WASHINGTON—The federal electronic health-record incentive program has produced too few benefits for the cost involved and imposed overly harsh mandates on providers, senators of both parties said Tuesday during a Senate Health, Education, Labor and Pensions Committee hearing.
The program started in 2009 by giving providers and hospitals cash in exchange for using EHR systems. Its goal was to improve care by moving data seamlessly through the healthcare system, but, “The evidence suggests these goals haven't been reached,” said Committee Chair Sen. Lamar Alexander (R-Tenn.).
The administration was “rushing ahead with penalties” that will touch half of eligible providers, he said, “I'm interested in finding ways to become enablers rather than mandaters.”
Alexander's frustration was shared by Sen. Sheldon Whitehouse (D-R.I.), who said, “I would love to work with my colleagues with rebooting meaningful use.”
Whitehouse was critical of the program's gaps in addressing behavioral health and nursing homes. The Democratic senator also tapped a concern shared by most of the legislators present: the high cost of building interfaces that allow doctors and hospitals to share data between themselves.
Whitehouse argued that vendors often “don't put their connecting fees in their pitch.” That contributes to a lack of transparency, said University of Michigan assistant professor Julia Adler-Milstein, who called for a Consumer Reports-style database for EHRs. Such a reference tool might allow doctors to choose systems that allow data to be shared more cheaply, she said.
Witnesses disagreed about the cost of data-sharing. Peter DeVault, director of interoperability at Epic Systems Corp., said that his EHR system involved two costs for hospitals seeking to share data: an upfront cost, and a licensing cost. The latter involves a per-patient-per-year cost of $2.35, he stated. The total costs, he suggested, “could vary widely.”
Another witness, Dr. Robert Wergin, president of the American Academy of Family Physicians, found DeVault's estimates to be too small, stating that costs of data-sharing were more typically $70,000 to $80,000 for his members.
The costs of that data-sharing fed into another often-raised argument: that more data-sharing would occur if there were a stronger business case for it. DeVault argued that, for example, doctors in capitated or accountable care organization financing arrangements would share more data. Providers under those types of financing regimes need to share data to save money, he suggested.
But that's not necessarily entirely clear, suggested Adler-Milstein. She is a member of an international group studying health IT convened by the Organisation for Economic Co-operation and Development, a group studying high-income economies.
Despite a variety of financing regimes, she said, “I don't think there's a country that we can say, 'They've gotten it right (with data-sharing) and we should look to that model.' ”
Despite the lack of conclusive answers, Alexander seemed convinced by the need for action, saying that he and other committee senators would be examining the sector to see how they could contribute.
Follow Darius Tahir on Twitter: @dariustahir
