This weekend, The Washington Post published an investigative report entitled “The Machinery Behind Health-Care Reform: How an Industry Lobby Scored a Swift, Unexpected Victory by Channeling Billions to Electronic Records.” The reporter, Robert O’Harrow Jr., clearly hit a nerve when he exposed the origins of the EHR funding portion of the Economic Stimulus Bill—The Washington Post received so many comments that it had to stop accepting responses! I am sharing my comments here, along with the original article.
Dear Mr. O’Harrow:
Thank you for exposing the behind-the-scenes efforts that led to the creation and funding of the Economic Stimulus Plan’s EHR incentives program. Industry insiders have long-recognized these inherent conflicts of interest, but have been reluctant to make them public.
It is important to understand that the situation is being perpetuated—the people now charged with developing the specific regulations regarding how the money is to be dispersed and the standards which will determine to whom it will be given are the very same stakeholders who were behind the legislation. One has only to listen to the recent “meaningful use” hearing in Washington and look at the appointments to the HIT Policy and Standards Committees for evidence.
First, to clarify your premise—it is not the entire industry that lobbied. It is the traditional EMR vendors who are positioning themselves to receive the benefits. Only the big, CCHIT companies have been invited to the table to be part of the conversation in any significant way other than through very limited opportunities for public comment. No vendors of alternative technologies, i.e., non-CCHIT-certified products, have been given any formal role, regardless of their successful adoption rates and greater physician satisfaction.
It is no wonder that CCHIT is the presumed set of standards which will be used to qualify EMR software for Stimulus Plan payments. The legislation was rushed through with such a short timetable for implementation that it is hard to dispute the conclusion that there is no time to develop new standards. The HIT Policy and Standards Committees are predisposed to CCHIT—the vendor community representatives on each committee are from large, CCHIT companies, and at least one committee member is a CCHIT commissioner. It does not seem to be of concern that these EMRs are the very ones that have experienced miserable adoption track records, (see Landmark EMR Studies), particularly among specialists, nor that evidence does not exist to show that CCHIT certification has improved this adoption record.
In an effort to push the implementation along, the interests of high-performance, private-practice physicians are not represented in the process. There are no full-time, private-practicing physicians on the Standards Committee, who can appreciate first-hand the impact the wrong EMR can have on a provider. The seven physician members spend most, if not all, of their time in informatics-focused positions at their respective institutions. Furthermore, the needs of non-primary care physicians are being ignored. By virtue of its composition, the Committee will focus on primary care—of the physicians on the Committee, five are internal medicine-certified, one is a pathologist, and the vendor representative trained as a neurologist. For primary care physicians, CCHIT-type software may be more usable than it is for specialists.
In the era of transparency, it is important that all of these issues be understood and then addressed before the enormous sums of money are dispersed with limited potential to achieve the desired outcomes.