In February of 2009, President Obama signed into law the American Recovery and Reinvestment Act (ARRA). Part of ARRA, the Health Information Technology for Economic and Clinical Health Act (HITECH), appropriated billions of dollars to encourage healthcare organizations and providers to effectively utilize Electronic Health Records (EHRs) and establish regional health information exchange networks. Starting in 2011, $31 billion in incentives will become available to physicians and hospitals, hoping to reward providers to develop an interconnected system, especially those that see large volumes of Medicare and Medicaid patients. The thought being that the effective use of this electronic exchange and use of health information will result in improved quality and coordination of patient care.
The incentive payments to physicians — ranging from $44,000 - $64,000 per physician and predicated on the Medicaid volume — are paid out over three to five years. In order to qualify for this seemingly lucrative plan, providers need to satisfy and comply with Meaningful Use Standards, which have just been finalized and published July 28, 2010 after months of waiting. There will be three stages of requirements, the last being phased in by 2015. Much of the early data collection revolves around coordination of care, such as maintaining patient demographics, eligibility, electronic claim submission and electronic prescribing of medicines (E-prescribe).
Most physicians have been procrastinating converting to an EHR, primarily due to startup costs and a well-documented loss of productivity. Under the HITECH Act, however, there will be financial penalties for those providers that do not comply by 2015. The government delay in releasing the final parameters of Meaningful Use place severe limitations on the ability to be compliant by the start up date of Oct. 1, 2011. Most EHR companies find themselves “scrambling” to ensure that the requirements are present in their software program. This becomes less of an issue, however, given that bonus payments are incremental through 2015 and will amount to the same whether or not the physician transitions in 2011 or 2012.
On a much grander scale, however, despite these economic incentives (which are relatively small given the total cost of moving onto an EHR after software/hardware costs and licensing), it has yet to be shown that this will result in increasing efficiency and improving quality of care to the patient. Doctors and hospitals essentially practice in silos of medicine, whether it be hospital, primary or specialty care. Reams of data are being housed and stored, but the physicians are practicing on bridges to nowhere. There is no interconnectivity, and the multiple EHR vendors … with proprietary software despite the common HL-7 platform … have little incentive to change the current system. More importantly, the consumer/patient has virtually no access to his or her medical record. We can access our frequent flier miles but not our active prescription list.
There is no question that the HITECH Act is a step in the right direction in moving healthcare providers into the electronic age. However, we still need a patient centered record that is web based, HIPAA compliant, where clinical information from the providers flows seamlessly and can be accessed, whether he/she is in Nashville or Anchorage.
There needs to be an effort by the physician community to begin developing protocols of treatment — evidence based and compiling true outcome metrics based on the disease state … not just utilization and costs. This will allow the patients to identify and choose true quality physicians based on data and not a popularity contest that you can add a review on a web browser. True quality and elimination of redundancy through better technology will lower the cost of medicine and provide better outcomes. It just will not happen overnight.
Dr. Raoul Concepcion is a board certified urologist in practice at Urology Associates with a specialty in urologic oncology and lower reconstructive urology. Concepcion is the president-elect of the Large Urology Group Practice Association (www.LUGPA.com), a not-for-profit organization representing nearly 20 percent of the practicing urologists in the country.