Background and issue
For many years, hospital leaders, physicians, researchers, academics and others involved in the delivery of health care have sought to fully embrace the opportunities that information technology may offer. Most agree that increased utilization of health information technology (health IT) could produce better outcomes than otherwise might be realized. But moving forward on enhanced use of health IT is a complicated, ever-changing sea of challenges and barriers that make its implementation uneven and, so far, its benefits less than hoped for by most.
Health IT includes under its umbrella the electronic health record (EHR, sometimes called an electronic medical record), e-prescribing, systems for dispensing medications in the hospital setting (computerized physician order entry – CPOE) designed to reduce the likelihood of medication error, and many other tools designed to improve outcomes for patients while driving unnecessary costs out of the system.
The EHR offers an example of the challenges associated with implementing health IT solutions. The technology that would allow physicians and other caregivers in a variety of settings to access a patient’s medical history has existed at least since the Internet came into wide use.
While there is great promise in implementing EHR, serious concerns remain, and implementation has been a challenge. Patient advocates continue to raise privacy concerns. Cybersecurity problems are becoming a new and serious threat for health systems implementing health IT. Experts debate what should and should not be included in EHR requirements. Vendors compete to develop functional platforms that will meet the needs of all stakeholders. Hospitals and physicians fear that they will be forced to absorb the substantial costs associated with implementation of the EHR in an increasingly challenging economy.
The American Recovery and Reinvestment Act of 2009, otherwise known as “the stimulus package,” included the largest investment in health IT ever. A provision in the law, commonly referred to as the Health Information Technology for Economic and Clinical Health (HITECH) Act, included approximately $19 billion in incentives through the Medicare and Medicaid reimbursement systems to assist providers in adopting EHRs. The payments are available when a hospital or provider organization demonstrates it has become “a meaningful EHR user.”
Under HITECH, eligible health care professionals and hospitals could either qualify for incentive payments when they adopt certified EHR technology and use it to achieve specified meaningful user objectives or face reimbursement penalties for failing to become meaningful users. Since the law passed the Office of the National Coordinator for Health IT (ONC), and the Centers for Medicare and Medicaid Services have worked to develop guidelines around what constitutes becoming a “meaningful user” of health IT systems, along with certification requirements for health IT vendors. The regulations that have been implemented have been incredibly challenging for eligible hospitals and physicians with complex and overly proscriptive requirements, challenging deadlines and questionable metrics in determining if a hospital or physician’s office has become a meaningful user.
CMS has acknowledged the need to focus more acutely on promoting interoperability and moving away from the current approach for meaningful use for physicians and hospitals, but there is still a substantial amount of work to be done.
Despite the challenges the program has faced, it has dramatically enhanced the use of health IT in hospitals and physicians’ offices across the country.
Vizient hospital members are facing enormous challenges to maintain the quality of care for their patients while dealing with reduced reimbursement rates from private and public payers. While increased use of health IT is an important goal, expenses associated with their installation and maintenance and technology updates are substantial.
Vizient supports the adoption of a comprehensive health IT framework and widespread IT implementation across the health care system, with appropriate measures to ensure patient privacy. The current law and subsequent regulations greatly expanded hospitals’ administrative burden in meeting proscriptive meaningful use requirements and ongoing patient privacy concerns. While we applaud and support efforts to increase patient privacy, it’s important to balance these efforts with realistic and achievable requirements for hospitals that do not detract unnecessarily from patient care with unrealistically demanding administrative burden.
While health IT utilization has greatly expanded under the HITECH Act, significant concerns have arisen about whether the program has achieved arguably its most important goal of providing a truly integrated system. As it stands, the key goal of interoperability – or the ability of health IT systems in different hospitals and physicians’ offices to actually have the capability to transmit and access information between providers – still remains an undelivered promise of health IT. It is essential that CMS and ONC focus on promoting interoperability before moving forward with more proscriptive and administratively burdensome requirements.
What we are doingVizient will continue to work with CMS, the ONC, Congress, and national and state hospital and health system organizations to ensure that hospitals have the resources necessary to implement health IT. EHRs, e-prescribing, and CPOE can deliver significant benefits to patients and, in the long run, cost savings to Vizient members. But hospitals must have the funding required to purchase, install and train personnel on the use of health IT components.
Vizient is also an active member of the Confidentiality Coalition. The Confidentiality Coalition is comprised of a diverse group of health care providers, payers and other health industry stakeholders. The coalition acts as an important resource for policymakers on privacy issues. The mission of the coalition is to advocate policies and practices that safeguard the privacy of patient and health care consumers while, at the same time, enabling the essential flow of information critical to the timely and effective delivery of health care. Vizient will continue to play an active role in the coalition and work to ensure that health IT implementation will move forward with responsible privacy protections.