House Ways And Means, and Energy and Commerce, Note EHRs Not What They Were Made Out To Be, Calls For HITECH Moratorium

I have called numerous times for a moratorium on ambitious national health IT programs.  See 2008 and 2009 posts here and here for example.  My calls are due to the prevalence of bad health IT (BHIT) in 2012, hopelessly deficient if not deranged talent management practices (especially when compared to clinical medicine) in the health IT industry, and complete lack of regulation, validation and quality control of these potentially harmful medical devices. 

I also called the HITECH stimulus act in its present form social policy malpractice.  (See my Sept. 2012 post "At Risk in the Computerized Hospital: The HITECH Act as Social Policy Malpractice, and Passivity of Medical Professional".)

Congress is starting to catch on:

Letter from House Ways and Means, and Energy & Commerce, to Secretary Sebelius of HHS.  Click here to download.

The letter to HHS secretary Sebelius is from Congressmen Dave Camp (Chairman, Ways and Means), Wally Herger (Chariman, Ways and Means Subcommittee on Health), Fred Upton (Chairman, Energy and Commerce) and Joe Pitts (Chairman, Energy and Commerce Subcommittee on Health).

In the letter the following is noted:

Dear Secretary Sebelius:

We are writing to express serious concerns about the final Electronic Health Record (EHR) Stage 2 Meaningful Use rules recently issued by HHS and ONC.  We believe the Stage 2 rules are, in some respects, weaker than the proposed Stage 1 regulation released in 2009.  The results will be a less efficient system that squanders taxpayer dollars and does little, if anything, to improve outcomes for Medicare.

The letter then notes that the "Stage 2 rules ask less of providers and do less for program efficiency" and that the Stage 2 rules fail to achieve comprehensive interoperability in the face of
warnings that:

..".failure to set a date for certain interoperable standards would put as much as $35 billion in Medicare and taxpayer funds in the hands of providrrs who purchase and use EHR systems that are not interoperable."

They note the Stage 2 rules fail to achieve interoperability in a timely manner and that "more than four and a half years and two final MU rules later, it is safe to say that we are no closer to interoperability in spite of the nearly $10 billion spent."

A major reason for this, I believe, is regulatory capture by the IT industry as I outlined in my somewhat rhetorically-entitled posts "Health IT Vendor EPIC Caught Red-Handed: Ghostwriting And Using Customers as Stealth Lobbyists - Did ONC Ignore This?" and "Was EPIC successful in watering down the Meaningful Use Stage 2 Final Rule?"

The House letter also notes:

It is highly counterproductive for providers to have purchased EHR systems that "cannot talk with one another" and cannot perform basic functions because of the insufficient standards set by your agency.

One of the critical "basic functions" is the note search capability upon which the vendors used their influence during the "public comments" period to have written out of existence, as in the above posts.  The influence became apparent due to serious public comment editing mistakes by customers.  One wonders what other episodes of vendor influence did not make it into the public spotlight.

The house committee members also note:

Perhaps not surprisingly, your EHR inventive program appears to be doing more harm than good.  A recent analysis of Medicare data by the New York Times explains the costly consequences.

Unfortunately, the letter did not spotlight the excellent analysis done by the Center for Public Integrity and published before the NYT article ("Cracking the Codes" by Fred Schulte et al.)

Finally, the letter calls for HHS to:

... Immediately suspend the distribution of incentive payments until your agency promulgates universal interoperable standards.  Such a move would also require a commensurate delay of penalties for providers who choose not to integrate HIT into their practice"  and to "significantly increase what's expected of Meaningful Users."

It is unfortunate the letter seems to make the assumption that health IT in its present form, and the industry in its present state of anarchy, can produce good health IT (GHIT) that is safe and effective.  (As I've written, we need ease-of-use, reliability and safety - basic "operability" - before interoperability.)  Perhaps the congresspeople need to read my recent post "Honesty and Good Sense on Electronic Medical Records From Down Under".

Financial issues are one major concern, but patient harm and death due to the disruptive influences of BHIT are, in fact in many respects more important.

