The article about Pediatric Associates in CA has a nugget with a potentially outsized impact: the implication that VFC vaccines…
Mark Anderson 4/15/09
My HIMSS Thoughts
Traditional buzz around vendors’ products with not much substance behind their claims. Most vendors were talking about how great sales were going and that the HITECH portion of the ARRA bill was going to really help explode sales. However, when I asked them what was in the HITECH bill, they had no idea of the details.
So the big buzz was HITECH, but …
Many intellectuals and government officials have been convinced that technology cost is the major factor for slow adoption of EHR technology. As we read in the August 2008 article in the New England Journal of Medicine, only 4% of physicians are fully utilizing EHRs in their practices today, with an additional 13% using parts of an EHR. In the hospital setting, HIMSS Analytics estimates that less than 2% of hospitals are using an EMR based on the seven levels of hospital technology adoption.
In reality, cost is a factor, but maybe a minor factor. With over 400 vendors in the marketplace, physicians have numerous opportunities to adoption EHR applications that cost less than $1,000 per year. This equates to less than 0.00033% of a physician’s annual gross income. We believe the real barrier to adoption has been twofold:
- Physician data entry time increases by 7X over the paper based system, and
- Physicians are not paid for data entry time.
Therefore, if we cannot decrease the physician’s data entry time, EHR adoption will never take off.
But wait — that’s where HITECH saves the day. The HITECH Act requires data sharing and interoperability between all care providers, thus potentially reducing physician data entry time by up to 75%. Finally, someone in the government figured out that the value of the EHR is in the data sharing between the primary care physician and the specialist, and between the specialist and the hospital, and even more importantly, between the patient and their care providers.
We predict that actual sales will not begin until after the economy turns around, and maybe not until January 2010 when "meaningful use" is is clearly defined.
When the bill was first announced, many organizations were excited to hear that the government was going to help fund EHR adoption. At first glance, most healthcare providers believed they were going to receive funding to purchase an EHR. They were wrong. Physicians who have already adopted EHRs were excited that they were going to receive funding to help reimburse them for their EHR. They were wrong.
Funding is going to providers who meet “meaningful use” criteria, can report quality indicators to the government, and most important, can exchange patient-specific clinical data with other providers in the community. Funding will not go to providers that have pre-existing EHRs unless they are connecting to a community HIE. One of the government’s primary goals is to eliminate the silos of patient information within an individual provider organization.
Therefore, the vast majority of the funds within the HITECH Act are assigned to payments that will reward physicians and hospitals for effectively using a robust, connected EHR system.
Mark Anderson is CEO and healthcare IT futurist with AC Group, Inc.
Mark, that was the most insightful thing I’ve read about HITECH so far, and I’ve read a lot, including all 200+ pages of the act itself…several times.
My own opinion is that meaningful interoperability won’t really address the issue that moving from paper to an EHR creates more work for physicians (at least during a ramp-up phase that can be quite lengthy). There might be some data that could be imported directly from other EHRs, through an IHE, into discrete data fields in a physician’s EHR, but it is unlikely that much of that would replace the data entry work that physicians using EHRs today.
In fact, community-wide clinical data exchange may increase the time and effort involved in providing care as providers have to review more notes, labs, diagnostic study results, etc. from other physicians’ records that previously just weren’t available. I’m not saying that’s a bad thing but we need to recognize that it involves work and slows docs down…again, of course, with no corresponding increase in revenue-per-visit to balance it out. Also, be prepared for more malpractice suits related to physicians’ failure to review data that was available through an HIE.
And as always, I must bang my tshaynik (look it up) that EHRs provide value in their ability to facilitate clear organization of patient data from within a practice, aside from the (immense) value of data sharing across systems and organizations.