The idea Tuesday was to have the National Committee on Vital and Health Statistics hold the first of two days of hearings on the meaningful use of electronic health-record systems.
The NCVHS got a lot more to chew ona daylong discourse on the ills of the nations healthcare system and a broad overview of what role health information technology might play in healthcare reform.
In the 785-page American Recovery and Reinvestment Act of 2009, terms relating to meaningful use appear 108 times in the sections on Medicare and Medicaid incentives and penalties for using or not using health IT. According to a Congressional Budget Office estimate, the stimulus act will funnel as much as $34 billion into the IT subsidy program.
For hospitals to qualify for stimulus act bonus payments, they must install and put certified EHR systems to meaningful use, which is defined, for hospitals, as the use of EHRs to exchange health information to improve the quality of healthcare, such as promoting care coordination and to submit information on clinical quality and other measures selected by HHS.
For physicians to qualify for EHR subsidies under the stimulus act, they must meet the above two requirements and also use their systems for electronic prescribing.
HHS rulemaking this year is expected to flesh out these cursory definitions in the statute. The NCVHS, which is a key advisory panel to HHS on health IT, got the ball rolling. An NCVHS executive committee heard testimony from 24 witnesses in six, hourlong panel sessions at a Washington hotel. Another 15 witnesses on four panels are scheduled to testify today.
Helen Darling, president of the National Business Group on Health, set the tone for the day by calling for a rapid transition from this absurd, outmoded paper-based system of healthcare record-keeping to a widely adopted EHR system. Darling said that it took 12 years to learn that a medication everyone had considered safe was actually dangerous, and it also took the Kaiser Permanente medical record system to find that out.
But there were even greater expectations for healthcare IT than improved patient safety. IT was touted by the stimulus act proponents as part of an overall program of healthcareeven national economicreform. It was again during the NCVHS hearings.
The financial crisis, the meltdown that this country has gone through has shown us more dramatically and tragically than ever that we need to transform the American healthcare system, Darling said. We have a fiscal crisis, not just a healthcare crisis, and the combination of all those things together means we have to act. And we have to act urgently.
Judy Murphy, a nurse who is a board member of the American Medical Informatics Association and the vice president of information systems applications for Aurora Health Care system, Milwaukee, was on one of two panels addressing the glide path to meaningful use. But Murphy, who described herself as a veteran of multiple EHR installations, took issue with the aviation analogy, likening the path ahead to more of an expedition than an airplane landing.
Healthcare has migrated to models of care that are patient- and wellness-centric, Murphy said. We see the patient as the center of the universe, but our patient records have not kept up, she said. Meaningful use, she said, will require healthcare workers to keep up with huge amounts of data as well as the inevitable changes in best practices, but patient-centered record-keeping also must be brought into the mix.
The move to personal health-record systems that are connected, or tethered, to provider EHRs is one example of providers and patients beginning to tap into the value of e-health, Murphy said.
When we open up our registration systems and scheduling books, it demonstrates that they are partners in their healthcare, Murphy said, referring to patients. It also puts the obligation of ensuring the accuracy of demographic information, personal and family histories and allergies where it belongs, with the patient, she said. I believe this area has the largest potential for the improvement of our healthcare, allowing the patient and the practitioner to co-manage healthcare.
Several panelists, including Allscripts-Misys Healthcare Solutions Chairman and CEO Glen Tullman, recommended the not-for-profit Certification Commission for Healthcare Information Technology be retained as the body to certify EHRs under the stimulus act. Tullman, whose Chicago-based firm develops EHRs, is a former member of the CCHIT board of trustees.
The use of claims data gleaned from billing systems versus clinical data pulled from EHRs to meet the meaningful use criteria of quality reporting also was debated.
Carolyn Clancy, the director of the Agency for Healthcare Research and Quality, said that claims data will likely have to do for a while. Several others stumped for the inclusion in the definition of meaningful use that providers be required to use EHRs that automatically create and post patient information to disease registries for clinical data analysis and quality improvement.
We need to build these capabilities in order to be ready for performance-based payment reform, said Elliot Fisher, a former internist with the Veterans Affairs Medical Center, White River Junction, Vt., and now a professor of medicine at Dartmouth University. Fisher recommended starting with two or three registries, maybe as many as 20, then youd be a long way down the road in two or three years in performance-based payment reform.
Fred Trotter, an IT consultant and programmer, represented the free and open-source health IT community, asked only that the government not stack the deck through stimulus act regulations and EHR certification requirements in favor of the vendors of proprietary software. Mandating the use of Current Procedural Terminology, or CPT, codes, a proprietary procedure-coding system developed and sold by the American Medical Association, or requiring prescriptions be moved through the for-profit SureScripts network, a proprietary system developed by the two main retail pharmacy industry trade associations and three large pharmacy benefit management companies, would be contrary to the tenets of open-source development, he said.
Trotter asked, rhetorically, why this meeting was taking place and why it has been deemed necessary to provide incentive funding before a high-tech industry like healthcare would computerize.
Were here because weve had a massive, catastrophic market failure, Trotter said. Sellers of proprietary healthcare IT systems have failed to provide a compelling option that doctors can buy.
In contrast, an outstanding instance of an EHR in meaningful use already exists at the VAs healthcare system because its VistA EHR was developed in the open-source spirit.
Only VistA has been widely adopted, has been doing all the quality stuff that we want to talk about, getting the moving of data, getting all the hospitals to talk to each other, and theyve been doing it for a long time.
Trotter reiterated a plea made by members of the open-source community during a town hall meeting with CCHIT leadership during the Healthcare Information and Management Systems Societys meeting that open-source software requires a different testing and certification methodology than that developed by CCHIT, which designed its system for proprietary software.
The VistA spirit, the open-source spirit, is the Microsoft of this industry, Trotter said. What Im going to ask you to do is to please, dont hold us back.