Friday, January 28, 2011

US House of Representatives Proposes to Defund Largest Non-Consented Medical Experiment in U.S. History: HITECH

In a new bill in the House of Representatives, the ‘‘Spending Reduction Act of 2011’’ (link - PDF), it is proposed to cut unobligated funds of, among others, division A of the "American Recovery and Reinvestment Act of 2009":

Spending Reduction Act of 2011

... TITLE III—RESCISSION OF UNOBLIGATED STIMULUS FUNDS AND REPEAL OF CERTAIN STIMULUS PROVISIONS

SEC. 301. RESCISSION OF UNOBLIGATED STIMULUS FUNDS.

Effective on the date of the enactment of this Act, there are rescinded all unobligated balances of the discretionary appropriations made available by division A of the American Recovery and Reinvestment Act of 2009 (Public Law 111–5).

SEC. 302. REPEAL OF CERTAIN STIMULUS PROVISIONS.

Effective on the date of the enactment of this Act, subtitles B and C of title II and titles III through VII of division B of the American Recovery and Reinvestment Act of 2009 (Public Law 111–5) are repealed, and the provisions of law amended or repealed by such provisions of division B are restored or revived as if such provisions of division B had not been enacted.

Division A of the ARRA Act of 2009 (link to PDF) includes this:

SECTION 1. SHORT TITLE.
This Act may be cited as the ‘‘American Recovery and Reinvestment Act of 2009’’.

SEC. 2. TABLE OF CONTENTS.

... The table of contents for this Act is as follows:

DIVISION A—APPROPRIATIONS PROVISIONS

... TITLE XIII—HEALTH INFORMATION TECHNOLOGY

Title XIII of the ARRA along with title IV of division B is better known as HITECH:

SEC. 13001. SHORT TITLE; TABLE OF CONTENTS OF TITLE.

(a) SHORT TITLE.—This title (and title IV of division B) may be cited as the ‘‘Health Information Technology for Economic and Clinical Health Act’’ or the ‘‘HITECH Act’’.

It looks like HITECH is one of a number of spending extravaganzas now on the proposed chopping block.

I can't be too sorry about this for these reasons:

  • This country cannot afford HITECH at this time. We are broke, with some calling the economic crisis of 2008 worse than the crisis of 1929, and the national deficit ballooning far out of control. The money would be far better spent at this time on care of those who cannot afford it.
  • HITECH appeared as if out of nowhere, with little to no input time from stakeholders. This suggests lobbying by those with conflicts of interest to push this bill onto the public, affecting their medical care without informed consent (see my March 2009 post "Draft Patient Rights Statement and Informed Consent on Use of HIT"). The bill includes persuasion along with economic coercion for non-adopting organizations and physicians. ("Adoption" = adherence to government-set standards of "meaningful use" of poorly usable technology.) I disapprove of the stealth process by which HITECH appeared. This is the U.S., not the old USSR.
  • Mass social experiments involving major systemic changes to our healthcare delivery system, with exceptional claims being made about IT, need to be backed by exceptional evidence. That evidence is lacking. (March 2011 addendum: the evidence might actually be in the negative direction. See my post "An Updated Reading List on Health IT.")
  • The technology is not ready. It is dangerous in unqualified hands, which most every medical center and physician office is in 2011 (i.e., an IT backwater). The field of health IT was somehow transformed from an experimental field into the 'savior of medicine' without the proof of value and safety that would ordinarily be required to move an experimental technology from lab to national rollout. Per the Washington Post, this process appears to have been a highly politicized one, favoring the corporate elites. The Washington Post’s 2009 article on the influential HIT vendor lobby “The Machinery Behind Healthcare Reform” is at this link.

While this House Bill is just the initial battle in the repeal of this and other mass expenditures, I would not weep for the HITECH act's passing. It would allow the restoration of health IT back to an unrushed and careful endeavor. It would also give time to work out the significant issues causing health IT difficulty (such as raised in 2009 by our National Research Council) before we embark on national diffusion.

In other words, its passing would reduce risk and help restore an essential level of sanity and due diligence to the healthcare IT sector, now afflicted by irrational exuberance bordering on delirium. We would avoid the largest non-consented medical experiment in US history, which as I have repeatedly written I feel would be disastrous with current levels of understanding of this technology and how to design, deploy and manage it. (My relative's 2010 HIT-related injuries only strengthened my convictions in this regard.)

Of course, I have no financial conflicts of interest regarding HITECH or health IT to weep about. Others do, and it's not hard to predict their financial interests will push them to oppose repeal "by any means necessary."

The next few months should be an interesting time in the politics of healthcare IT.

A replacement HITECH act that's "HI" on research and caution, but not so "HIGH" on stealth, coercion and euphoria (i.e., as on mind altering substances) would be welcomed.

-- SS

11 comments:

Anonymous said...

They are reading and listening.

Congrats to the House Republicans for realizing that HITECH was, in essence, the purchase of a pig in a poke. What a waste of taxpayers' money.

Everyone should get behind this bill and strip HITECH of its funding.

Live it or live with IT said...

I'll go further in support of repealing HITECH. The HITECH effort has stymied lots of good ideas. So it has had the exact opposite effect as was intended.

Anonymous said...

This would be great news as my health system is in HIT chaos. I would not weep either, if taken away. In fact, maybe I could sleep at night and not worry about the system having a "glitch" that harms or kills a patient.

Anonymous said...

This should put some additional doubt into those who are thinking that the MU funds are a slam dunk give away. There may be NO funds at all.

Scot M Silverstein MD said...

Anonymous January 29, 2011 3:57:00 PM EST writes:

This should put some additional doubt into those who are thinking that the MU funds are a slam dunk give away.

Another aspect of the expensive national experiment best terminated, until the technology is proven meaningfully usable, meaningfully effective and meaningfully safe.

-- SS

Anonymous said...

Gees, I am sticking with the safe and resilient system that I have used for more than a decade. If I buy an EHR, the likelihood is low that stimulus funds will come my way. There will be a stimulus to get rid of the user unfriendly EHR.

I will use good old fashioned paper, facsimile, and telephone to provide safe and efficacious care to my patients.

If all of my patients had hangnails as their only disease, the EHR may be usable, but not for complex interractive comorbidities with complex medication programs. You go bleery eyed looking at the pages of clinically useless information.

As you have said so aptly on this blog, "legible gibberish".

Al Borges MD said...

My only conflict of interest in my wish for HITECH to die off is that if it continues, it will eventually put my small office and other offices like mine out of business in favor of large group practices which can be controlled easily by big government.

Three cheers for the Republican controlled House!

Scot M Silverstein MD said...

Al Borges writes:

Three cheers for the Republican controlled House!

In an apolitical sense, I would write - three cheers for a move to decrease runaway speculative spending on unproven technologies and irrational exuberance, while increasing the time needed to move experimental HIT to affordable and mission-useful status.

-- SS

EMR and HIPAA said...

Seems like the cheers might be too early. A bill in the house isn't going to lead to the repeal of HITECH. It will have little effect since Congress and the president will block it.

Maybe it will cause doctors and practices to think a little bit more before they blindly go after the government hand outs.

Scot M Silverstein MD said...

Re: EMR and HIPAA said...

I don't know what will happen. Besides the House, there are a lot of Senators also acutely aware of health IT problems and the plight of the uninsured, on both sides of the aisle. As I wrote in the post, "The next few months should be an interesting time in the politics of healthcare IT."

-- SS

Mark @ Israel said...

In my opinion, HITECH is worth repealing. I agree in all of the reasons you have included. Indeed, the country cannot afford it yet and the technology is not yet ready.