One sure indicator that the political status quo in Washington—a divided Congress and four more years of continuity in the executive branch—will be maintained came this morning when the Health IT Policy Committee met to discuss the future course of the federal electronic health-record incentive payment program.
The committee, created by the same American Recovery and Reinvestment Act of 2009 that created a program of $27 billion in incentive payments for the adoption and meaningful use of EHRs, was readying for publication and public comment its recommendations for Stage 3 meaningful-use criteria, which likely won't go into effect until at least 2016.
Dr. Farzad Mostashari, the national coordinator for health information technology, dropped in on his gathered advisers to present them with an addendum of seven suggestions he wanted the committee to make sure were addressed in what is now a 38-page document of Stage 3 rules. The committee's recommendations are slated for official publication in the Federal Register sometime next week.
One of Mostashari's most emphatic asks was that the committee take a hard look at incorporating into the Stage 3 targets a requirement that providers exchange information using query-and-response technology.
Such technology was to be at the core of the proposed National Health Information Network touted by the first national coordinator, Dr. David Brailer, when he took office in 2004. It would enable the electronic records of an unconscious patient from New York to be found and accessed by an emergency-room physician in California. Query-and-response requires a level of sophistication significantly higher than the "push" information exchange technology to be used in Stage 2, where a message, such as a care summary, can be sent via secure e-mail from one provider to another.
"Stage 2 was a giant step forward for health information exchange," Mostashari said, but "the big missing piece here" is that "if I still go to an emergency room, they can't query my information. That's the first issue I want to put back on the table."
Though he didn't mention it specifically, Mostashari's boss, HHS Secretary Kathleen Sebelius, received two letters last month from Republican leaders in both the House and the Senate criticizing—with varying levels of acidity—an alleged lack of health information interoperability despite federal expenditures for health IT incentive payments under the 2009 stimulus law.
The federal push for healthcare IT had previously enjoyed bipartisan support, and while it may have lost some immunity from political sniping recently, there's no turning back, according to Dr. William Bria, president of the Association of Medical Directors of Information Systems and formerly chief medical information officer for the Shriners Hospitals for Children system, Tampa, Fla. Bria was recently named one of Modern Healthcare's Top 25 Clinical Informaticists
"This is a permanent transformation in healthcare," Bria said, and interoperability through query-and-response is going to be part of it.
"We're not there yet," he said, but "you're approaching the time when, sea to shining sea, you can do it. It's the delivery on the 'information anywhere' vision."
The election results also mean that the country will "stay the course" on healthcare payment reform, Bria said. Technology will be an important tool to the "rebalancing of healthcare delivery, and that includes payment."
"What we need is the pressure of politics in the next four years, and it is going to be on cost containment," Bria said.
For example, he said, Medicare might take a second look at paying for five office visits a year for a patient with a controllable chronic condition, when the information exchanges for several of those checkups could be accomplished more efficiently through new home health programs and patient monitoring technology.