The five testifying panelists were learned and the subcommittee members engaged, but the hearing could easily have taken place in 1997.
Let me put that another way: An unknowing time traveler from 1997, sitting in the gallery through the entire hearing this week, would not have heard a single technological reference that would have struck him as curious or futuristic. Instead, speaker after speaker deployed metaphors tethered to 19th and 20th century technologies: Train tracks. Electrical connections. Plumbing?! Worse, these metaphors were used to describe not only the current state of health information technology (HIT) and EHR products, but also the panelists’ aspirations. It is no great revelation to say that HIT has lagged significantly behind the rest of the high-tech world, but it was troubling to see a panel of experts in the field rhetorically cementing that lag and labeling it as progress.
Subcommittee member Dana Rohrbacher (R-Calif.) asked an incisive question that goes precisely to my point. Observing that his wife’s smartphone can share information seamlessly with people all over the world, Rohrabacher wondered why government is spending billions of dollars to bring HIT only to a level of technological parity with the rest of the consumer universe. Noting incredulously that “I’ve seen it in real life myself,” he said that $20 billion (the amount Congress has budgeted for Meaningful Use incentives) is an awfully high price tag—especially during a persistent budget crunch—to incentivize a single sector to do what the rest of the tech world is already doing in every other market space.
Two doctors on the subcommittee drilled down further. As part of a larger question about the persistent lack of interoperability among health information systems, Dr. Andy Harris (R-Md.), an anesthesiologist, criticized static software’s inherent inability to catch drug interactions when crucial patient information resides outside of a proprietary network. Panelist Rebecca Little, an executive at HIE solutions provider Medicity, responded that sometimes “translators” are needed “in the plumbing” of health information exchange. While that is undoubtedly correct in the context of the anachronistic health information technology in prevalent use today, it is precisely wrong when looking to the future: we need to liberate information from the “plumbing."
Speaking from his personal experience, practicing physician Rep. Dan Benishek (R-Mich.) bemoaned the sorry state of too many electronic health record systems in the marketplace, stating that they do not provide actual interoperability and cost too much money. Meaningful Use payments do not cover even implementation costs for most, and the technology too often “doesn’t do the job.” Noting the policy goal of improving access to quality care, Benishek said exasperatedly, “If the hospital goes broke, the access to care isn’t there either.” To which this government affairs VP at a cloud-based services provider, sitting at his desk outside of Boston, answered, “Amen!”
Now, let’s return to the title of the hearing: “Is Meaningful Use Delivering Meaningful Results?” After nearly two hours of testimony, the answer seems to be: “It depends who you ask.” On one hand, witnesses correctly pointed out that Meaningful Use incentives have resulted in a huge uptick in EHR adoption. Providers attesting to “meaningful use” are, by the government’s reckoning, “delivering meaningful results.” Res ipsa loquitur. On the other hand, the providers that Dr. Benishek mentioned, those spending too much money for systems that don’t “do the job,” might quibble with the government’s definition of “meaningful.”
EHRs that meet Meaningful Use standards but have slow workflows, lock up information in proprietary silos, interfere with doctor/patient interactions, or impose costs that exceed their benefits, neither helping struggling medical practices nor improving the health care system overall. This is the understanding that animates everything we do at athenahealth to provide cutting-edge, cloud-based HIT that delivers truly “meaningful results” to our network of more than 38,000 providers nationwide.
What comfort the HIT innovation community could take from this week’s hearing came in the combined understanding reflected in the questions posed by those three subcommittee members: Many EHR products cost too much money and impede (sometimes intentionally) interoperability; despite billions spent by the government and billions more budgeted, HIT continues to lag behind the rest of the tech world; and, perversely, some of those incentive dollars are perpetuating use of lagging technologies.
The challenge to HIT innovators is illustrated by the fact that we did not hear any understanding of the vast potential of cutting-edge technology to improve the health care system. While others continue to talk in inherently earthbound terms, we need to better communicate the limitless potential of the cloud, and advocate relentlessly for policies that allow and encourage continued innovation.
Adding some voices of innovation to these testifying panels will be a good start. And adding some of your voices of innovation right here on our blog can’t hurt either.