National coördinator: David Blumenthal.
Chris Crisman
With the rules finally set for health IT stimulus money, now comes the long march to implementation.
Seventeen months after the U.S. stimulus law authorized billions to subsidize electronic health records (EHRs), 864 pages of rules for how physicians and hospitals must show "meaningful use" of the technology are finally set. Now comes the hard part: implementing the technology in a country where, by one estimate, only 17 percent of doctors use EHRs at all.
"This is a turning point for electronic health records in America, and for improved quality and effectiveness in health care," David Blumenthal, the national coördinator for health information technology, said in a statement after the rules came out last week.
Ideally, EHRs can warn doctors against prescribing a drug that would interact badly with something a patient is already taking. Or the technology could reveal that a patient has already had a diagnostic x-ray and doesn't need another one, saving money and reducing radiation exposure. In 2006, the U.S. National Academy of Sciences' Institute of Medicine said medication errors injure 1.5 million Americans each year--and that computer systems could prevent many of these mistakes.
Such technology can also make it far easier to systematically keep track of patients with chronic conditions. For example, it could identify diabetics who have missed lab tests and appointments and may be at risk of dangerous complications that could include foot amputations.
The money, totaling as much as $27 billion over the next decade, will finally start flowing next May. Individual physicians can receive up to $63,750 if they accept Medicaid, or up to $44,000 if they accept Medicare but not Medicaid. Hospitals might receive millions of dollars.
But to collect the cash--and avoid financial penalties a few years from now--physicians and hospitals will have to show that their systems are not only installed, but are compliant with the new "meaningful use" rules. Among the requirements: that doctors write electronic prescriptions--replacing error-prone handwritten versions--and can give copies of electronic records to patients.
The draft rules came out in January, but were later eased. Under the loosened rules, doctors now must handle at least 40 percent of prescriptions electronically, down from 75 percent. And they must be able to record demographic information on patients in a format that computers can read at least 50 percent of the time. The original requirement was at least 80 percent. Subsequent rules will get more stringent once doctors have begun implementing electronic records.
Given the primitive state of health IT in America, "it's going to be very difficult for physician organizations" to make the changeover, says Ben Quirk, a partner at TempDev, a health-care IT consulting firm in San Francisco. With that said, "this is a really good opportunity to make the leap," he adds, and for those who already have some computers installed, "this is a good opportunity to get the real benefits out of their existing system." Major players, such as GE Health Care, are now customizing their products to comply with the new regulations and will reap a bonanza from the wholesale adoption of information technology.
Despite a longer-than-expected rule-making process at the U.S. Department of Health and Human Services, "it's going well," says John Halamka, chief information officer of Beth Israel Deaconess Medical Center and Harvard Medical School, who chairs a key health IT standards panel. "Cost savings from coordination of care and reduction in errors will begin in 2011."
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1-- Big organizations and Hospitals are already beginning the "Standards Dance" In short-- all the major hospitals are betting that THIER multi-billion dollar system will be adopted as the de facto standard: Why? Because We're Columbia Presbyterian.
No-- Ours is the standard! Why? Because We're Weill Cornell Medical Center!
No-- Ours is the standard: Why? Because we spent more money than the rest of you!
Implementing standards in this area will be as it is with anything involving the Medical Profession: First you have to bring in the Cat Herders.
Then the following by-blow of EMRs will be a major financial earthquake in the small office/Primary care segment. EMR's require a far greater financial commitment than most single practitioners hanging their shingle are willing or able to cope with. And the anecdotal stories are already swirling about EMR companies that are here today and 'poof' gone tomorrow. . .along with ALL the doctor's patient data
I wouldn't say that standardization is the problem; standards are easy to produce once you get everybody in a room. Yes, everybody jockeys for competitive advantage, but we're really just talking about record formats, not the record-keeping systems themselves.
But finding a sufficiently credible standards body for the task is a problem. I suppose the government will want to be involved, which means that things will proceed much more slowly than they have to. (Doing something under ANSI auspices is a lot more ponderous than doing them under, say, IETF and W3C.) But ultimately we're not talking about rocket science here. If you've got a couple of XML schemas defined, you've got the basis for an interoperable system.
The harder problem will then be getting the various providers of records repositories to peer properly with each other. If my patient records are in provider X's system but my doctor is subscribed to provider Y, there has to be a way for Y to get to X with proper security and billing info. This sort of thing has been done on the internet and in the telephone network for years, but it takes time for all the peering relationships to get up and running.
The leftists and socialists will lose many seats in Congress come November. The pResident with be dis-elected two years hence.
