Monday, January 24, 2011

Is the Executive Branch/HHS Trying to Put Lipstick on a Pig Regarding Health IT?

In another example of executive branch spin on healthcare - this time, the Office of the National Coordinator of Health IT (ONC) within HHS - data that gave an off-narrative message about healthcare IT was initially withheld according to Modern Healthcare's Joseph Conn.

The data withholding is reminiscent of the data manipulation practiced in the pharmaceutical industry.

Legislative branch, take note:


Not-so-rosy rumors

By Joseph Conn

Modern Healthcare.com

Last week, Dr. David Blumenthal announced the results of two surveys funded by the Office of the National Coordinator for Health Information Technology on hospital and physician participation in the federal electronic health-record incentive programs.

But Dr. B left out a few numbers in going over the results of the survey of office-based physicians conducted by the National Center for Health Statistics. On request, the ONC and NCHS released those missing numbers.

Docs were asked: "Are there plans to apply for Medicare or Medicaid incentive payments for meaningful use of health IT?" Blumenthal reported on their answers in part, noting that 41.1% indicated "yes" and 14% said "no." However, a 44.9% plurality, which he did not mention, chose "uncertain whether we will apply." [Nothing to see here ... move along - ed.]

Those who answered "yes" were asked a follow-up question: "What year do you expect to apply for the meaningful-use payments?" Of the 41.1% of docs who indicated they were sure they would apply (a figure Blumenthal released), nearly one in five (19.7%, a number he didn’t mention) were unsure as to when. [Must be the Luddite faction - ed.]

Additionally, the NCHS asked physicians, "Which incentive payment do you plan to apply for?" Their responses to this question also weren’t mentioned by Blumenthal last week. Not surprisingly, given current eligibility thresholds, 65.1% selected Medicare and just 6.8% chose Medicaid, but again there was considerable uncertainty, with 28.2% choosing "unknown" or leaving the choice blank. [This finding suggests rank confusion to me more than anything else. In case nobody noticed, physicians are rather busy these days taking care of patients, and don't have time to find out what's in lengthy government documents - ed.]


Read the whole article.

It seems the executive is simply determined to push this technology onto a significantly skeptical physician community - skeptical of the incentives, of MU, of government intentions, and/or of the technology itself.

Of course, perhaps they feel that such data on a beneficent technology that will absolutely, positively benefit medicine and patients needs to be withheld - for the greater good, of course, which some people have to suffer to achieve (see the post "MAUDE and HIT Risks: Mother Mary, What in God's Name is Going on Here?"). ONC on healthcare IT in recent months:

http://healthcarereform.nejm.org/?p=3732&query=home
... The widespread use of electronic health records (EHRs) in the United States is inevitable. EHRs will improve caregivers’ decisions and patients’ outcomes. Once patients experience the benefits of this technology, they will demand nothing less from their providers. Hundreds of thousands of physicians have already seen these benefits in their clinical practice.
(Also see http://hcrenewal.blogspot.com/2010/07/new-england-journal-on-meaningful-use.html).

and

http://www.massdevice.com/news/blumenthal-evidence-adverse-events-with-emrs-anecdotal-and-fragmented
... [Blumenthal's] department is confident that its mission remains unchanged in trying to push all healthcare establishments to adopt EMRs as a standard practice. "The [ONC] committee [investigating FDA reports of HIT endangement] said that nothing it had found would give them any pause that a policy of introducing EMR's could impede patient safety," he said. (Also see http://hcrenewal.blogspot.com/2010/05/david-blumenthal-on-health-it-safety.html).


A good number of physicians still appear to possess critical thinking skills.

Perhaps the new Congress (i.e., legislative branch) can benefit from physician-style skepticism about health IT as well.

-- SS

4 comments:

Keith said...

As one of the docs struggling to make sense of all these incentives, and to determine whether the equation swings in favor of adoption of an EMR system at this time, I would be curious to hear what you suggest? When I look at the likely loss of productivity over the course of months or longer and theissues of whether EMR actually does anything to improve patient care, one has to wonder. My sense is to forego all the carrots for ow and wait till these systems have the bugs worked out of them. Quite likely, the prices will drop significantly once the market consolidates like seems to happen with most IT advances.

Scot M Silverstein MD said...

IMO adoption now or later is a decision that should be made based on personal temperament regarding any experimental technology or treatment. Some will adopt early and accept risks (although I believe their patients need to be informed of the poss. risks of experimental technology as well and give meaningful consent to its use in their care); others will need more time and proof; others will never adopt (at least not willingly).

On the other hand, our government -- as I've stated on this blog numerous times -- needs to SLOW DOWN in its promotion and diffusion plans for the technology until the risk/benefit is better understood, and from unbiased sources. Our government also needs to watchdog the extant technology.

The authors of "The Impact of eHealth on the Quality and Safety of Health Care: A Systematic Overview" that I wrote about here put it well:

Our major finding from reviewing the literature is that empirical evidence for the beneficial impact of most eHealth technologies is often absent or, at best, only modest. While absence of evidence does not equate with evidence of ineffectiveness, reports of negative consequences indicate that evaluation of risks – anticipated or otherwise – is essential ... Given this, there is a pressing need for further evaluations before substantial sums of money are committed to large-scale national deployments under the auspices of improving health care quality and/or safety."

-- SS

Anonymous said...

Best advice: DON'T BUY.
Following this strategy will protect you and your patients. Why would anyone want to go on the hook for $ thousands to purchase equipment that reduces efficiency and endangers patients. There just ain't any proof that they improve outcomes.

Scot M Silverstein MD said...

There just ain't any proof that they improve outcomes.

There actually is, but only in special settings - e.g., large academic hospital with strong Medical Informatics research unit.

Most medical settings are not that.

Problem is, there is also an increasing corpus of reports on risks in "non-special" settings.

-- SS