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

March 27, 2015 | by

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. (more…)

EHRs can’t exchange patient records? $$ in workarounds.

March 17, 2015 | by

Some of the Excedrin/Panadol Headaches (#11, #14, #23 and #54) in healthcare are around the very ‘miracle technology’ that was supposed to make it all seamless, non-duplicative, time/cost-effective and coast-to-coast–EHRs. The exchange of patient records between hospitals, within health systems between sites and with medical practices plus vice versa–works haltingly if at all. It works best within well-established, highly integrated delivery systems –the VA, DOD, Mayo Clinic, Kaiser, Geisinger, Intermountain Healthcare. But once you’re away from it–good luck. Where are the problems? The closed standards of the major hospital EHRs–Epic, Cerner, Allscripts, McKesson and brethren; the extreme customization most health systems demand (nay, a major Epic selling point!); structured versus unstructured data and how handled; a lack of a secure interoperability standard are but a few. Where is the gold? Getting patient health records exchanged, accessible and transportable, among systems that were essentially designed not to speak with each other. (more…)