Finally, to those who would suggest a political angle to this letter (I note comments on sites such as on the Histalk blog that the authors are Republicans), I note that ONC was started in 2004 by George W. Bush, and that health IT has always had broad bi-partisan support.

Reality in healthcare is more often than not apolitical, and injured and dead patients really don't care much about ideology.

-- SS

House Energy & Commerce Calls for Sharing of "Lessons Learned" on Health Care IT

U.S. Rep. Charles W. Boustany, Jr., MD, R-Southwest Louisiana, introduced the Patient-Controlled HealthIT Act (H.R. 6345) to allow patients to control their medical records. Electronic medical records have indeed created much potential for misuse. This is an interesting piece of legislation. Boustany, a former cardiothoracic surgeon, introduced the bill to spur investment in Health IT to help reduce the cost and improve the quality of healthcare for all in Southwest Louisiana, an area seriously affected by Hurricane Katrina.

Of even more interest is H.R. 6357, recently released by Energy & Commerce on Health IT: H.R. 6357 , the “Protecting Records, Optimizing Treatment, and Easing Communication through Healthcare Technology Act of 2008", a.k.a. the "PRO(TECH)T Act of 2008."

I note the E&C HIT bill calls for the National Coordinator (ONC) at HHS to prepare a report:

IMPLEMENTATION REPORT. - "The National Coordinator shall prepare a report that identifies lessons learned from major public and private health care systems in their implementations of HIT systems, including information on whether the systems and practices developed by such systems may be applicable to and usable in whole or in part by other health care providers" (Item 5, page 12).

It is possible that the numerous hits I noted from domain "House.gov" on my website of collected HIT difficulties over the past few months played a role in this proposed language. I track my site's viewers by IP for research purposes (e.g., see this 2006 AMIA poster "Access Patterns to a Website on Healthcare IT Failure": Abstract [pdf], Poster [ppt]. Evidence for this is the language at my site's introductory page to lessons learned:

"Organizational and human factors issues associated with healthcare IT have led to project difficulties and failures. Detailed case accounts might improve knowledge sharing between healthcare organizations on lessons learned and best implementation practices. Web-based, detailed information on healthcare and other IT project difficulty that can be used as “lessons learned” by others in their own projects is uncommon.

With the increasing push for EMR implementation at national levels, knowledge sharing via the Web on project difficulties might be helpful to those involved in design and implementation. In clinical medicine and indeed in any scientific field, you cannot just count the hits and ignore the misses ... We believe filling the information gap on healthcare IT difficulties is an essential goal to which medical informatics specialists can contribute, and that doing so would be helpful to patients and the healthcare community."

The E&C language is a good summary of that wording, which I crafted years ago.

This "lessons learned" item in the proposed legislation suggests Congress is aware that there are lessons to be learned, which implies they are also aware of difficulties, failures etc. that waste precious healthcare resources and time, and transfer money from healthcare to the IT and IT consulting sectors.

As readers here certainly know from my postings, I've been calling for this type of information sharing about HIT problems and solutions for the past decade, to little avail (as an information science "experiment", try a google search on "healthcare IT failure" or similar concepts and see how little comes up).

One might ask where, in fact, the large management consultants have been on this issue. Firms such as Accenture, Deloitte, Booz Allen Hamilton, and many others that have large health care consulting practices but lack experts with formal Medical Informatics expertise have been asleep at this particular switch, it seems.

One can imagine they will try to capitalize on this proposal should it pass into law (which I believe it will). This is both amusing and scary, because in my view (after watching these firms in action in my various healthcare IT leadership roles), they have been more part of the problem in HIT difficulties, closely allied with the Management Information Systems culture and its rigid data processing-card tabulator paradigms and methodologies, much less part of the solution.

In any case, this E&C proposal is a welcome development.
Finally, to those in the HIT vendor sector and in the Medical Informatics community itself who've disparaged writings on HIT difficulties and failures because they were not "academic", not "useful", were "anecdotal", or even "disingenuous" (such comments were actually made about Koppel's paper on CPOE difficulties, see here and here and here and here), I can express this simple observation:

You were wrong.

-- SS