Electronic Health Reporter

Several key U.S. senators continue to be critical of the electronic health record incentive program who claim it’s a huge expenditure ($35 billion) that’s just not meeting the goals promised.

According to a piece by Ken Terry of Information Week, in which he cites a report issued by the six senators, which states: “While promoting the use of health IT is a laudable goal, a growing body of objective analysis and empirical data suggests the program needs to be recalibrated to be effective.”

The senators — John Thune (R-S.D.), Lamar Alexander (R-Tenn.), Pat Roberts (R-Kan.), Richard Burr (R-N.C.), Tom Coburn (R-Okla.) and Mike Enzi (R-Wyo.) – are also requesting from the Department of Health and Human Services’ (HHS) secretary Kathleen Sebelius to provide them with answers about the program by June 16.

Terry also reports that the senators issued an open letter to “health information technology stakeholders and members of the public” seeking comments on the white paper by May 16.

These questions to HHS follow a letter that these senators sent basically demanding that the meaningful use program be stopped in the midst of Stage 2, in which they cited examples of what they viewed as “weakness in the meaningful use Stage 2 requirements,” as well as pointing to additional information that provided opposing views of the incentives and what they were actually doing.

According to the senator’s paper there are five areas where the program is failing and needs to be changed or addressed in some manner, including increased costs to the healthcare system, lack of interoperability, lack of oversight, risks to patient privacy and long-term program sustainability.

I can’t see how any one of these five points could be argued against, and with good reason. Depending on your side of the aisle, perhaps you disagree with me, but I think you might find it difficult to point to something concrete.

“The 2009 HITECH Act, which authorized the EHR incentive program, was expected to save money,” the report said. Instead, “early reports raise concerns that health IT may have actually accelerated the ordering of unnecessary care as well as increased billing.”

Increased billing certainly is a concern, and we all know upcoding is happening. Of course, there are those who argue that EHRs allow for proper coding and is making for an accurate system which to this point was flawed because of untidy and archaic paper billing processes.

Finally, the report – again according to Terry’s piece – made clear that the senators believe there’s no clear path to interoperability among health IT systems used by different providers. “Because care coordination depends on interoperability, the authors said, this failure could lead to the whole investment in EHR adoption being wasted.”

Again, this is hard to argue against. Few, if any, EHR systems speak directly to each other and there’s little in the way of change coming. Don’t be fooled by the recent announcement that CommonWell is going to solve health IT’s problems. Even if we see anything from this “initiative,” it won’t come quickly and it likely won’t come cheaply.

Terry points out, though: the senators’ report inaccurately stated, “None of the required core or menu objectives in stage 2 requires communication with other healthcare providers.” Under the Stage 2 rules, eligible providers must provide electronic clinical summaries at transitions of care and referrals for at least 10 percent of their patients who go through such transitions. Moreover, at least one of those exchanges must involve a provider that is using a different kind of EHR or a government-designated test EHR.”

Terry is right in pointing out that that does mandate some movement, but really is it enough of a ripple in the ocean in which we swim to make any bit of real difference?

The piece concludes with a few interesting notes. For example, are CMS and the Office of the National Coordinator of Health IT doing enough to protect patient privacy in EHRs, and – probably most interestingly – “at a time when Medicare reimbursements are expected to drop and providers are facing many other regulatory burdens, providers may lack the wherewithal to maintain their EHR systems after government payments end in 2015. Moreover, if their EHR vendor does not keep recertifying for later stages of meaningful use, the providers may have to switch EHRs and transfer their data.” Again.

But at the heart of the senators’ query is the same many of us have expressed: is meaningful use simply moving too quickly? If so, why?

Why, indeed.