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Here We Go: Our Post-Election View on EHR

by Dan Haley, SVP and General Counsel

Much commentary in the wider world today, Election Day+1, is focused on the fact that for all the billions spent, all the ads run, all the robocalls made, 2012 in the end turns out to be a status quo election. We have no change in the executive, no real change in either chamber of Congress, not even much of a change in the electorate.

Of course there is an inherent difference between a president’s first term and his second. In the second, with the looming specter of a re-election fight wiped forever from his personal political horizon, the president is afforded the chance both to be more magnanimous and more ambitious.

The Obama administration’s agenda with regard to health information technology (HIT), especially toward EHR adoption, has been clear and unambiguous, and we expect it to remain so. How exactly the second term agenda will differ from the first, either in focus or intensity, remains to be seen. However there are a few predictions that we can make with a high degree of confidence:

  • The Meaningful Use (MU) incentives program will continue. With their genesis in the Stimulus Act—broadly opposed by a significant cadre of Republicans—those incentives faced the very real possibility of reduction or elimination had Gov. Romney won. As it is, the HIT policy committee meets today with a walk-through of the MU Stage 3 draft and request for comment (RFC) high on the agenda. We expect to see that RFC in the near term, and hope that on more certain political footing the Office of the National Coordinator (ONC) reasserts itself in the effort to drive MU standards higher and to implement more aggressive timelines for meeting those standards than we saw in the Stage 2 rules.
  • At the same time, persistent media attention to questions about the costs and benefits of government supported electronic health record adoption, continued concern about whether Meaningful Use is producing true interoperability, allegations of billing fraud facilitated by use of HIT, and anecdotal claims of HIT-related risks to patient safety mean that the Congress will continue to aggressively question the administration about the Meaningful Use incentive program. This starts November 14, just a week following the election, as the House Committee on Science’s Subcommittee on Technology and Innovation convenes a hearing titled “Is Meaningful Use Delivering Meaningful Results?” We have strong points of view on each of these important issues (stay tuned to this blog), and look forward to inserting ourselves into these conversations early and often on behalf of our tens of thousands of care givers, for whom “Meaningful Use” has in fact been meaningful. We will also continue to encourage policymakers to confirm that the billions spent on incentives are in fact incentivizing adoption of transformational technologies, not serving as life support for technologies that otherwise would fade into the sunset. We will also keep pushing for the policy changes beyond just monetary incentives that will truly create a context for technological transformation of the health care system, such as the creation of a legitimate market for the open exchange of health information.
  • Finally, we expect to see some clarity on the long simmering issue of potential regulatory oversight of HIT. In the FDA Safety and Innovation Act of 2012, Congress strongly encouraged Health and Human Services Secretary Kathleen Sebelius to convene a work group consisting of a broad set of industry stakeholders to inform a proposal for an oversight framework that appropriately balances patient protection with the policy imperative of encouraging innovation in HIT. We strongly believe that such a workgroup will be invaluable in formulating a rational oversight framework and we have taken every opportunity in our Washington-facing interactions to build support to encourage the secretary to take Congress up on that suggestion. With a closely contested election pending, it was understandable for the secretary to defer her decision. Now that the election is in the rearview, we hope to see that work group convened. In the meantime we’ve been working hard in conjunction with other stakeholders to build consensus for a risk-based framework. We will continue that work and look forward to participating in what we expect will be much more deliberate and focused conversations in the coming weeks.

The world didn’t change yesterday, overall or with respect to HIT policy. But it would be a mistake to assume that everything stayed the same. Elections are always clarifying; they blow away the thick haze that cloaks Washington in the months leading up to November. These are just a few of the pressing issues facing HIT and the health care system overall. As always, athenahealth is excited to jump into the fray and work to solve the big problems on behalf of the care givers we serve and the innovators we represent.

Here we go…

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