The amount of government money paid out in incentive payments to encourage eligible health care providers to move from paper medical records to certified electronic health record (EHR) systems -- i.e., the meaningful use incentives -- has begun to draw the attention of lawmakers.
Pointing to the nearly $8 billion in incentive payments made so far and the estimated $20 billion the government will pay out in total under the Health Information Technology for Economic and Clinical Health Act (HITECH Act), Representative Ben Quayle (R-AZ) did not mince words in his opening remarks as chairman of the House Subcommittee on Technology and Innovation, which held the hearing on November 14.
“This is a significant Federal expenditure,” he said. “Given our current budget situation, it is vital that these taxpayer dollars are spent effectively in ways that lead to reduced costs and better health care down the road. Nearly four years after the HITECH Act, taxpayers should know what we have to show for it.”
Among the subcommittee members chief concerns was progress on interoperability of EHR systems. If data cannot be easily shared among providers because they each have different EHR systems, then it will be much more difficult to realize the full benefits of EHR systems in lowering costs through coordination of care, reduction in duplicative testing and procedures, and fewer medical errors.
Representative Quayle also expressed concern that some meaningful use requirements fail to take into account the complexity of health care and may be diverting valuable time and resources from other work that would do more to lower costs and advance quality care.
Farzad Mostashari, National Coordinator for Health Information Technology, testified in defense of the program. He explained that the HITECH act set up the Office of the National Coordinator for Health Information Technology (ONC) to facilitate a collaborative approach on reaching interoperability instead of having the government determine a single EHR platform that all providers would need to adopt. In addition, while it may look like there has been little progress on interoperability because moving records is still difficult, there has actually been a lot of progress made when one considers where health IT was at when the HITECH act was first passed.
“In 2009 when we were drafting the initial set of meaningful use criteria and required standards, our plans necessarily responded to the reality we faced,” Mostashari explained. “Different vendor products used different proprietary or local codes; there were strong disagreements about how laboratory results or patient summaries should be packaged; and there was simply no consensus on how the Internet could be used to securely send patient information. Over the past two years, thanks to the initial steps we took in stage 1 and the relentless work of almost 1,000 industry participants in ONC’s standards and implementation activities, those problems have been ameliorated, and we can now leap towards interoperability and exchange in stage 2.”
Mostashari’s testimony was followed by testimony from:
- Charles H. Romine, Ph.D., Director, Information Technology Laboratory, National Institute of Standards and Technology
- Marc Probst, Chief Information Officer and Vice President, Information Systems, Intermountain Healthcare
- Rebecca Little, Senior Vice President, Medicity
- Willa Fields, DNCs, RN, FHIMSS, Professor, School of Nursing, San Diego State University
The other witnesses agreed on the progress that has been made in the adoption of EHR records thanks so the meaningful use incentives program, but acknowledged that interoperability is a more difficult goal to achieve, especially in the short term.
“We must set a clear road map and support an exchange infrastructure and the adoption of standards that will make it easier to share health information so clinicians and patients have the information in the form and time they need it to make appropriate healthcare decisions,” Probst said. “What may seem like small steps required by meaningful use, are actually big efforts for provider organizations and if not done correctly will not only fail to achieve greater efficiencies for health care, but could ultimately create less secure and less safe healthcare delivery.”