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bipartisan policy center

Think tank reports contradict GOP EHR claims

By Joseph Conn
Posted: October 9, 2012 - 2:15 am ET

Analyses in two reports by a bipartisan think tank contradict claims made by four Republican leaders who called for a suspension of federal incentive payments for electronic health-records systems because of a perceived lack of interoperability of health information systems.

One of the reports—both of which were released Oct. 4 by the Bipartisan Policy Center—was based on a survey of 527 physicians on health IT issues and states that physicians see potential for EHR exchange to positively impact healthcare performance.

Areas for improvement include the quality and the coordination of patient care, meeting the demands of new care models such as patient-centered homes and accountable care organizations, and even reducing healthcare costs, according to the report.

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A companion report indicated new Stage 2 performance criteria for the EHR incentive program as well as healthcare payment reforms that have laid a foundation for increased interoperability.

In their Oct. 4 letter to HHS Secretary Kathleen Sebelius, Reps. Dave Camp (R-Mich.), Fred Upton (R-Mich.), Wally Herger (R-Calif.) and Joe Pitts (R-Pa.) said the Stage 2 meaningful-use criteria, which go into effect in 2014, “fail to achieve comprehensive interoperability in a timely manner, leaving our healthcare system trapped in information silos, much like it was before the incentive payments.”

The Republicans called for HHS to delay payments and penalties for not meeting meaningful-use targets until the government can define clear standards for interoperability.

Electronic health information exchange could positively impact quality and coordination of patient care, meeting the demands of new care models, patient-centered homes and accountable care organizations and even reducing healthcare costs, according to the 30-page report, Clinician Perspectives on Electronic Health Information Sharing for Transitions of Care.

The survey questions and analysis for the report were provided by the American College of Physicians and Doctors Helping Doctors Transform Health Care, a not-for-profit coalition of several medical societies and organizations involved in health information technology.

The survey report also was mentioned in a statement last week by Camp, chairman of the House Ways and Means Committee.

According to the statement, “More work must be done to improve electronic health information technology standards,” citing the physicians' survey result that “more than 70% of respondents reported 'a lack of interoperability' as a major barrier that impairs them from sharing information in an electronic setting.”

The subsequent letter to Sebelius from Camp and his three colleagues called for HHS to “immediately suspend” federal EHR incentive payments until HHS “promulgates universal interoperability standards.”

In the Bipartisan Policy Center survey, however, the 70% of physician respondents who cited a lack of interoperability as a barrier to exchange were among physicians who self-described as those who were “not exchanging clinical information … at any significant level today.”

Janet Marchibroda, chairwoman of the health IT initiative at the Bipartisan Policy Center, said the survey did not define interoperability or ask questions to assess the level of interoperability physicians already achieved.

“We need more research in this area,” she said, adding that the findings support the idea that progress on interoperability is being made.

“Stage 2 of meaningful use builds upon Stage 1 by expanding requirements for providers to share information electronically for transitions of care and requiring certified EHR technology to receive, display and transmit many more types of data using standards, including nearly all of those identified by our survey of clinicians,” Marchibroda said. “So in other words, the meaningful-use requirements, which go into effect less than a year from now, considerably improve interoperability and support health information sharing, including those needs identified by the survey.”

The 36-page companion report, Accelerating Electronic Information Sharing to Improve Quality and Reduce Costs in Health Care, was bullish on Stage 2, saying the new rules contain “more robust requirements for interoperability and exchange, particularly as it relates to transitions of care,” adding that, for the first time, “the Stage 2 standards specify requirements for data transport.”

Survey results were collected from physicians between June 6 and August 21. Of all physicians surveyed, 83% were EHR owners and 75% were EHR users.

Eighty percent indicated they were “somewhat” or “very” positive when asked whether they believed health information exchange across care settings would improve their ability to coordinate care and improve the quality of patient care, 78% indicated the same levels of enthusiasm for exchange in helping them meet the demands of new care models while 57% marked the same level of belief that HIEs would reduce healthcare costs.

Lack of interoperability by their EHRs and lack of information exchange infrastructure were cited most frequently (by 71%) as a “major barrier,” followed by the cost of interfaces (69%), followed by privacy and security concerns and liability issues, which tied at 25%.

Physicians surveyed worked in practice sizes ranging from groups of two to five physicians, 34%; solo practitioners, 24%; six to 10 physicians 16%; and 11 or more physicians, 26%. Most (51%) were in primary care. Only 25% worked for hospitals or academic medical centers, with 55% working in ambulatory care/office-based practices or multispecialty clinics.

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