Saturday, September 11, 2010

Health Information Exchanges and Electronic Medical Record Negative Reward Incentives



Health Information Exchanges and Electronic Medical Record Negative Reward Incentives are still controversial. The American Recovery and Reinvestment Act includes a wide variety of mandates, including HITECH to stimulate acquisition of EMR and building a national health information exchange network.

As a student and consultant of health information exchange development and the federal and state government incentives for ‘rapid’ development’ of medical digital records, I am struck at the lack of organized medicine’s and individual practitioners opinions regarding EMRs.

Congress has been sold a ‘bill of goods’ much like buying the Brooklyn Bridge for $1.00. (And the price will go up next year if you don’t buy it now). This is very much snake oil medicine, at its worst.

Let me be clear about one thing.  I am not anti-EMR or anti-HIE development.  The present developmental plans benefits mostly health information technology vendors

I am not a Luddite, by any means, however from all the information I have been able to gather, there are few if any  studies that document meaningful return on investment.

This “catalytic innovation”, a term which I coined five years, ago is a disruptive technology.

Physicians and patients should contact our senators and representatives in Congress and at the state level to change the formula for incentives. The EMR products offered to physician practices and consumer electronic health records,  are not mature enough to invest billions of dollars at the taxpayer’s expense. The timeline is defective in several ways.

1. Evaluation, study and implementation also require training time.

2. The HIT industry does not have the manpower and/or resources to accomplish this within the specified time period.

3. There has been very limited success for practitioners and hospitals to adopt EMR.

4. The impact of the health reform legislation has yet to be determined on the overall cost of health care. Numerous early studies indicate the cost to the consumer will rise substantially with health reform. Certainly the stated goals are admirable for our society. Early indicators are that the insurance industry will do it’s best to maximize profit during the early years of health reform as a hedge against future legislation requiring expanded coverage of benefits and the mandates from the states to eliminate the ‘uninsured’. States are not in the health care business and previous experience with major risk policies reveals that States depend upon private insurers to manage and indemnify the policies and operate Medicaid and Medicaid HMOs. The same market forces will continue to impact the model and many insurers will refuse to offer these policies or drop contracts with the state.

5. It will require several more years prior to penalizing those who do not adopt EMR, when the current  products of choice are inadequate, and based upon old models of billing and collections.

6. Certainly if the stated goal of medical homes as well as non-procedural reimbursement methodology the present plan is not in line with the goals of increasing efficiency, nor collecting meaningful information. Our currently available EMR  systems address neither the purported goal of meaningful data for individual practices, nor promoting best outcomes. The current Gantt chart time line will  stimulate the acquisition of poorly designed clinical information systems.

7. The term meaningful use (for whom?) is inadequate and is not defined in terms of the differing type of practices, or hospitals.

more……in my next blog post.


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