IT Everything: Health IT Blog – The Gang of Carp vs. the Gang of Good Cheer

It's fashionable these days to call every cluster of U.S. Senators a gang.

The Gang of Six. The Gang of Eight.

This week, six Republican senators, having formed their own grouping—let's call it the Gang of Carp—released what they called a “white paper.” In it, they carped about problems with the management and direction of several federal health information technology programs funded by the American Recovery and Reinvestment Act of 2009. They said we need to “reboot” the program, as if it had crashed. That assessment was unbalanced and unfair.

Also this week, a group of 10 healthcare IT cognoscenti—let's call them the Gang of Good Cheer—put out their own “discussion paper,” finding bliss in healthcare IT. Pangloss would have beamed at their grand vision of “an exponential rate of progress in the use of health and health-related data” as if there weren't serious shortcomings thus far. Their paper, too, was unbalanced; cheerleading bordering on euphoria.

Healthcare IT is a many splendored thing, so two groups can have different perspectives, but let's keep a level head, shall we?

The Gang of Carp found five health IT “implementation deficiencies,” a lack of a clear path toward interoperability; not controlling costs as touted; the feds' lack of program oversight, privacy and security risks; and long-term affordability. The senators mentioned not a single good stemming from nearly $15 billion in public investments thus far. Those include $12.7 billion on direct EHR incentive payments and another $2 billion appropriated by the ARRA directly to the Office of the National Coordinator for Health Information Technology at HHS for a host of other health IT programs, including mobilizing consensus on standards and implementation specifications for interoperability of systems, state health information exchanges, the Beacon Communities, the regional IT extension centers and health IT training for workforce development.

Here's a start, senators—absent that funding, and the diligence over the last several years of the folks at the CMS, state Medicaid programs, ONC, state HIEs, RECs, universities and community colleges, we wouldn't be anywhere near where are now, with 75% of hospitals and 44% of physicians and other eligible professionals using decent quality EHRs. That's an outstanding achievement.

On the other hand, the Gang of Cheer so unfailingly accentuated the positive about the national health IT effort as to harm their report's overall credibility. The closest they came to something critical was that, despite government efforts, reporting of patient-safety problems “often does not occur,” which they handle by saying EHRs have the potential to improve the situation. They did recognize that privacy and security issues remain, but noted meekly that federal regulators only “have begun to explore modifications to research regulations to address these concerns.” HIPAA, the chief federal privacy law, passed in 1996. Why not recommend a fix, or at least tell the feds that after 17 years of foot dragging on privacy, they really need to get on the stick?

Meanwhile, the Gang of Cheer chose to ignore that the hardest 25% of hospitals and 56% of EPs that need to be brought into the EHR fold still haven't adopted or meaningfully used EHR systems, or that enormous challenges loom over standards adoption and interoperability, and propose solutions?

I'm an optimist by nature, but also a skeptic, so, I don't know which is worse, unbalanced carping or shameless cheer leading.

Moving the largest industry in the U.S. toward adoption and the meaningful use of information technology has been hard, is hard and will continue to be hard. It's been a long time coming, but it's going to take a lot longer to achieve.

Along the way, things have failed, are failing and will fail; but victories have been won, are being won and will be won.

This entire national health IT endeavor will go best with both realistic optimism and fair criticism, so folks will be encouraged, but also can self-correct as quickly as possible.