First thing on the agenda will be the repeal of Socialist/Maxist delivery of health services.
This has been a sad two years for the Republic.
Dear Shootist,
The health care information technology effort described in my story was part of the bipartisan stimulus package, not the health-care reform law that you find objectionable.
If you don't like the idea of doctors getting technology that can help them avoid making drug errors or avoid ordering duplicate X-rays--as well as helping them get wise to drug-addicts who are seeking multiple painkiller prescriptions--be sure to dis-elect all of your representatives.
I don't know how many different EMR systems are being used, but I've read the number 200 in a couple publications. None of these can share data unless they have a custom designed conversion program. Yet, the federal government has made it very clear that if physicians don't adopt an EMR they will be penalized financially. However, as they also have no qualms about throwing taxpayer dollars down rat holes, they have offered to pay part of the cost of physicians adopting EMRs. If someone can explain to me how forcing physicians to computerize records on incompatible systems is going to improve patient care, I'm all ears.
Here's an approach:
1) To begin with, you've got individual doctors talking to islands of record-keeping, with no common interchange format.
2) The record-keeping providers standardize on an interchange format. This is actually pretty easy to do, especially with XML. There are obviously important patient location and security issues, but those problems are far from unique to the medical industry.
3) The record-keeping providers start peering with one another, so now their subscribers (doctors and medical organizations) can start to reach the records of patients that are in other providers' systems, with appropriate security and billing provisions. There's actually something pretty difficult that has to occur at this phase: Assuming that a given patient has partial records strewn across many systems, collecting all the partial records into a coherent history for the patient is non-trivial. I could see a nice business growing up around periodically synchronizing records for an individual patient across many different providers.
4) Shortly after that, things become rapidly commoditized, so that doctors are free to change their subscriptions from provider to provider, looking for the best price, features, and performance. It's also possible that patients will choose their own repositories. Either way, you now have a fully consolidated set of records for a patient, accessible from any system.
If these were internet standards (and they aren't), this process would probably take about 5 years from inception to maturity. I'd guess it will take the medical industry 10 years, but you'd start to see the benefits in less time than that.
Absolutely! Once the free market system realizes that this could be an extremely lucrative industry, there will be a veritable stampede to stake a legitimate claim in it. The ones who will be the most successful, will be the ones who are the problem solvers. It's just that simple!
Get it right, one step at a time.
It would seem far more logical to implement a national health care IT system one step at a time. As a large percentage of the US population obtains their medications through large pharmacy benefit managers, and medication errors and compliance are sources of injuries and failures, why not work on a common database for all prescriptions. Prescriptions would be ideal for a common format, and the larger problem will be access and security. Once they get this right add other easily formatible info... do it one step at a time, get it right and it might prove a plus for patient care.
Dear David, the benefits for the system will be yield in the long term as every project the starting phase is always one where you are spending a vast amount of money.
I always read with great interest those articles on the EHR the reason is that in Europe and particularly in France it is also a crucial reform even though some hard (financial) choices have to be made. The most important is to keep the patient in sight, the aim is to provide better cares by keeping a Medical record for every patients this could subsequently be translated into some substantial savings
Having practiced primary care internal medicine for almost 30 years, I often hear from the politicians or the media, but have seen no evidence that needless duplication of testing is a significant cost. Its a bit like the claims that preventive care will save a lot of money... studies to date have shown positive health benefits but generally at additional costs except in a limited number of endeavours such as as prenatal care and vaccines. I am not opposed to EHRs nor to preventive care, in fact I am supportive. But in terms of patient care... a national database with everybody's medications, allergies, and lab data that is easy to access yet secure, will deliver almost all the information that is needed on an immediate basis, and avoid most of the duplication that occurs.(labs)
Manufacturing in the United States is in trouble. That's bad news not just for the country's economy but for the future of innovation.
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JPMcSR
3 Comments
Electronic Health Records
This would be great if the IT ego can be put aside. I now have a Medic Alert Health Key®. The problem is when attempting to review in a computer other than my own, reveals that it can not load unless I am the administrator. At work, it does not work. At the hospital, it does not work. In an ambulance, it does not work. Their computer systems prevent it's use due to the fact that their administrators disallow any download/upload of a program. I do not know any of the actual technical jargon. But I do know that was $50. spent for virtually no use. Someone needs to develop this technology around actual usaability. It is not enough to be able to save electronically, you actually need to be able to use it when needed.
It would also be great if the meds that need to be reported and repeated to every physician could be carried electronically, so that you would not have to recall, under stress during the office visit.
Have a Aparkling Day!
JPMcSR
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