Getting A Return on Electronic Health Record Investments

Note from Brian. A fundamental health care infrastructure problem is the continuing inability of Electronic Health Records (EHR) to seamlessly share data, despite a 4 year program that taxpayers poured $30 billion into. 

This failure in interoperability is a barrier to care coordination, forcing poorer outcomes at much greater cost. Not having complete or consistent patient information also seriously degrades the capacity of any health care provider to perform under risk-based reimbursement arrangements.

Perhaps the best solution to this issue is Direct exchange, which has created a framework, that would be integrated into every EHR, for secure exchange using a national network of accredited email providers. Some 160 communications and provider organizations now support this fledgling effort, on more than 10 million patient encounters have been updated using it.

No group should be more invested in interoperability and complete patient information than purchasers. These attributes are clearly in the interests of better care and cost.

On Thursday at Noon ET, David Kibbe, MD, the Founder and CEO of Direct Trust, will host a Webinar that lays out the business case for an interoperability platform, and why purchasers should support it. Hope you'll join us.

In the meantime, here's an article that lays out the basics of the issue.

David C. Kibbe and Brian Klepper

A standoff is brewing between the federal government and America’s electronic health records (EHR) industry that threatens to exacerbate our health care cost crisis and undermine reform efforts.  Despite accepting some $30 billion in subsidies that encouraged EHR purchases and promised to facilitate seamless health information exchange, key EHR companies have steadfastly refused to make their tools capable of talking to other EHRs by complying with a national standard. They have instead tried to force the market to adapt to their own proprietary approaches. Physicians, hospitals, and patients have been caught in the middle, wondering who will come out on top.

Fulfilling their commitment to the American taxpayers will require all EHR firms to reconfigure their products so they can exchange data, or return the money they received. The question is how to do this without harming the doctors and hospitals that have implemented these products.

Under what is known as the Meaningful Use program - part of the 2009 stimulus bill - the federal government has awarded 400,000 doctors and hospitals yearly bonuses to purchase and “meaningfully use” EHRs. Bonuses were passed through to the EHR vendors, and doctors could then use the EHRs for functions like tracking conditions and care, prescribing medications and ordering tests. Clinicians were supposed to share medical records, regardless of their vendor, as seamlessly as banks wire money – this is called “interoperability” - creating a national electronic health information superhighway.

But little has turned out as planned. Providers got mostly free EHRs and vendors reaped huge financial rewards, all at taxpayer expense. But many EHRs still can't communicate. Given the importance of data sharing to care coordination, there has been little objective evidence that care or cost has improved, or that patients, purchasers or providers have benefited from the newly installed EHRs.

Proponents of the Meaningful Use program have argued that EHR adoption will eventually pay off. But replacing paper records with software does not inherently improve the processes that underlie care and cost, and in fact it can complicate daily routines, creating more work for busy professionals. Even though most hospitals and medical practices now use EHRs, these same organizations still rely on non-secure faxes and inefficient snail mail to move patient information from one place to another. Many still expect patients to keep their doctors informed by shuttling paper records, often printed out from the EHRs, from one office to another.

The failure to make EHRs capable of sharing data has placed the whole effort at risk. Four years after the Meaningful Use program began, doctors and hospitals are dropping out in record numbers, even though their Medicare and Medicaid payments may be reduced significantly as a result. Nearly 260,000 physicians and other clinicians experienced one percent Medicare payment reductions on January 1, 2015 for failing to meet the 2014 Meaningful Use requirements. Another 55,000 providers were granted “hardship exemptions” from penalties because their EHRs couldn’t perform the required functions.

Simply put, the government’s Meaningful Use program became burdened with too many requirements that were neither meaningful nor useful. Most important, regulators failed to grasp that EHRs greatest value comes not from locking away large amounts of data on each patient, but from making relatively small amounts of really relevant patient information easily transferable from one EHR user to another. The upshot was that providers grew increasingly dissatisfied with their EHRs and disenchanted with the federal bonus program.

A recent Congressional report sounded an alarm on this point, noting that non-interoperable EHRs “frustrate Congressional intent [and] devalue taxpayer investments in Certified EHR Technology).” An accompanying bill demanded that the Meaningful Use program begin de-certifying EHR vendors who put barriers in the way of information exchange.

De-certification would cost those vendors dearly, but would also leave their provider customers in a bind. Instead, legislation could immediately modify the Meaningful Use program to allow more time to achieve EHR interoperability. It could halt new requirements until 2018, and limit non-participation penalties to a maximum of one per cent of Medicare payments. The EHR certification process could be quickly redesigned to prevent closed platform products from receiving a pass from the certifiers, and re-certification could be required by end of 2015.  

Widespread private and secure health information sharing can be achieved through open standards that are already available. Tools using these approaches allow doctors and hospitals to learn to manage care and cost under the risk-based payment arrangements they know are coming, while implementing more and better care coordination programs – by far the most meaningful uses for EHRs.

Until we act on this issue, America’s health care quality will lag. We’ll continue to have longer waits at doctors’ offices, more needless and repetitive paperwork, billions of dollars wasted and lives lost due to incomplete or delayed patient information. It’s as though we launched a rocket to the moon, and then applauded while it endlessly circled the earth, never reaching its destination.

Dr. Kibbe is CEO of Direct Trust and serves as senior adviser on health IT issues to the American Academy of Family Physicians (AAFP). Dr. Klepper is CEO of the National Business Coalition on Health.