A centerpiece of the Administration’s efforts to reform health care is an expansion of the use of electronic health records and other increased use of information technology in the delivery and administration of health care. A large part of that effort is the $20 billion plus made available in the stimulus bill to pay incentives to physicians and hospitals that utilize electronic health records in a “meaningful” way. The Department of Health and Human Services has released its proposed rule regarding the incentive payment requirements and an interim final rule regarding certification of electronic health record systems has also been issued. (HHS Press Release) (Links to Rule and Fact Sheets)
The proposed and interim rules together run around 700 pages, and even though this is partly due to double spacing, large type and a lot of typical formal gibberish, they are long and complex. A few posts will be needed to even superficially discuss these proposals. One fair observation is that while this program creates obvious business opportunities both for vendors of EHR systems and consultants to help with implementation, careful research, some reported in our recent posts, continues to demonstrate that it is unlikely that the use of electronic health records will in fact reduce costs or even improve quality. Experience also demonstrates that installing these systems is itself costly and complex and interferes with current work processes for an extended time, causing revenue loss and potentially affecting quality of care. The maximum incentive for physicians is around $44,000 over several years. This will not in most cases cover the cost of the system, the costs of implementation, the loss of revenue and the general hassle most physicians will experience. Hospitals likely will have similar issues.
Not surprisingly, therefore, providers have been cautious at best in their initial response. The American Hospital Association said there were serious flaws in the proposed rules. (AHA Statement) The American Medical Association simply said it looked forward to studying and commenting on them. (AMA Statement) And the Medical Group Management Association said the proposed rules would be hard for many physician practices to comply with. (MGMA Statement) We could hope that the Administration would have learned from other countries experiences with the introduction of health information technology or even the experience of providers in the United States and been both more creative and more realistic in encouraging adoption. Even now, it would be wise to lower expectations.