Sunday, March 6, 2011
Is there room for doom and gloom with regard to the government's ARRA-subsidized electronic health records initiative? We know Dr. Blumenthal is leaving ONC and returning to Harvard and there is already speculation, here, as to the type of replacement the Secretary should favor. In a recent New York Times article, "Carrots, Sticks and Digital Health Records," available here, the always well-informed Steve Lohr alludes to the risks of the new Republican Congress pulling back some of the HITECH funding. Lohr also perceptively contrasts Blumenthal's consensus-based model with the President’s Council of Advisors on Science and Technology (PCAST) recent recommendation, available here, that there should be more government-led “top-down design choices.”
According to a recent speech by Dr. Blumenthal reported by Government HealthIT, here, 18,000 providers have registered with CMS for the meaningful use-dependent subsidy program for EHRs. That sounds impressive. But what percentage of potentially eligible providers does that represent? Indeed, a recent PriceWaterhouseCoopers survey "Putting patients into 'meaningful use,'" available here, suggests that fewer HITECH subsidy participants will achieve "meaningful use" (down to 82% compared to 90% this time last year). Not surprisingly hospitals are pushing back against heightened criteria for Stages 2 and 3 or Meaningful Use; College of Healthcare Information Management Executives comment to ONC, available here.
New data also suggests that some of the core tenets of the EHR movement may be ripe for reconsideration. The contentious history of EHRs has been about funding, not about their impact on improved healthcare. Yet, new research by Max Romano and Randall Stafford, "Electronic Health Records and Clinical Decision Support Systems," Arch Intern Med. Jan. 24, 2011, here (subscription), casts doubt, noting "no association between EHR use and care quality for 19 indicators and a positive relationship for only 1 indicator." Less surprising, perhaps, is that patients still trust their doctors much more than EHRs, according to a new survey reported in Computerworld and available here.
So, is there any good news to report about EHRs? Well, Daniel Gaylin and colleagues, "Public Attitudes about Health Information Technology, and Its Relationship to Health Care Quality, Costs, and Privacy," Health Services Research, Jan. 2011, available here (subscription), report that a large majority of consumers favor the adoption of EHRs and believe that they will improve quality and that those benefits may outweigh privacy risks. And, in a February Health Affairs article "Many Physicians Are Willing To Use Patients’ Electronic Personal Health Records, But Doctors Differ By Location, Gender, And Practice," available here, Matthew Wynia and colleagues report that although "64 percent [of doctors] have never used a patient’s electronic personal health record, 42 percent would be willing to try." Way to go!
Under the last administration the only approach to EHR adoption was cheerleading. The last two years has seen a lot more than that. In a recent blog post, available here, the outgoing (yet hopefully not yet lame-duck) ONC leader waxed lyrical over the adoption numbers:
In the last two years, however, there has been a significant upward inflection in the adoption rate. For primary care providers, adoption of a basic EHR increased by half from 19.8 percent in 2008 to 29.6 percent in 2010. And with HITECH Act programs now in full swing, it looks clear that adoption and use of health information technology will go into high gear. Already, 81 percent of hospitals and 41 percent of office physicians are saying they intend to achieve meaningful use of EHRs and qualify for Medicare and Medicaid incentive payments.
In the circumstances perhaps it is only fair to let Dr. Blumenthal lead a few more cheers.