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As one of the most fractious sessions of Congress was winding down amid the “fiscal cliff” debate, members of the House committee on science, space and technology took stock of the federal government’s health IT initiatives and the complex quest for interoperability.
Representative Ben Quayle, an outgoing Republican from Arizona, said he wanted to hold the technology and innovation subcommittee hearing because of implementation concerns from some of his physician constituents. Quayle also said he was wondering if the roughly $8 billion paid to providers as part of the Office of the National Coordinator’s Meaningful Use incentive program has yielded successful returns, given the federal government’s poor finances.
Along with representatives from Intermountain Healthcare, HIMSS and Medicity, federal health officials explained the ONC’s progress in helping American doctors and hospitals adopt health IT systems, and there was also some debate about the challenges of standardizing health IT, in the midst of so much financial pressure and with such a muddy swamp of privacy and legal concerns.
Reading his comments from a tablet computer, Farzad Mostashari, MD, national coordinator for health IT, said the HITECH Act and health IT programs it has spawned are largely turning out to be worthwhile investments, citing a doubling of EHR adoption rates among physicians and the new delivery models that are using data to improve care.
Marc Probst, CIO of the nonprofit network Intermountain Healthcare, serving Utah and southeastern Idaho, brought up the goal for national health IT standards and more streamlined patient identification. Probst said Intermountain’s 22 hospitals and 185 physician clinics have used health IT to more effectively treat patients with chronic conditions and have reduced unnecessary care and hospitalizations.
Probst also spent part of his allotted five minutes relaying the story of the Australian railroad industry, as a fable for those who think national standards are a waste. Somewhat like health IT vendors in the U.S. during the past several decades, he said, Australian rail companies built rail lines using different gauges throughout the 1800s and linking them all was a huge burden until national standards were adopted in the 1920s. As Mostashari noted later, U.S. rail gauges were standardized in 1853.
Probst said building interoperable systems requires an investment and that markets have started embracing standards, with some evolving organically.
[See also: CMS offers MU stage 2 spec sheets]
While highlighting the complexities in developing consensus with hospitals, insurers, vendors and other stakeholders, Charles Romine, director of the information technology laboratory at the Commerce Department’s National Institute of Standards and Technology (NIST), pointed to progress in designing more integrated and productive EHR and health information exchange systems — or as Maryland Democratic Representative Donna Edwards put it, “more intelligent” health IT systems.
Romine said NIST has developed a health IT simulation software that can model how different EHR systems can, or perhaps cannot, link and that can better assess progress with clinical use cases and HIPAA compliance.
Rebecca Little, senior VP at Medicity, an HIE owned by insurer Aetna, said health information exchange in the context of federal healthcare reform is “the necessary ingredient to transforming patient care and creating a more effective, efficient and ultimately less costly health system,” especially considering aims to reduce avoidable hospitalizations for Medicare and Medicaid patients.
Health data can be used to measure the efficacy of various delivery models, she said, citing the success of Aetna’s 750-patient Medicare Advantage collaborative care pilot in Portland, Maine.
And addressing several lawmakers’ concerns over the usability of EHR systems, Mostashari said the EHR products have improved significantly since the MU program first got underway, with competition spurring innovation and the creation of more consumer friendly and more sophisticated systems.
Willa Fields, San Diego State University nursing professor and HIMSS board chair, said that “We aren’t where we need to be with usability,” but as more providers and physicians get wired, vendors are going to better able to tailor their software.
And considering the federal government’s interest in fixing the nation’s healthcare system, Fields also recommended more public-private collaboration in health IT investment and research, citing the tradition of bipartisanship on the issue.