The federal government has pushed hard to get healthcare providers to put patient records online, but according to a group of Republicans in the U.S. Senate, billions of dollars have been wasted and even more billions may be at risk.
“Reboot: Re-examining the Strategies to Successfully Adopt Health IT” is a white paper authored by six Republican senators: John Thune (S.D.), Lamar Alexander (Tenn.), Pat Roberts (Kan.), Richard Burr (N.C.), Tom Coburn (Okla.), and Mike Enzi (Wy.). The report lists five reasons why the current effort to move to electronic health records is faulty (these are further detailed at the end of this article):
- Lack of Clear Path Toward Interoperability.
- Increased Costs.
- Lack of Oversight.
- Patient Privacy at Risk.
- Program Sustainability.
In the section on “Increased Costs” the senators point to healthcare providers, who they believe may misuse the system by way of a “phenomenon” known as “code creep.” In the white paper, code creep is defined as the supposed practice of physicians cutting and pasting one electronic health record into another “making it appear that the physician conducted more thorough exams than, perhaps, they did.” Other examples are physicians who may use the convenience of EHR systems to order additional medical tests.
The senators point to a recent New York Times story about studies that have found that since EHR systems have been put in place, healthcare costs have increased rather than declined. However, there is no hard data that “code creep” is a widespread problem, or even if it exists at all. However the senators want the federal government to suspend the EHR program and take a hard look to see if any of the code creep practices are prevalent.
The senators published the paper “to initiate a dialogue with the administration and the stakeholder community” and “to foster cooperation between all stakeholders –- including providers, patients, EHR vendor companies, and the Department of Health and Human Services –- to address the issues raised in this paper, evaluate the return on investment to date, and ensure this program is implemented wisely.”
What follows are more detailed explanations of the five flaws with EHR program from the senators’ report:
Lack of Clear Path Toward Interoperability. The HITECH Act, a $35 billion program of grants and incentive payments in ARRA, was created to promote the use of electronic health records (EHRs) among hospitals and physicians, with the ultimate goal of incentivizing the adoption and use of health information technologies meeting a certain data standard so that providers can share patient health data nationwide. The ability to share data, it was said, would reduce the overall need for as many tests, arm providers with better patient information, and enhance the quality of patient care. However, to achieve this aim, having interoperable systems is necessary. Unfortunately, early reports suggest that federal incentive payments are being made without clear evidence that providers can achieve “meaningful use,” or the ability to use the health IT program internally, and without an adequate plan
to ensure providers can share information with each other.
Increased Costs. Members of Congress and policy analysts across the political spectrum have promoted health IT as one tool to help bring down health care costs. Through efficiencies in storing and sharing records and ordering and coordinating patient care, as well as structural savings through better data and research, cost savings are estimated in the billions of dollars in the next decade alone. For example, the Congressional Budget Office estimated that the HITECH Act will save the Medicare and Medicaid programs a total of about $12.5 billion through 2019. However, early reports raise concerns that health IT may have actually accelerated the ordering of unnecessary care as well as increased billing for the same procedures.
Lack of Oversight. Based on Department of Health and Human Service’s Inspector General and Government Accountability Office (GAO) reports as well as stakeholder comments and a review of program data, it is increasingly clear that the Administration does not have adequate mechanisms in place to prevent waste and fraud in its health IT programs. Too often we have heard stories of “money spent” being used as a metric of success, rather than specific, concrete program goals and tangible deliverables that are focused on achieving interoperability. There have been reports of taxpayer dollars being paid to providers who cannot or do not have to demonstrate that the technology is actually used as prescribed, because the administration relies on provider “self-attestation” in many cases to determine eligibility for payments. In some cases, contractors receiving government funds may be creating obstacles to interoperability. In other cases, providers who have previously received federal incentive grants are reportedly now forced to adopt less advanced technologies to meet current standards, effectively forcing them to scrap prior federally subsidized investments.
Patient Privacy at Risk. We are concerned the administration has not done enough to protect sensitive patient information in a cost-effective manner. Among other problems, regulations related to payments made to providers do not require providers to demonstrate that the technology is secure; consequently, patients’ sensitive, personal medical information may be at risk. In fact, the Inspector General of the U.S. Department of Health and Human Services found that the security policies and procedures at the Centers for Medicare and Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology – two federal entities which oversee the administration of the health IT program – are lax and may jeopardize sensitive patient data. Being proactive in addressing privacy and security concerns while minimizing the additional burden on providers is a critical part of ensuring the long-term success of EHRs. Further, problems with data entry, computer programing errors, and other unforeseen complications can affect the security of patient data and have the potential to jeopardize patient care.
Program Sustainability. For providers who have accepted grants or incentive payments, it is unclear how much it will cost to maintain their health IT systems after the initial grant money and incentive payments run out. For example, in 2015, incentive payments in most scenarios cease, and providers face penalties in the way of reduced Medicare reimbursements if they do not comply with federal requirements. Even worse, these penalties are most likely to affect small providers who may not have the economies of scale needed to make complex electronic systems cost-effective. Moreover, the complicated patchwork of overlapping reporting and compliance requirements is already placing ongoing compliance burdens on all participating providers. We are concerned that compliance and maintenance costs for providers may be unreasonably burdensome.