Last April six senators led by Sen Thune (R-SD) sent a letter to Secretary Sebelius expressing concern that the money being spent on the EHR incentive program was not money well spent. They detailed these concerns in a white paper called “REBOOT: Re-examining the strategies needed to successfully adopt IT”.
Among their concerns were that the program:
- Lacked a clear path toward interoperability
- Payments were made without evidence of meaningful use
- EHRs were increasing the ordering of unnecessary tests and increased billing
- Provided inadequate safeguards to protect against fraud and abuse
- Does not require providers to demonstrate their technology is secure
- Does not assure sustainability with penalties hitting providers, especially small providers
- Created a patchwork of overlapping reporting requirements
The white paper was part of a broader effort to solicit feedback from the administration and the provider community about the incentive program. Some of the info in the white paper is accurate while some was misguided or inaccurate.
Sometime the week of July 1, the HIMSS Government Relations and our Institute for eHealth Policy were asked by lead staff of the “Reboot Group” to convene a series of closed-door bipartisan Senate staff briefings so that they could prepare for what are likely to be at least three upcoming Senate Finance hearings on the status of HITECH. The hearings will start on July 17th with ONC and CMS as witnesses. The first briefing was scheduled for July 10th. HIMSS arranged for me as HIMSS Chair-elect and head of the North Dakota-Minnesota Regional Extension Center (REACH) to brief the group along with Elliot Sloane, Ph.D. an expert on data standards and co-chair of the IHE (Integrating the Healthcare Enterprise) International Standards body and Janet Marchibroda, Director of Health Innovation at the Bipartisan Policy Center. This briefing was attended by 36 Republican and Democratic Senatorial staffers. The three of us updated them on what the incentive program has been able to accomplish and the data that show the program has clearly driven the adoption of electronic health records. We also pointed out that the interoperability standards that are required for Stage 2 will include the ability and requirement to exchange patient information across silos of care. Finally we described how reporting requirements are being harmonized allowing providers to report once and satisfy several programs.
We also highlighted a number of concerns. One is the growing disparity between the rural and the urban/suburban. Many of the larger systems that had adopted EHRs before the creation of the incentive program have seen clinical and financial benefits. Their products have had years to mature and these facilities have had years to compile patient data and redesign their workflows. These factors have made it easier for them to get the benefits of EHR use and to achieve meaningful use. For most of the hospitals in rural communities, it is a different story. Many are only now beginning to use EHRs and many of the products designed for small hospitals are not as mature as those in larger systems. We also pointed out that small hospitals do not have the IT staff of a large system and that their geographic isolation creates a barrier for them to find the staff and resources to necessary to implement and optimize the use of an electronic health record. We urged that they pay attention to the needs of these communities in order to not further deepen the digital divide.
We also made it clear that to “reboot” now would derail a program that was clearly headed to the interoperability goals that some of the senators did not believe were in 2014 certified software and Stage 2 requirements. Meaningful Use requirements come in phases and each release is timed so as to learn from the previous phase while allowing enough time for vendors to enhance their software and time for providers to adopt the software for the next phase. This “course correction” is built into the current incentive program negating the need of a “reboot.”
Finally, we expressed our concern for the providers who, through no fault of their own, have been unable to implement certified software. Some hospitals have encountered long waiting periods, and recently, some hospitals have seen their promised upgrade schedules for 2014 certified software be delayed indefinitely by their vendor. Though they may be able to apply for a hardship exemption so as to avoid the penalties, these facilities will lose out on the incentive designed to assist them in the cost of implementation and will no longer have access to the subsidized technical assistance from a Regional Extension Center. This issue will also need their continued attention.
In all, it was a great experience and great opportunity for which I am grateful. Thanks to the HIMSS staff responding so quickly to the request, we were able to make 1/3 of the senate offices aware of the value of the incentive program, why it should continue and, at the same time, make them aware of some of the issues that will need continued attention.
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