What's the big deal? That was the reaction of some industry observers to the recently announced plan by HHS and the CMS to provide 1,200 physicians in a dozen communities with bonus payments for quality reporting using electronic health-record systems. The move was touted by the government in its news statement as "the largest step yet" toward boosting physician adoption of EHRs, a goal of President Bush.
"It's a tiny step," said C. Peter Waegemann, chief executive officer of the Boston-based Medical Records Institute. "It's OK. I wouldn't want them to not do it, but it is certainly not a major step forward. It's certainly not such a big step as when we get standards."
HHS Secretary Mike Leavitt made the announcement during a phone call Tuesday morning to a news conference at 499-bed Good Samaritan Hospital in Cincinnati. Leavitt had been scheduled to be there in person, but was called to the White House to provide counsel on pending legislation on the State Children's Health Insurance Program. Cincinnati is home to a pioneering regional health information organization called HealthBridge.
Leavitt said the project will target physicians in small- to medium-size practices, where many Americans receive their healthcare. Most physicians have computers in their offices, Leavitt said, but only 25% have some kind of information system, and only 10% of doctors in group practices and 5% of physicians in solo practice are using an EHR.
"This is not just about getting computers in doctors' offices," Leavitt said, or even EHRs, noting that the goal is to solve simultaneously the problem of EHR adoption and interoperability.
Leavitt said the government doesnt have all the answers.
"We will learn a great deal about how to make this work better," Leavitt said. "We want to learn and we need to get better at paying for value and not just volume."
Leavitt said the program will be seen not only as a milepost on the road to EHR adoption, "It's a direction post that I believe that will be profoundly acknowledged and recognized in the marketplace. We have every reason to believe that this will be a red letter day when this history is written."
Waegemann, whose Medical Records Institute has been promoting healthcare IT trade shows for nearly 24 years, says the governments claim that the program will be seen as a historic event is "overblown."
"It seems that Washington wants to get a confirmation of what people in the field know already. It's a process in linking and making docs more compliant in getting information out, but it's not a major step."
Waegemann noted that with just 1,200 physicians, the bonus program involves only a fraction of the U.S. physicians working in ambulatory care. (With 311,200 office-based physicians in 2003-04, according to the 2007 report by the federal National Center for Health Statistics, 1,200 physicians is slightly more than three-eighths of 1% of all ambulatory-care doctors.)
He also said he doesn't see this as the beginning of a more expansive government-funded EHR subsidy program.
"I don't see the signs that we'll spend some real money or do some of the things that we need," he said.
Finally, it won't produce the paradigm shift that private industry soon will, Waegemann predicts. "I think that the announcement of Microsoft, or when Google comes out (with its much-anticipated healthcare offering) that we're moving to a Web-based architecture will be more than 20 times this announcement."
In a telephone interview Tuesday, Robert Kolodner, head of the Office of the National Coordinator for Health Information Technology, said when the program starts, EHR systems used by physicians at first may not be able to electronically report quality measures directly to the CMS because the data transmission methodology hasn't been set and programmed into available software. At first, physicians will aggregate the data at their practices and report it to the CMS by some other means.
Over the next couple of years, however, through government inducements, certified EHR systems capable of electronic quality reporting will come to pass. Those government programs will include the promotion of quality reporting "use cases" by the American Health Information Community, an HHS advisory group; the selection of appropriate data standards to make those use cases operational by the federally funded Healthcare Information Technology Standards Panel; and the inclusion of quality reporting functionality in testing criteria developed by the federally supported Certification Commission for Healthcare Information Technology. For now, "We're not going to be expecting (an EHR) system to do something that's not built in, but we'll raise the bar," Kolodner said.
Physician Allan Korn, senior vice president and chief medical officer of the Chicago-based Blue Cross and Blue Shield Association, attended the Cincinnati meeting and expressed support for the CMS bonus program, adding in a written statement that it is "an important step in recognizing and rewarding providers for delivering quality, coordinated care supported by the adoption and use of an EHR."
Like Waegemann, William Bria, the physician who is chief medical information officer at the Shriners Hospitals for Children system in Tampa, Fla., is less than overwhelmed by the CMS effort. Bria is also chairman of the Association of Medical Directors of Information Systems, a professional organization for physician-informaticists.
"We're past the time for saying whether this is a good idea or not," Bria said, noting, tongue-in-cheek, that he is "resisting the temptation to say it's an amazing grasp of the obvious."
In 2004, President Bush set a goal that most Americans should have a personal electronic health record by 2014 and he signed an executive order directing the government to push for a national health information network. But the president's order also required that federal officials could "not assume or rely upon additional federal resources or spending to accomplish adoption of interoperable health information technology."
In Bria's view, when it comes to physician adoption of EHRs, the government is still bumping its head against that ideology, although the latest program could be read as a deviation, "in a very modest way."
Still, Bria said, "It's certainly not an astounding amount of money. You could even be unkind and say it is an inadequate amount of money for the need in question."
For those, like Bria, who would welcome a larger federal role in IT subsidies, "It's not the solution that we were looking for. And if it fails, what does that mean, or (if) it succeeds, what does it mean?"
"We're past the time for saying whether this is a good idea or not," Bria said. "Having the whole nation up on something that is interoperable is nothing new. But how to do it? That is the question."
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