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April 18, 2013 1:03 PM Republican Senators Have Some Reasonable Changes for Electronic Health Records

By Aaron Carroll

This is a long-standing topic for me, but here’s the nickel summary: I love information technology, but am skeptical about its “imminent” widespread use. This is in part because doctors don’t like electronic records in general, and in part because the meaningful use requirements for EHRs don’t really address the problems they face. I have long maintained that the biggest problem is a lack of standards for such systems.

It turns out that a number of Republican Senators agree with me:

On Tuesday, six Republican senators released a 28-page white paper — titled, “REBOOT: Re-examining the Strategies Needed to Successfully Adopt Health IT” — outlining their concerns about current federal health IT policy, FierceEMR reports.
The white paper accompanied a letter that the six lawmakers sent to HHS Secretary Kathleen Sebelius. The letter requested information about the agency’s progress in promoting electronic health record adoption through the meaningful use program…
In the white paper, the lawmakers acknowledged that the meaningful use program aims to improve health care quality and reduce costs. However, they wrote, “nearly four years after the enactment … we see evidence that the program is at risk of not achieving its goals and that $35 billion in taxpayer money is being spent ineffectively in the process.”

I read the letter, and it asks for a lot of information from HHS. I can’t tell how much of it is due diligence and how much is just a painful demand for busywork. However, the white paper is interesting. It identifies five major issues:

  • Despite expectations of cost savings, the digital systems may be increasing unnecessary medical tests and billings to Medicare.
  • The government has not demanded that the various digital systems be able to share medical information, a critical element to their success.
  • Few controls exist to prevent fraud and abuse. Many doctors and hospitals are receiving money by simply attesting that they are meeting required standards.
  • Procedures to protect the privacy of patient records are “lax and may jeopardize sensitive patient data.”
  • It remains unclear whether doctors and hospitals that have accepted stimulus funding will be able to maintain the systems without government money.

I think a number of these are spot on. There’s evidence for the first. My anecdotal experience tells me the third is somewhat true. The fourth is always a concern, and the fifth is something I agree with as well. But it’s the second that I can’t endorse loudly enough. If there’s one thing I want out of meaningful use, it’s a requirement that data be potentially imported and exported in one standard format. If we just got that, EHRs would be so much more useful.

I look forward to the administration’s response to this. Given the fact that these requests are coming from Republican Senators, I’m more optimistic than usual that perhaps the HITECH Act could be amended to include some of these requirements.

@aaronecarroll

[Originally posted at The Incidental Economist]

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Aaron Carroll ,MD, is an associate professor of Pediatrics and the associate director of Children’s Health Services Research at Indiana University School of Medicine.

Comments

  • Peter Groen on April 20, 2013 9:21 AM:

    To summarize, (1) you love information technology but are skeptical about its “imminent” widespread use. You can be personally skeptical all you want, but health IT systems and EHRs are spreading like wildfire. It's unstoppable.(2)You say doctors don’t like electronic records in general, which I find true only of new users, especially in small practices. VA clinicians long ago embraced and love the technology. (3) You maintain that the biggest problem is a lack of standards for such systems. Ridiculous. Health IT standards developed over the past decade or two are very robust. It sounds like a voice from the very distant past when people said the benefit of word processing, PCs, online banking, etc. were questionable.