Will tens of billions of dollars in forthcoming incentive payments for meaningful use of electronic health records meet the HITECH Act’s goal of improving care quality and patient outcomes while bringing efficiencies to the health care industry?

That’s a question posed to attendees of the Institute for Health Technology Transformation’s Summer Health IT Summit in Denver, and responses were mixed.

The incentive funding is a baby step to facilitate transformation within the industry, and likely was the best that Congress could come up with to get the industry to accelerate automation, says Barry Chaiken, M.D., president and chief medical officer of DocsNetwork Ltd., a Boston-based consultancy.

But the incentives are not big enough and will compete against other incentives that perpetuate the status quo, Chaiken asserts. For instance, the EHR incentive is miniscule compared with the payment incentive to over-treat patients. “Who’s going to make sure a doctor doesn’t do more CTs or extra tests?” he asks. “The EHR is not going to correct the wrong incentives in our environment.”

Incentives, Chaiken argues, impact people’s judgment. “It’s not that people are bad, the incentives are wrong.” Hospitals, he notes, make more money on foot and leg amputations than on keeping diabetics healthy. Consequently, it’s impossible in this political environment and economy to think that problems the meaningful use incentives are designed to correct will be fixed quickly. The incentives, Chaiken adds, may support industry transformation but won’t make it happen.

Chuck Christian, director of information systems and CIO at Good Samaritan Hospital in Vincennes, Ind., concurs that meaningful use isn’t a silver bullet but remains a valuable program. “It has truly raised the rhetoric and made people talk about how we can do better. This is causing us to have these conversations as a team.”

The issue of HITECH’s effectiveness will rest on whether meaningful use incentives actually compel physicians to go electronic, says Sandy Carter, a consultant at GWC & Associates in Cheyenne, Wyo.

Again, other economic incentives get in the way. Most physicians, she notes, get paid by service--the more patients they see the more they get paid. But many EHR vendors haven’t really worked with physicians to improve workflows, and that hampers physician acceptance of the technology, she adds. If it takes a physician 30 minutes to enter documentation in an EHR but takes three minutes to do so on paper, the physician will go back to paper, Carter says.  Health information exchanges also may unwittingly play a role in poor economics, she fears. Through local and state HIEs, doctors can get more data on patients and that will reduce costs by reducing redundant care, but also will reduce payments.

Simplifying the electronic record is important to adoption and the way to do that is to have physician input play an integral role in EHR development, says David Rosenberg, M.D., a solo family practitioner at Jupiter (Fla.) Concierge Family Practice. An electronic records system has to think like a physician and let the physician easily do 80 percent of their tasks, “and we can figure out the other 20 percent,” he contends.

Rosenberg uses an EHR and truly believes it helps improve care while making his job easier. But will meaningful use incentives work? “We’re not going to know it unless we go through a trial,” he says.

The incentives authorized under HITECH won’t be wasted, says Ron Kubit, president of Intuitive Technical Solutions, a Denver-based consultancy. “It’s just evolution,” he asserts. “Other industries utilize information technology and have their evolution and acceptance phases.”

There’s been no pressure to automate records in the health care industry, Kubit contends. Now, that pressure is being brought to bear by the government but the industry itself will take charge of its transformation. He notes that physicians at Kaiser Permanente initially didn’t like the EHR when the organization automated and now rave about it. “No one likes change.”

HITECH has done its job to prod the industry, acknowledges Christopher Jackson, M.D., a physician informaticist and emergency physician at 30-hospital Sisters of Mercy Health System, Chesterfield, Mo. “Most physicians and nurses have been doing the same things since the 1960s. We needed something to get stuff going.”

The problem with HITECH, however, is anytime you get the government involved in an initiative, it’s not a grassroots effort and becomes difficult to get to the next level, Jackson explains. That next level is using the data in EHRs to truly bring positive change. There’s a high likelihood that providers will be able to meet meaningful use criteria but not be meaningful users of EHRs unless they really use the data. “We need fluid, correct data in real time,” he says. “EHRs aren’t there yet. They don’t have a nice user interface with beautiful data behind it.”

Jackson also worries that the government telling the industry what to do will take focus away from what industry should be doing. The first stage meaningful use criteria are reasonable, he says, but he’s not sure subsequent criteria will be. “How many resources will I have to utilize to do what they want rather than what I need to do, such as improve patient safety?”

The biggest current impediment to HITECH’s success is that physicians are skeptical they will be paid as promised, Jackson says. Affiliated physicians are extremely concerned about whether they’ll get incentive payments, and it gets even dicier with Sisters of Mercy-owned practices. These physicians don’t know how much of their incentive funds they’ll actually receive because they are employees using EHRs that their employer paid for.

So, will employed physicians get $44,000 in incentives? Or $3,000? Or somewhere in between? “That’s a problem,” Jackson says. “Whose money is it? We already budgeted for an EHR and have other projects we’d like to use some of that money for.” Sisters of Mercy leaders say employed doctors will get incentive payments, but they’re not yet saying how much, he adds.

--Joseph Goedert


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