The hearing of the House Committee on Science and Technology subcommittee on technology and innovation follows recent questioning of the value of the meaningful use program by eight Republican committee leaders in the House and Senate.
Subcommittee chair Rep. Ben Quayle (R-Ariz.) in an opening statement said the subcommittee has focused its work on advancing innovation in a constrained budget environment. He acknowledged the potential of information technology to fundamentally change health care, but given the significant federal expenditure for meaningful use and the current budget situation, “taxpayers should know what we have to show for it.”
“While adoption of health IT products and services has increased since the passage of the HITECH Act, I have serious concerns about our progress towards greater interoperability of health I.T. systems,” Quayle continued. “Without interoperability, many of the potential benefits of health I.T. could go unrealized.”
Quayle also said he was concerned that meaningful use requirements do not take into account the complexity and diversity of the health care market. “It is crucially important that health I.T. is used to improve care without burdening certain providers with requirements that divert valuable time and resources. Clearly, there are key questions that must be answered to ensure that taxpayer dollars are spent wisely, and to ensure that I.T. in the health care industry is used to reduce costs and improve care.”
Mostashari told House members that there is clear evidence the health care community is embracing health information technology, thanks to efforts beginning during the Bush administration and continuing through meaningful use and supporting programs funded under the HITECH Act. Physicians doubled. and hospitals have nearly tripled, their use of systems that meet the criteria for a basic EHR between 2008 and 2011, and more than 150,000 physicians and 3,000 hospitals have received an meaningful use incentive payment since that program began in 2011, he said.
Members of Congress have expressed concern about the progress of achieving EHR interoperability, but Mostashari said there have been large barriers and they are rapidly falling. “In 2009 when we were drafting the initial set of meaningful use criteria and required standards, our plans necessarily responded to the reality we faced. Different vendor products used different proprietary or local codes; there were strong disagreements about how laboratory results or patient summaries should be packaged; and there was simply no consensus on how the Internet could be used to securely send patient information. Over the past two years, thanks to the initial steps we took in Stage 1 and the relentless work of almost 1,000 industry participants in ONC’s standards and implementation activities, those problems have been ameliorated, and we can now leap towards interoperability and exchange in Stage 2.”
Addressing concerns about progress made under meaningful use, Marc Probst, CIO at Intermountain Healthcare in Salt Lake City, testified, “My answer is yes, progress has been made, but this progress must be thoughtfully accelerated. We must leverage all of the expertise in the federal government to accelerate the adoption of standards that will make it easier to share health information so clinicians and patients have the information in the form and time they need it to make appropriate health care decisions. Presently, we lack a shared infrastructure that will make this interoperability possible.”
Addressing concerns that meaningful use criteria are too easy, Probst, also a member of the federal advisory HIT Policy Committee, said the opposite is the reality--achieving meaningful use is hard. Despite Intermountain’s long history of using EHRs, primarily developed in-house, the delivery system has not yet achieved meaningful use but is on track to receive its first incentive payments in 2013.
“I share this Intermountain example to highlight two important facts: Achieving the requirements of the meaningful use program is not easy, and the meaningful use program has very real penalties attached to it. Providers and specifically CIOs across the country are increasingly feeling the pressures which meaningful use is creating. Coupled with programs such as accountable care organizations, ICD-10 requirements and the need to ensure privacy and security of newly created petabytes of data, the lack of comprehensive standards is exacerbating the challenges of HIT across the country. What may seem like small steps required by meaningful use are actually big efforts for provider organizations and if not done correctly will not only fail to achieve greater efficiencies for healthcare, but could ultimately create less secure and less safe healthcare delivery. The stages for meaningful use started fast and continue to be rolled out at a very quick pace.”
Full text of testimony presented to the subcommittee is available here.