A cornerstone of President Obama’s national health system—Health Information Technology (HIT)—promises unanticipated problems. A new study by the National Center for Policy Analysis (NCPA) examines the goals and obstacles that lie ahead for electronic medical record-keeping. A new multi-faceted bureaucracy under the Health and Human Services Department (HHS) was supposed to begin in 2012 to impose mandates on doctors and hospitals to toe the line on electronic medical records (EMRs) for patients.
But it has already begun. On Oct. 5, it was reported the U.S. Coast Guard did not meet new federal standards for electronic medical records (EMRs) for its 34 clinics. So, it had to spend $14 million to award a contract for a new electronic health records system that meets federal standards dictated by rules issued by the power-loving Secretary of HHS.
If doctors and hospitals comply with federal regulations on health information technology, they will get some government bribe money. “Although some proponents discuss the perceived benefits of HIT, missing from the debate is an honest discussion of experiences with actual HIT systems,” stated the NCPA study. “The ultimate goal should be to improve quality, increase efficiency, and add convenience—not just to create wired facilities.” In the U.S. now, suppliers of pharmaceuticals and medical equipment “are often completely wired.”
Therein lies a large potential problem. Dr. Jose DeJesus, a Virginia physician, explains: “Anyone who makes a major investment in any kind of electronic medical records system had better negotiate a provision that it will be made compliant with future federal standards[.]” “Such an agreement,” continues Dr. De Jesus, “will be meaningless” if your system is out of compliance with the federal mandates,” he wrote some months ago in Physician Entrepreneur, an online publication. “Don’t assume that the federal government will pay for your system, especially anything that you invest in before official standards are announced.”
The NCPA study says electronic medical records “are not in widespread use despite being often cited as the technology with the greatest potential to improve quality and reduce costs. Two well-known estimates put the potential savings at around $78 billion annually. However, the Congressional Budget Office (CBO) found that no evidence yet exists to support claims of substantial savings from HIT. Proponents of HIT are hoping that research that uses integrated data bases of patient treatments across large populations will yield information on which treatments work best.” The study’s authors, Devon Herrick, Linda Gorman, both senior fellows, and John Goodman, president and CEO of NCPA, said, “To be effective, this would require following patients over many years.” Those spending money on HIT systems “without also investing in training and having processes that take advantage of the new technology are unlikely to fare well,” the authors said.
A potential advantage of having patients’ records stored electronically is that “distance becomes irrelevant when consulting with a physician.” But, installing HIT systems in a hospital or doctor’s office is “much more complicated” than installing software on a computer linked to the Internet. Privacy and security could be invaded by hackers, and patient data could be altered “making EMRs available to far-flung health care providers necessarily makes them accessible to the world at large.”
“Government mandated technology is not the solution.” Although many HIT proponents support government imposed HIT, the study said, they assume a plan devised by government officials may work. It is especially unlikely to succeed if it provides no incentives for health care providers to adopt and properly use the technology….[w]here third parties do not dominate, providers…HIT is quite common. Walk-in clinics, telephone and e-mail services, concierge physicians and pharmacy outlets are examples.” Many large health systems in the U.S. use EMRs and other forms of HIT, including health insurer Kaiser Permanente and the Veterans Affairs health system. But according to David Blumenthal, national coordinator for HIT at the Department of HHS, only about 17 percent of doctors and 8 to 10 percent of hospitals use EMRs. Undoubtedly more will fall in line because the bribes have started–$18,000 for a Medicare doctor, even more for a Medicaid doc.
A major reason HIT isn’t more popular is that those most likely to benefit—patients and insurers—are not the ones bearing the costs. It’s the doctors and hospitals being told to comply. Apparently that’s why subsidies are needed for those medical providers who meet HHS rules. Provisions governing HIT were set up under a law passed as part of the stimulus package (sometimes laughingly called the American Recovery Act) nearly a year before the now-widely disliked ObamaCare took effect. That law is called The Health Information Technology for Economic and Clinical Health Act. It gave Health and Human Services Secretary Sebelius authority to impose penalties for violations of another law—a Civil Rights Act—to protect patient privacy. A fine of up to $1.5 million could be levied for violations. If this complex of laws is confusing you, think how puzzled the bureaucrats will be as they try to protect patient privacy while making health information more widespread through electronic technology.
“Harvard School of Public Health found limited quality gains from EMRs. And average length of stay for patients in advanced HIT systems was 5.5 days versus 5.7 days for hospitals without such systems. HIT has been successfully implemented where it makes business sense, either by reducing overall costs or improving the product that a business offers compared to its competitors. Cancer Treatment Centers of America (CTCA)…implemented a system of electronic medical records in 2008. CTCA believes EMRs help its integrated teams of caregivers communicate more effectively with each other and with patients. Its patient survival rate is higher than the national average,” the NCPA study said.
The NCPA study also reports how HIT failed in Britain’s socialized health program in 2008. HIT systems at several large hospitals were shut down in London by a virus in late 2008, with nearly 5,000 computers infected. Patient records were not accessible, causing long delays in treatment. A centralized network allowed the virus to spread to other hospitals as well.
The ObamaCare law requires HHS, in consultation with the HIT Standards Committee to develop standards to facilitate electronic enrollment of individuals in Federal and state health and human services programs. The new bureaucracy will decide what health care technologies it is going to bless and what it’s going to require of payers and providers of health care.
As NCPA concludes: If government bureaucrats picked privacy and security standards for banking, access to balances online might be impossible and automated teller machines (ATMs) might not exist. How, then, can we really expect bureaucrats to be experts in health technology?