In the halls of Congress this week, one House committee moved along a $560 million health information technology grant and loan package, while a separate subcommittee heard testimony on why the experts who testified think this is a good idea.
The Energy and Commerce Committee passed the Protecting Records, Optimizing Treatment, and Easing Communication through Healthcare Technology Act of 2008or the PRO(TECH)T Actby voice vote, while the Ways and Means Health Subcommittee held a hearing on promoting the adoption and use of health IT. Officials from organizations such as the American College of Physicians, the Marshfield (Wis.) Clinic, the Congressional Budget Office, and others spoke at the hearing.
Before the House Budget Committee CBO Director Peter Orszag repeated his message that a Medicare mixture of both carrots and sticks was needed to spur health IT adoption.
But Yul Ejnes, chairman of the ACPs Medical Services Committee, warned Congress not to mandate health IT use given that, under the current state of affairs, for many physicians, the business case to invest in EHR/HIT simply does not exist.
It also does not make sense to mandate HIT given that issues relating to interoperability, standards and functionality have yet to be fully resolved, said Ejnes, an internist in a 50-physician private practice in Cranston, R.I., in his written testimony. Mandates are not sensitive to differences in practice resources, patient-case mix, staffing ratios, geographic locations, ownership and myriad of other factors that will affect the ability of practices to acquire and use HIT.
Ejnes also suggested that:
- Physicians who acquire and use information systems be paid for coordinating care.
- That Congress make grants, loans and or tax credits available to small physician offices to help them acquire computer hardware and software.
- That the federal government further clarify the self-referral safe harbor exceptions that allow hospitals and other entities to assist physicians in acquiring health IT (also noting that three federal agencies are working on their own rules for this).
Ultimately, however, Ejnes testified that health IT would have the greatest benefit within the patient-centered medical-home, or PCMH, model.
Financial incentives to facilitate the promising PCMH delivery model provide a mechanism to further HIT adoption and use in the context of an improved delivery system, Ejnes said. PCMH practice recognition that is inherent in the model provides assurance that the practice has acquired and uses HIT in an optimal manner. Collecting, analyzing, using and reporting how care compares to vetted measures of clinical quality is also inherent in the PCMH model.
One significant barrier to health IT adoption that Ejnes identified is that the financial savings that can accrue by using electronic records go to other parties instead of the physicians who invest in the technology. This point was echoed by Douglas Reding, vice president of the 780-physician Marshfield Clinic, one of the largest private practices in the U.S., and one that has spent some 30 years working on its own EHR, which it calls Cattails MD.
There is no question that HIT is expensive, and perhaps cost-prohibitive, Reding said in his written testimony. Physicians and providers are expected to pay for it, funding and maintaining the infrastructure of systems that utilize population-based information to improve patient health. There is a very small return on the investment in HIT to the physician, which is a return in efficiency and time. The significant benefits accrue to the patient and the payer, whether it be employers or the government. If Congress mandates changes such as imposing restrictions on the utilization of patient information for operations as proposed in H.R. 6357, we estimate that the cost of HIT will increase dramatically, undermining the return on investment that should accrue to patients and payers.
Even Dave Whitlinger, director of healthcare device standards and interoperability with Intel Corp., told the subcommittee that some mix of financial support and incentives was needed.
This was in contrast with Intel Chairman Craig Barrett, who drew the ire of physicians and healthcare leaders when, at the 2006 Healthcare Information and Management Systems Society conference, he suggested that they must stop thinking that someone else is going to pick up the tab for IT. "No other industry has discussion about who's going to pay for putting a computer in my facility to make me work better," Barrett said at the time.
Whitlingers comments carried a different tone, and he spoke of how IT could help achieve the transformations the nations healthcare system needs.
While the bulk of healthcare today is delivered in hospitals and clinics, todays acute-care-centered system is ultimately unsustainable in the future, he said in his written comments. The old one-on-one physician to patient paradigm will not suffice. We need to move away from the physician-centered care-delivery paradigm toward a patient-centric model where delivery and funding are channeled via care teams with a community approach toward care. IT is a powerful enabler to help provide the care necessary to meet this tide head on.
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