I’ve gone through the $19 billion healthcare IT Stimulus Plan with a fine-toothed comb. Incentives will be paid to physicians who meet “meaningful use” requirements set by the government. To show “meaningful use,” physicians must purchase a “government EMR” which means that the government dictates the features and functions that the software package must have.
Unfortunately, the government does not have the wherewithal to create standards that will allow EMRs to be usable, effective, and fast.
The starting point for government EMR standards under the Stimulus Plan will likely be the Commissioners on the Certification Commission for Healthcare Information (CCHIT). It is a travesty that the 21 member CCHIT commission is devoid of busy, high-volume, front-line, private-practice physicians. (For a list of the 21 commissioners, see: http://cchit.org/about/commission).
Moving past CCHIT, the Stimulus Plan creates a newly formed HIT Policy Committee that is charged with setting overall policy and overseeing the distribution of the Stimulus Plan funds. The committee will consist of a partisan group of 20 politically charged individuals with only one physician representative. The probability that the one physician will be a busy, high-volume physician in private practice is near zero. The “cast of characters” comprising the committee is worth noting:
- 3 members appointed by the Secretary of the Department of Health & Human Services (at least one from HHS and at least one public health official)
- 1 appointed by the majority leader of the Senate
- 1 appointed by the minority leader of the Senate
- 1 appointed by the Speaker of the House
- 1 appointed by the minority leader of the House
- 13 appointed by the Comptroller General which shall include:
- 3 advocates for patients or consumers
- 2 members representing health care providers, one of which shall be a physician
- 1 from a labor organization representing healthcare workers
- 1 having expertise in health information privacy and security
- 1 having expertise in improving the health of vulnerable populations
- 1 from the research community
- 1 representing health plans or other third-party payers
- 1 representing purchasers or employers
- 1 having expertise in health care quality measurement and reporting
- “Such other members as shall be appointed by the President and representatives of other relevant Federal agencies.”
In addition to the HIT Policy Committee, the government formed the HIT Standards Committee that will set EMR standards. By law, this committee will consist of consumers, ancillary healthcare workers, purchasers, health plan representatives, technology vendors, researchers, members of relevant Federal agencies, providers and individuals with technical expertise on health care quality, privacy, security, and on the electronic exchange and use of health information.
The private-practice physician’s voice will barely be heard and the standards will be set by non-physician bureaucrats. Instead of incorporating the voice of physicians, the new standards will incorporate a cacophony of voices from a variety of industry stakeholders—most of whom have agendas that oppose those of physicians.
EMRs from the makers of Medicare and Medicaid will not succeed. Only hybrid EMR systems that listen to the one, unified voice of physicians would be adopted on a mass scale.
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