OT: I am trying to raise awareness of another set of intrusive laws and regulations headed our way.
These are my notes on a speech I heard recently at a conference. The speaker told a way that the government is going to “help” us.
HITECH is a provision of ARRA (the Porkulus bill) dedicated to increasing our use of EHRs. EHR means Electronic Health Record. In the context of this talk, EHR means both “individual medical record” as well as “software used to record this medical record.”
[As background information here: there are a lot of software companies on the market providing EHRs or EMRs as they are also called (electronic medical records). These companies sell primarily to hospitals and other large organizations but also would like to sell into smaller practices. To date, the adoption rate is not high. The intentions are good: a good medical record can prevent the doctor from giving you drugs that have a bad effect with your other drugs, can give the doctor the complete picture of your health and history, and can eliminate duplicate tests.]
HITECH provides a “stronger and more effective set of incentives” for the adoption of EHRs.
Title 13 provides $2 billion to develop foundations for EHRs.
Title 4 provides $23 billion in incentives to Medicare/Medicaid providers who adopt “meaningful EHRs.”
At some point in the future (couple years?), there will be financial penalties, and they’ll be “much larger” than the incentives.
“We’re here to stay.”
They are working on rules for “meaningful use.” They’ve sent the proposed rules out for review (he didn’t specify who the reviewers are) and have received approx. 3000 comments. I think the final list is expected to be complete in 2012.
Currently on the list: At least 80% of the patients seen or admitted must have at least one entry in an EHR. At least 80% of patients 13 years old or older must have smoking/non-smoking status recorded. There were other items on the list, but I didn’t write them down.
There are plans to raise the bar in 2015, I think. Phrasing: we “plan to ratchet this up.”
ALSO, physicians must submit quality measures re smoking, blood pressure, and more. For hospitals, there is an even larger set of quality measures (more than 30).
EHRs must support standards when exchanging data.
[As more background here, there is a large set of standards related to medical data. Some of these pertain to data formats. Various states have privacy & security laws as well. Some EHR vendors and other players in the software industry have been working at mechanisms by which your doctor can get your medical records from other facilities, subject to patient consent. The intentions are good. But I hope I don’t have to remind anyone about 1) defects in software, 2) Joe the Plumber’s experiences with Ohio state employees.]
ALSO, EHRs must be certified by law. Politically it would not be feasible to simply mandate one particular vendor’s EHR, so we’re going with establishing a set of rules about what the EHR must do in order to be legally used by doctors who received Medicare/Medicaid $.
HITECH (or maybe part of our recent “healthcare” bill) funds an extension center to provide EHR assistance. The speaker talked about some three-bed hospital in Alaska that doesn’t have the funding, the manpower, “or—frankly—the talent” to implement an EHR. This extension center will “help” that hospital. [I’m guessing that everyone knows each other in that town and that an EHR is monumental overkill, but hey that’s just me.]
The speaker talked about NHIN—the National Health Information Network. Again the government is working on defining “meaningful use” for data exchange. We will need 50,000 MORE people THIS year and next to develop certification programs in healthcare IT (information technology). [The speaker has a PhD in healthcare IT, by the way.] We might be able to fill this need partly by hiring some people who have been laid off.
The legislation (not sure which bit) provides $20 million (I think) for “beacon communities.” The goal is to identify 15 communities, address a community health concern that can be addressed with interoperable EHRs. This is to be announced. The goal is to evaluate the impact of data exchange. [Odd this, because the speaker started out by telling us unequivocally that data exchange Is A Good Thing.]
The same legislation provides for Advanced Research Centers. To be announced soon. I didn’t write down a dollar figure.
This is all “purely voluntary,” said the speaker.
Also, the government “is adopting a free-market approach,” to pay for performance. [The speaker apparently doesn’t recognize that a free market requires multiple sellers acting freely, without rules established to eliminate all but one of the sellers.]
The tenor of the entire talk was about convincing doctors. I never once heard the speaker mention the notion that perhaps the PATIENTS would not care for all this.
BEWARE.
