information when we want or need it. Health professionals and care systems trying to implement value-based payment and delivery reforms struggle to get the information they need to do that transformation. Communities trying to improve the health of their citizens have trouble getting the data they need and turning it into useful information.

Last week, the Robert Wood Johnson Foundation released its latest and last in a 10 year series of health information technology reports. The title of this year’s report is: “Health Information Technology in the United States, 2015: Transition to a Post-HITECH World”. Like previous editions, this one is an independent assessment of the state of our national health information technology infrastructure. It examines the progress, mishaps and many of the remaining challenges.

Although, we do not yet have that health information infrastructure, we do have a range of opinions about what has gone right and wrong over the last 10 years. There’s even a wide range of opinion among past and current national HIT coordinators. This year’s RWJF report includes an interview with all of them. Their comments range from: if we hadn’t acted we’d basically still be “Waiting for Godot” to we did act and ended up creating a sort of Eisenhower-like HIT “military industrial complex”.

Farzad Mostashari:

“’Oh, the marvels of technology that would have emerged had the government not stepped in. Oh, you should have just waited.’ So, first of all, waited until when? We waited 20 years, right? Waited for what? Second of all, where’s the counterfactual? You know what the counterfactual is? Behavioral health. You know what the counterfactual is? Long‐term care. Show me the beautifully innovative technology that’s now easily adopted by long‐term care health professionals. It doesn’t exist.”

David Brailer:

“Three things are clear. First, there was significant uptake in adoption before HITECH because the industry knew it was time and desperately wanted improvements. They simply needed the government, as the biggest payer for health care, to lead. Second, a vast amount of expensive public capital has been spent in HITECH, largely as a substitute for private capital, and the market will be wary of new investments if there is ever the potential for new government money to pay for it. Third, HITECH left us with an unwieldy, confused regulatory scheme that will slow down or block the innovations of the future.”

Our HIT reality is probably somewhere in between. At this year’s Washington, DC RWJF report release event, current national coordinator, Karen DeSalvo, provided some wise glass-is-half-full leadership: We are making enormous progress. We also face hard challenges. Now is not the time to let up.

Personally, I remain a guarded optimist about this epic quest for our health information infrastructure. On the other hand, I’m also an avid cyclist who lives to ride two or three hundred miles a week precisely because it hurts so much.

What say you?

Michael Painter is a senior program officer with the Robert Wood Johnson Foundation. 

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Categories: Tech, THCB

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HealthmessagingRob LambertsMightyCaseyMichael_PainterLeoHolmMD Recent comment authors
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Healthmessaging
Member

As the caregiver of a cancer patient over the last few years … and a very active user of health care … patients are no where close to getting complete, intelligible or convenient access to to their health care data on a uniform electronic basis. My wife currently has 14 patient portals in facilities across the US none of which speak to one another … nor allow clinicians to to easily access her historical data. Frankly it is much easier and more reliable for us to obtain her lab results and radiology reports in a hard copy format and hand… Read more »

mbushkin
Member

Very sorry about your wife’s problem. But there is a simple solution that can aggregate complete copies of ALL her records from ALL her providers in one place that she owns and can carry on her keychain, in a wallet or wear. It’s available today. It’s called MedKaz®. (see medkaz.com) Hope it helps!

Rob Lamberts
Member

I think this post (and subsequent comments) are spot-on. Incentives are important, but won’t themselves fix the problems at hand. Adoption does not equate to using something as it should be used. I know that was the original intent of “meaningful use,” but the criteria became more the goal than the actual meaningful use of EMR systems. Why? Because the goal from vendors was to sell their products, and the way they sold their product was for MU compliance, not clinical utility (it turns out that these are sometimes opposed to one another). But the main problem, from the perspective… Read more »

MightyCasey
Member

I’m really feeling the lack of a “like” button here … LOVE what Rob said.

Michael_Painter
Member

I agree with you–that this technology can easily and often does reinforce the problems rather than embody the transformational solutions. It certainly could provide a huge lift–as you describe–if the other pieces were in place. Your experience is very telling.

