Obama's plans for health care IT: Too much money too soon?

Hospitals and doctors fear a digital divide -- and indiscriminate spending

NEWTON, Mass. -- President Barack Obama's plan to inject $25 billion into the health care industry could create a technological divide between large and small health care organizations, according to doctors and health care professionals. And some worry that his efforts to create a national electronic health records (EHR) system could affect the quality of health care in the U.S.

Those were among the concerns to emerge Thursday at the Massachusetts Health Data Consortium's 2009 Health Information Technology (HIT) Conference here. Several hundred health care professionals attended the day-long conference, which took place as Congress is debating how much money should be included for health care IT in the president's economic stimulus plan.

"This isn't going to be like landing a passenger airplane in the Hudson River with no lives lost; I think there are going to be some casualties," said John Glaser, CIO at Partners HealthCare System Inc., a private collaborative that includes 36 Massachusetts hospitals, specialty and long-term care facilities as well as Harvard Medical School. "There will be some waste. You can't bring that much money into this industry that fast and not have some of that occur."

Glaser, who took part in a panel discussion at the conference, was referring to the fact that health care organizations and individual doctors will start getting incentive money for EHR systems in 2011, giving them less than two years to get ready for the rollout. And that doesn't include figuring out how to coordinate the sharing of sensitive information between caregivers.

The Health Information Technology for Economic and Clinical Health Act, or HITECH (download PDF), would provide roughly $25 billion for the creation of a national EHR system that would fundamentally change the way medical information is stored and shared among hospitals, private practices and other health care providers. The first $5 billion of the money would go immediately to the Office of the National Coordinator (ONC) for Health Information Technology to lead the way.

Under HITECH, physicians would be eligible for between $40,000 and $65,000 if they show they are using IT to improve the quality of care.

Micky Tripathi, CEO of the Massachusetts eHealth Collaborative, said the money that will go out in 2011 isn't really incentive money for large hospitals that have already rolled out EHRs -- or for those about to roll such systems out. "There's going to be a windfall, because they're basically going to get paid for not changing their behavior all that much," he said.

For smaller health care operations, the gusher of money could lead to a groundswell of technology adoption with little rhyme or reason. "For those who are about to implement [EHR systems] now, one of the issues is, essentially, that this isn't a thousand points of light. This is more like 10,000 bonfires," Tripathi said. "Who helps the solo practitioner, the two-person group, the small hospital?"

For many smaller hospitals and private practices taking a wait-and-see approach to EHR rollouts, money will not be available, and "for those who do implement, we still have the problem that 30% to 40% of retail implementations fail," Tripathi said. "So we haven't solved that problem. All you've done is given them money and said, 'Go out and implement in the same crazy ways we're implementing now.'"

Instead, Tripathi suggested, technology adoption should be linked to regional health IT extension centers that can coordinate data exchange and promote quality care. "To me, the better protection of the investment is to say: 'You need to link those incentives with implementations either conducted by or certified by those extension centers,'" he said.

But Glaser argued that the Obama plan does take into account the need for state and community involvement to ensure greater continuity in the rollout of EHRs.

"It is a very responsive set of [measures]," Glaser said. "I do believe this is a remarkable moment. I have never seen a change as significant as what we are about to experience after this legislation passes, which is presumably by the end of this month."

Laura Adams, a board member of the National eHealth Collaborative and CEO of the Rhode Island Quality Institute, pointed out that 60% of Medicare payments go to things such as the treatment of complications from diabetes rather than to preventing the disease itself. The collaborative is a public-private group working to create digital health care information and share it securely.

Adams said that building the new EHR system on top of the current "crippled medical payment system" will be "absolutely toxic" to success. "My God. I hope we don't have our current payment system in the years to come," she said.

The Rhode Island Quality Institute is a nonprofit organization made up of health care providers, insurers, academics and government organizations.

After the panel session, Adams explained that "doctors who have the best outcomes are paid the same as doctors with the worst outcomes," with hospitals and caregivers that provide poor care often rewarded with additional money for avoidable follow-up patient treatment.

Instead, Adams said that the money expected to flow into the health care system under Obama's plan should be used to penalize hospitals and caregivers who provide subpar treatment and reward those who provide good care that ultimately saves the system money.

Copyright © 2009 IDG Communications, Inc.

  
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