Pondering the squandering redux: $28 billion gone out the HITECH window

In 2009, the US Congress enacted the HITECH Act, as part of a much broader recovery measure (ARRA or ‘the stimulus’), authorizing the Department of Health and Human Services (HHS) to spend up to $35 billion to expand health IT and create a network of interoperable EHRs. Key to this goal of interoperability and seamless sharing of patient information among healthcare providers was achieving stages of ‘meaningful use’ (MU) with these EHRs in practice, to achieve the oft-cited ‘Triple Aim‘ of improved population health, better individual care, delivered at lower per capita cost. Financial incentives through Medicaid and Medicare EHR programs were delivered through multiple stages of MU benchmarks for hospitals and practices in implementing EHRs, information exchange, e-prescribing, converting patient records, security, patient communication and access (PHRs).

Five years on, $28 billion of that $35 billion has been spent–and real progress towards interoperability remains off in the distance. This Editor has previously noted the boomlet in workarounds for patient records like Syapse and OpenNotes. Yet even the progress made with state data exchanges (e.g. New York’s SHIN-NY) has come at a high cost–an estimated $500 million, yet only 25 percent are financially stable, according to a RAND December 2014 study.

Five Senators who have been following HITECH’s implementation through HHS and the Office of the National Coordinator for Health Information Technology (ONC) process the fail in Health Affairs Blog:

  • Stage 1 incentivized the adoption of EHRs that are difficult to use and are not interoperable without expensive upgrades. (If they even exist. This Editor has previously observed the 2009-12 boom in practice EHRs, many by IT firms with no previous healthcare experience. By 2011-12 there were at least 600 to reportedly 1,000 for practices, many of which have either merged or vanished–along with many millions of HITECH funds.)
  • EHRs also cost a small fortune: nearly 45 percent of physicians from the IBIS national survey spent more than $100,000 and 77 percent of the largest practices spent nearly $200,000.
  • It didn’t increase effectiveness either. In February, CMS reported that only 25 percent of eligible medical providers and hospitals had attested to either Stage 1 or Stage 2 for 2014
  • “…according to physician surveys, electronic health records (EHRs) are a leading cause of anxiety for physicians across the country. The EHR products are not meaningful to physicians, which is clear when you consider that half of all physicians will have their Medicare payments cut in 2015 for not adopting government benchmarks for EHRs.”
  • In 2009, the Congressional Budget Office estimated that with interoperability there would be “$12.5 billion (savings) through 2019. These savings have yet to materialize and with 50 percent of doctors unable to meet current program requirements, it is unlikely that taxpayers will see these savings in the near future”
  • Patient privacy and security is at greater risk than ever (as we’ve noted here)
  • “As a result, our nation’s health care providers are stuck with the huge cost of unwieldy systems trying to conform to government mandates. They are stuck adopting EHR systems which don’t fit into their established workflows. And if they actually want to share their patients’ data, they are stuck with even more costs imposed by vendors.”

The Senators call, rather softly, for greater ONC focus on standardization, certification and action items to fix what it can with what’s left.

Niam Yaraghi in the Brookings Institution blog begs to differ, strongly. The HITECH Act backed a false assumption by those who knew little about how the private healthcare system really worked; that only if they could, providers would want to exchange patient information. Not really–because there is every incentive against it. He recommends redirecting the remaining HITECH funds to innovation in the healthcare system to the original goals of efficiency and quality of health care, pointing out that HITECH’s emphasis on EHR software starved that same innovation from the start. A better solution to increasing EHR interoperability would be through self-regulated, industry-based certification alliances like the Wi-Fi alliance, because then healthcare organizations would be both shaping and backing it.

Related in TTA: More Federal spending on ‘IT bridges to nowhere’ in Pondering the squandering of taxpayer money on IT projects

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