Fdebrantes
Member

I’ve always been an optimist that we can achieve true interoperability of EMRs so long as the government and private sector payers promote the type of financial incentives that will encourage and not discourage the comprehensive sharing of clinical records. In the RWJF report on the State of HIT, my colleagues and I wrote a chapter on the link between incentives and interoperability, and it’s a very strong link. Unfortunately, the government is using that link to discourage interoperability. Medicare’s misguided philosophy of encouraging the formation of integrated militates strongly against the sharing of health information across health care organizations.… Read more »

Michael_Painter
Member

And if anyone knows health care incentives, Francis, it’s you. Folks would be wise to listen. Thanks for the great comment.

MightyCasey
Member

amenAmenAMEN, Francois. The healthcare system (in which I include the pundits you mention, since they’re the Spin Zone for the status quo, whatever status is quo with the big money players at any given time) has had this long, involved, *expensive* discussion still thinking they’re standing over the supine forms of patients who are too dim/unsophisticated/whatever to participate in the discussion the grownups are having. What I think we’ve experienced with the entire healthcare reform rodeo – ushered in with Bush II and David Brailer in ’04, then codified as “official system wide reform” (it isn’t, not yet, but it’s… Read more »

Michael_Painter
Member

I love this response–especially “we are not waiting.” You go “girl”.

Paul @ Pivot ConsultingLLC
Member

The big $ incentive and the penalties for non adoption induced adoption before the product was ready….and assured that big health system administrators would sign up….with far too little physician input. So the products actually interfere with doctors interactions with patients. It is as if in the 1990’s the govt. forced adoption of cell phones for everyone, locking in the old Motorola Star Tec phone as the standard….erecting a huge barrier to entry for new players……likely preventing or severely delaying the invention of the iphone. Someday in the far future EHRs will really help doctors and patients….but that time has… Read more »

LeoHolmMD
Member
LeoHolmMD

Thank you.

Michael_Painter
Member

You’re so right–value to the people using the technology is critical. Thanks for the comment, Paul.

mbushkin
Member

As a consumer, occasional-patient, and investment banker-turned-healthcare IT entrepreneur, I think both extreme views are partially right and wrong. If the government hadn’t forced care providers and hospitals to adopt EMR systems, I doubt many would have done so on their own and most would still be using paper. Why? Because there was no sound business reason to change. It simply made no sense for doctors or hospitals to spend enormous sums and endless man-hours to install a system which, if successful, would save lots of money for insurers and self-insured employers but very little for the care provider. HITECH’s… Read more »

LeoHolmMD
Member
LeoHolmMD

The current structure is unsalvageable. The government has forced hospitals to instal 8-track players that are impossible to improve. Unfortunately, many groups are now in vendor lock, just in time for the money to run out. A free market is not going to solve anything because none of the stakeholders you mentioned even believe in one.

Michael_Painter
Member

It sounds like you’re in the same camp with Francois–see his comment above. Thanks for your thoughtful comment here too.

mbushkin
Member

Thanks, Mike. If you recall, we spoke about our solution to the lack of interoperability and the inability of patients to access/control their records. It’s called MedKaz®. I’m very upbeat because it meets these needs head-on by making the patient the focal point of his/her care.

BobbyGvegas
Member

“Do you think it’s likely people who want health information will soon have routine, seamless digital access to it?” __ No. I say that as a long-time analyst, former programmer (forensic environmental radioanalytics), DOQ-IT and Meaningful Use REC project coordinator, and now a patient under lengthy treatment for a potentially life threatening disease. The fragmentation and obstruction is as bad as ever, possibly getting even worse — ironically abetted by the wild proliferation of myriad IT apps in the healthcare sector. All of the cherubic talk about “interoperability” is just that, talk. I call it “interoperababble.” In fairness, the reasons… Read more »

Michael_Painter
Member

Thanks for the always thoughtful and smart comment, Bobby. It seems like we have a lot of pessimists here so far…