Medical Device Daily Washington Editor
WASHINGTON – A broad consensus has formed that the roll-out of healthcare information technology (HIT) in the U.S. is overdue, and the idea that the costs of implementation will be dwarfed by the benefits has gained widespread support in both the public and private sectors. But the anticipated benefits aren't seen as a sure thing by all parties.
John Ensign (R-Nevada), who chairs the technology, innovation and competitiveness subcommittee of the Senate Committee on Commerce, Science and Transportation, held a hearing on June 21 to get an update on the progress toward universal adoption of HIT systems in a jam-packed Senate hearing room, despite the absence of other members of the Senate.
Ensign opened the hearing by saying that “we all know that the promise of healthcare information technology is very real,” but that “today, the standard-setting process is fragmented.” Ensign also alluded to the difficulties in driving adoption of HIT in a nation with a multitude of healthcare systems, but said that he wanted to “focus on progress.”
Carolyn Clancy, director of the Agency for Healthcare Research and Quality (Washington), was the lone witness on the first panel. She said it is “fair to say that we're making good progress” in converting paper to electronic health records (EHRs) by 2014, in accordance with President George Bush's goal voiced in his 2004 State of the Union address.
Clancy argued, however, that “attention must be paid to how we ensure the public trust.”
Research indicates that the migration of best practices to typical practice often takes 17 years, Clancy noted. She emphasized the need “to shorten the translation of research into practice,” recommending use of clinical decision support systems for getting these practices into play in a shorter time frame.
“We know that patients and doctors” are interested in best practices, Clancy said. “What we're most excited about” is the prospect of integrating best practices into patient records.
But she noted an important exception here: “We can learn something when clinicians override” best practices, with such information subsequently added to the body of knowledge for best practices formation.
Clancy cited the variation in the models projecting the potential savings” via use of HIT. “If poorly designed or implemented, [HIT] will not bring these benefits,” she said, “and in some cases may even result in new medical errors and potential costs.”
John Halamka, MD, chief information officer at Beth Israel Deaconess Medical Center (Boston), pointed out that banks have standardized data formats, as demonstrated by the fact that “I can walk up to an ATM, insert my card, and retrieve whatever local currency I need.”
That observation, though, is qualified by the fact that the typical medical record contains far more data than the typical ATM bank record.
“Currently, there are more than a dozen organizations creating healthcare standards in the U.S.,” Halamka said, and “so many versions and variations that the standards are non-standard.” But he assured Ensign that the American Health Information Community (AHIC) is tackling the problem and has winnowed “570 candidate standards to 180 appropriate standards,” with the goal of paring the list to “a few dozen” by the end of this month.
Former U.S. House speaker Newt Gingrich, founder of the Center for Health Transformation (Washington) – an omni-present commentator on HIT issues – blasted the Congressional Budget Office (CBO) as a barrier to HIT adoption. Gingrich called the CBO an “anachronistic, static” entity producing “stunningly” inaccurate forecasts, and that the degree of these inaccuracies should be a major concern to policy makers.
The CBO, Gingrich said, “ignores the economic growth, efficiencies and cost savings that would result from implementing innovative and transformational policies.”
And he insisted that “the idea that CBO cannot score healthcare savings is just unbelievable.”
“The CBO revised its budget deficit projections for this fiscal year . . . [and] in less than six months, the CBO was off by nearly 12%,” Gingrich said. Citing several other erroneous forecasts, Gingrich asked: “How can our elected officials make informed policy decisions with such faulty analyses?”
In his testimony, Mark Leavitt, MD, the chair of the Certification Commission for Healthcare Information Technology (CCHIT), insisted that the laggardly deployment of HIT resulted in “billions of dollars wasted annually in unnecessary duplication of tests and procedures.”
CCHIT's execution of a proposal to develop compliance criteria and an inspectional regime for HIT systems, he said, has “met all contractual milestones to date.” CCHIT will announce its first round of quarterly certifications of HIT systems on July 18.
Regarding web-based access to EHRs and prescription fulfillment, Leavitt described privacy concerns as “a knee-jerk reflex,” pointing out that Internet financial transactions are an everyday event. “Paper cannot tell you who has looked at it,” he said, but that audit trails can identify observers of files even on the Internet.
“Consumers [of healthcare services] should be able to look at these audit trails,” Leavitt said.
CBO entered the HIT fray with its analysis of H.R. 4157, a bill sponsored by Nancy Johnson (R-Connecticut) to promote HIT.
In a June 15 summary addressed to Charles Rangel (D-Michigan), the ranking minority member of the House Ways and Means Committee, CBO stated that H.R. 4157 would make “all entities . . . eligible for the safe harbors,” including “clinical laboratories, imaging centers, suppliers of durable medical equipment, pharmaceutical manufacturers, and other entities.”
The document states that while the bill forbids any understanding that a doctor who benefits from shared HIT hardware or software would refer patients to a specific hospital in return, “CBO expects that, in some cases, that condition would be implicit” and that such a state of affairs would “lead to an increase in the volume of services that Medicare and state Medicaid programs pay for, thus increasing costs.”
The CBO document observed that the faster adoption of HIT “might lead to administrative efficiencies, which could reduce administrative costs for the government,” but that any improvement in healthcare utilization “might mean less use of medical services [or] might mean an increase in utilization.”
“CBO does not estimate any net change in direct spending” as a result, the document states, but CBO argued that the earlier shift to the ICD-10 standard for disease classification from ICD-9 would boost healthcare premiums, and because some such premiums are paid before federal tax calculations are applied to payroll, “H.R. 4157 would reduce federal revenues” by an unspecified amount between 2009 and 2011.