The discussion at the June 16 meeting included some criticism that the work group had not called for measurable improvements in claims processing and other cost-cutting activities involving use of an EHR until 2015, not in 2011 when other clinical performance metrics are proposed by the work group to be required and when the initial subsidy payments under the law will come due.
Blumenthal said the insurance industry, in a letter to President Barack Obama, called for the president and Congress to create a uniform, national billing system. He said that EHRs should lead to a more efficient billing and payment process. Blumenthal noted the work group is to report back with a revised draft of its meaningful use definitions in mid-July and should have the efficiency issue revisited by then.
The committee is going to go back to the drawing board, Blumenthal said. We can, I think, do better than we did and theyre going to try.
But Blumenthal also noted some of the clinical measures the work group already has included in its proposed meaningful-use definitionssuch as blood pressure monitoring, or cost prompts for medicationscould also lead to efficiencies in terms of lowering overall healthcare costs. Keeping people on their blood pressure medications, for example, is an extremely cost-effective therapy for stroke, heart failure and complications from diabetes, he said.
Burgess appeared to play devils advocate, saying physicians coming out of medical schools and residency programs already are comfortable with computers, and in fact, will more than likely insist on joining a practice that has them. This is going to be the norm, he said. Why is this so important to push this along faster than would normally occur. It will occur anyway. I guess what Im getting at; is the juice worth the squeeze?
Blumenthal said if all American physicians were of the age of people leaving residency, evolution might be a workable strategy. But there are 220,000 physicians in the U.S. over the age of 55, about one-third of practicing physicians. Blumenthal said he didnt think it was fair to ask American citizens to wait to get around this generational change.
To those physicians inclined to wait due to the cost of the systems or the lack of help implementing them, its for those folks that this legislation has been enacted, Blumenthal said.
Blumenthal said it will take until the end of the summer to announce a series of support measures for physicians seeking to implement EHRs, most likely a reference to an HHS-funded, health IT extension service that the stimulus law requires be built from scratch. They will be, we hope, a down payment on creating the infrastructure in helping people adopt electronic health records, he said. Then, there will be notices for applications for funding published in the federal register.
Burgess also asked whether Blumenthal will take advantage of the Veterans Affairs Departments Veterans Health Information Systems and Technology Architecture clinical IT system as an open-source system to help providers meet meaningful-use standards.
Blumenthal said it will be up to providers to go into the market and find systems that are best for them, but added, Open-source software like the VistA system can do that. It is a very, very capable system. I expect that it would meet the requirement for meaningful use. There are many reasons why the VistA system hasnt taken off and there may be other open-source systems that will take off and be certified for meaningful use, he said.
Blumenthal said hed prefer to focus any near-term efforts toward developing interoperability between providers on the local and regional level, noting that as a practitioner in Boston he is far more likely to have patients receiving treatment at facilities nearby than across the country.
He also said the some states have more-stringent privacy rules than the main federal rule under the Health Insurance Portability and Accountability Act of 1996, which the stimulus law also amended and made more stringent.
We are going to be working with states to resolve those conflicts and try to get them to do it within the 2011 time frames, Blumenthal said.
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