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The Clipboard Routine

by Stephanie Zaremba, Director of Government and Regulatory Affairs

Anyone who has been to a doctor’s office is likely familiar with the “clipboard routine.” You arrive at your physician’s office and check in with the front desk, where you are handed a clipboard. It doesn’t matter if you are a brand new patient, were referred by a doctor right down the hall, or seeing your beloved primary care physician for the umpteenth time. The clipboard asks you for the same information: your name, date of birth, phone number, allergies, medications, recent surgeries, family history and so on.

It is maddening.

In every other aspect of our lives, the days of form filling are largely over. We can log in to new websites automatically using our Facebook credentials and pay online retailers with one click by leveraging existing secure accounts like Amazon. Google coordinates our activities across a number of accounts and devices.

If we’ve said it once, we’ve said it a million times: Health information technology lags decades behind the rest of the information economy. But it doesn’t have to be this way.

Information flows across the internet because when people or entities have an incentive to share information, they usually do. When you are referred to a new specialist, you are handed a clipboard because your doctor has no incentive to share your records with the specialist. It’s easier for everyone to put the burden on you.

There is a simple legal fix that could change this paradigm. The Anti-Kickback Statute and Stark Laws were written before anyone could imagine an internet where information flows freely, and as a result, the unintended consequence of these laws is to prohibit incentives for doctors to share information.

The basic premise of these laws is simple: A physician can’t receive a financial benefit for referring a patient to another care provider or prescribing a drug, treatment, etc. In a fee-for-service world with perverse incentives to drive up volume, we want providers to recommend care based on what is best for our health, not best for their wallets. But these laws are broad, and they also prohibit desired activity, like physicians sharing the investment that is necessary to share health information electronically.

Health systems hold a lot of data about patients, and they should be able to share the cost of the infrastructure that physician offices need in order to access that data. Physicians should have flexibility to construct innovative arrangements around data sharing, whether it is a full donation of electronic health record systems or an agreement where a per-transaction fee is paid every time information is sent.

Health policy is full of thorny issues in need of complicated solutions. The clipboard routine is not one of them. There are certainly many other policies, like the patchwork of state and federal privacy laws, that inhibit care coordination, but the existence of other barriers shouldn’t stop us from tackling this one. Congress is already looking at reform of the Anti-Kickback Statute and Stark Laws, and a simple fix to promote information sharing should be on the table. Payments between care providers to cover the cost of information exchange should not be prohibited.

 

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