Wednesday, October 10, 2012
On October 4, four Republican Congressman, all with powerful positions concerning health care, wrote Secretary Sebelius urging suspension of "meaningful use" Stage 2 payments until a stronger program is in place, http://waysandmeans.house.gov/uploadedfiles/hhs_ehr_mu2_final.pdf. The Congressmen, Dave Camp (Chair of the House Ways & Means Committee), Wally Herger (Chair of the Ways & Means Subcommittee on Health), Fred Upton (Chair of the House Committee on Energy and Commerce), and Joe Pitts (Chair of the Energy & Commerce Subcommittee on Health), expressed concern that the Stage 2 regulations are too weak to insure genuine interoperability of electronic medical records. As a result, the Congressmen contended, a great deal of taxpayer money will be wasted on payments for electronic records that do little to improve care or reduce costs.
The Congressmen have a point, despite the apparant partisanship of the letter. There is a history of apparent reluctance on the part of the Office of the National Coordinator for Health Information Technology, and with it HHS, to meet head-on industry complaints about the difficulty and costs of meeting standards or industry contentions that regulation will stifle innovation. Models of technology forcing that were employed in furtherance of environmental protection appear not to have been considered by ONC and HHS. The requirement to meet Meaningful Use Stage 2 was delayed by a year, from 2013 to 2014, to allow vendors more time to develop products. As I indicated in an earlier post, http://lawprofessors.typepad.com/healthlawprof_blog/2012/09/onc-backs-off-rule-making-for-governance-of-health-information-exchange.html, ONC has decided not to develop governance rules for health IT exchanges, out of industry concern for impact on innovation. The stage 2 meaningful use requirements are not very strong, either, as the Congressmen point out. For example, core requirements are only that 50% of prescriptions be electronic, that only 50% of care referrals must be accompanied by electronic care summaries, that only 50% of patients must have access to health information (with 5% using it), and the EHR be capable of generating only one list of patients by condition. (For a handy comparison of stage 1 and stage 2 certification criteria, see http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/Stage1vsStage2CompTablesforEP.pdf) All of these--and other--requirements are important to anticipated improvements in care to be garnered from the introduction of EHRs. For example, generation of lists of patients with a specified condition (e.g. diabetes) may be an important way to ascertain the quality of patient management across a practice.
And there is a great deal of money in meaningful use. Individual providers may earn over $40,000 over 5 years by becoming meaningful users--even if their EHR, like the one offered by PracticeFusion, is entirely free to the physician-user (but paid for by advertising), http://www.practicefusion.com/. I hope that these payments will not simply become a windfall to medical professionals (and those whose products they purchase), but will have the teeth to genuinely improve patient care.