Thursday, June 30, 2016

The Blunt Instrument of Federal Funding for Health IT

Last week the ONC announced that 96% of hospitals had at least a basic EHR in place in 2015, which is up significantly from the 10% adoption rate in 2008. As an industry we’ve gone from practically no medical records stored electronically to virtually all of them in just 7 years. This growth rate is impressive, but it’s unfortunate that it took until 2008 and a $20 billion incentive from the federal government for widespread adoption to occur.
The impetus and source of funding for this rapid adoption is, of course, the HITECH Act, in which the federal government encouraged adoption by subsidizing EHR procurements.
Encouraging adoption is one of the four roles the Federal government has claimed with respect to Health IT, and doing so through direct stimulus is a straightforward approach. A financial incentive can motivate high-level behavior, but it’s much more difficult to ensure the newly adopted technology is used to its full potential. Government can only exert limited influence over the direction of technological change, which is one reason Bill Gates describes government as a “blunt instrument”.
The HITECH incentives provide a subsidy for hospitals to procure EHR technology, and the Meaningful Use standards set a minimum threshold for how the technology is to be used. But
the specific features and uses of the software are left up to the software developers and users to determine. This arrangement provides a constructive way to break the deadlock that had prevented adoption from occurring before 2008.
The blunt instrument of government funding began the process of EHR adoption so that a critical mass of electronic records became available to enable new and innovative ways to care for patients, but government incentives demonstrate their bluntness when it comes to anticipating and managing the implications – both good and bad – of a mostly electronic recordkeeping infrastructure.
Now that the preponderance of medical records is electronic, rather than paper, it’s possible to quickly exchange individual records, run reports and analytics across patient databases, and easily generate reportable statistics and metrics. These are the fundamental, operational building blocks required to optimize any system, and theONC’s Interoperability Roadmap describes how a technological infrastructure is key to what they call the Learning Health System.
Of course, there are also downsides to moving medical records from paper to databases in such a short time frame. One problem is a shortage of workers to accomplish the implementations. Another problem is that other aspects of Health IT are struggling to keep up with the rapid shift to electronic health records.
Cybersecurity is a particularly worrying part of the struggle. Electronic records are an attractive target for hackers, which was never a problem with paper-based records. IT departments experience difficulties providing sufficient privacy, security, and compliance for their new data asset. This is one reason that cybersecurity made the list of top HIT trends for 2016.
In spite of the risks and challenges, the Health IT industry is committed to a digital future. The path forward will be characterized by two major concerns: how to deal with the implications, such as security, of storing electronic health records; and how to best take advantage of the new, digital infrastructure to improve patients’ health and realize the Learning Health System.

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