For many, however, optimism is dim as participation in the Physician Quality Reporting Initiative—the CMS effort to reward doctors who submit claims-based quality data—has lowered their expectations of what the feds can accomplish with their computers.
Dr. Steven Waldren, director of the American Academy of Family Physicians' Center for Health IT, says AAFP members participating in the PQRI have reported being put on hold for 45 minutes, getting paid late, or not getting paid at all.
“Meaningful use is bigger and more extensive than PQRI, and we have concerns we'll see the same problems,” he says. “People have already been burned once—with no payment or late payment. If that happens with meaningful use, maybe they'll have burned the bridge one too many times.”
Dr. John Halamka, chief information officer of Harvard Medical School and Beth Israel Deaconess Medical Center, both in Boston, says he'll be attending a National Research Council meeting in February to learn more about the plan. “In the meantime, I can say that healthcare reform will require us to focus more on clinical data and less on administrative data to improve quality, reduce cost and enhance access,” Halamka writes in an e-mail. “A new generation of IT systems and interoperability with (electronic health records) will be required for CMS to meet the president's goals.”
Dr. William Bria, chief medical information officer for 20-hospital Shriners Hospitals for Children, Tampa, Fla., and co-founder and president of the Association of Medical Directors of Information Systems, says the modernization upgrades will be expensive—for CMS and providers alike. But he adds that expense is only part of the equation.
“Everything is going to cost a lot of money,” Bria says. “This should always be a byproduct of the right thing to do for patients, instead of another hurdle to clear for financial incentives.”
According to the report, with this modernization plan, “The vision is to transform the data environment from one focused on processing claims to one with state-of-the-art capabilities for data analysis and information sharing.”
The report, which doesn't put a price tag on the upgrade, states that the plan will be updated after other reports from federal science and IT advisers are received. In an e-mail, CMS spokesman Joe Kuchler says it is premature to discuss the CMS report or how IT modernization initiatives may affect doctors and hospitals.
“Clearly, the impact of CMS data modernization on hospitals and physicians will be a central issue as we take into consideration the reports mentioned above and develop the next version of our implementation plan,” Kuchler writes.
The report notes that the CMS “processes and retains the largest volume of healthcare-related data in the world,” and it uses an IT system that has been developed with “many fragmented and piecemeal changes” over 45 years using “a patchwork of technology and data” that may not meet the demands of pay-for-performance programs or comparative effectiveness research.
The report mentions other shortcomings such as how the CMS keeps information about providers in at least 25 databases, each with a different purpose.
An initial focus of the modernization will be on “greenfield projects”—new installations instead of upgrades to existing systems—involving the creation of a single source of data for Medicaid and the Children's Health Insurance Program. The plan involves sending Medicaid and CHIP data to an “Enterprise Integrated Data Warehouse environment,” from which it will be integrated with Medicare data and will be accessible “for internal and external data consumers” from an Internet portal via a unified, web-based user interface, the report says.
The modernization is expected to generate savings by reducing the risk of system failure; simplifying system infrastructure through the retirement of hardware, applications and databases; reducing product license and maintenance costs; reducing labor costs associated with legacy hardware and systems; and allowing for negotiation of better prices on IT resources.
The report also touches on another factor creating urgency: Key staff members who know how the various system patches operate and know the “workarounds necessary to keep the systems functioning” are at or near retirement age.