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August 19, 2013

Senate Hearing: Health Information Technology Using it to Improve Care – Meaningful Use may Not Be So Meaningful After All


Recently, the Senate Finance Committee held a hearing entitled "Health Information Technology (HIT): Using it to Improve Care." Health information technology is a topic we have previously addressed in the past few months.  

The purpose of this hearing was to engage the provider community on issue pertaining to HIT and the adoption of electronic health records (EHR). Key topics of discussion during the hearing included delaying the Stage 2 Meaningful Use requirements, achieving interoperability among EHR systems, providing additional resources to small and rural hospitals to adopt HIT systems, and imposing additional regulations on providers to encourage the adoption health IT.  

Witnesses invited to testify at the hearing included:  


Chairman Max Baucus (D-MT) discussed the importance of technology in advancing the quality of healthcare, calling HIT a "critical lynchpin" to improving health and reducing costs. Noting the potential value of health IT, Chairman Baucus said that technology can help identify dangerous drug interactions, avoid duplicative test, and allow doctors to "deliver the right care at the right time." He also expressed concern that while the HITECH Act of 2009 provided financial incentives from Medicare and Medicaid for the use of health IT, the funding did not cover the entire costs of installing EHR systems, and despite the investment, those clinicians are still communicating by fax. Chairman Baucus also said that financing presents a unique issue for rural hospitals, where accessing the initial necessary capital is near impossible.  

Sen. Orrin Hatch (R-UT), ranking member on the Committee, said that he has heard from a variety of EHR vendors and providers of the challenges of complying with Meaningful Use standards. He said that while the goals of health IT reform—to transform care, increase quality and lower costs—are well founded, the incentives in place to encourage adoption could have unintended consequences. Sen. Hatch noted that while there are financial incentives for providers to transition to EHR systems, incentives are not in place for vendors to develop EHR systems that are capable of cross-platform communication. 


Ms. Marchibroda explained that through research and engagement with healthcare stakeholders, the Bipartisan Policy Center (BPC) identified several gaps in healthcare IT implementation. While EHR adoption has reached 40 percent, she said that there are still significant barriers to rural healthcare providers. Additionally, long-term care providers and behavioral health specialists do not qualify for EHR incentives. In order to achieve their stated goal to improve quality and reduce costs, Ms. Marchibroda said there needs to be a greater information flow between EHR systems. She said that the health information exchange is surprisingly low, as only 30 percent of hospitals and 10 percent of ambulatory practices participate in operational health information exchange efforts. Ms. Marchibroda emphasized that the impending Stage 2 compliance requirements for Meaningful Use do not provide enough time for vendors to address issues related to interoperability. But regardless of the strain on EHR vendors, she said that the government should not delay Stage 2 implementation. Ms. Marchibroda continued to say that the government should work on a greater alignment of information sharing, while ensuring the development of a long-term public-private relationship for data sharing. She concluded that the HITECH Act has spurred tremendous advancements in healthcare IT, but there needs to be a focus on achieving Meaningful Use and improving patient outcomes, rather than scrutinizing the details of IT system functions and features.  

Dr. Glaser began by expressing appreciation to Committee members, Sens, Pat Roberts (R-KS), Michael Enzi (R-WY), John Thune (R-SD), and Richard Burr (R-NC) for their focus on the EHR incentive program, and their recently published report, "REBOOT: Re-Examining the Strategies Needed to Successfully Adopt Health IT." He said that healthcare IT providers are improving care by streamlining patients' medical history, which reduces clinical errors and preventable oversights. However, he warned that the Stage 2 requirements are quite stringent, and rural hospitals or smaller practices often do not have the resources to achieve Meaningful Use. Dr. Glaser continued to say that the massive changes to the healthcare system in the coming months will cause providers to rush the installation of EHR systems, which will likely result in systems more prone to technical bugs and problems. Dr. Glaser made five recommendations to address these potential problems: (1) give hospitals and providers more time to install EHR systems by extending the stage two implementation date to October 1, 2015; (2) the federal government should seek to be less prescriptive and more flexible in its compliance standards; (3) have the Stage 3 requirements focus more heavily on outcomes, rather than features and functions; (4) provide a greater focus on making financing options available for rural hospitals and small practices; and (5) have more universal standards for EHR systems, with a greater focus on interoperability.  

Mr. Fattig said that Congress will need to make changes to the meaningful use program to ensure that small and rural hospitals can adequately comply with the Stage 2 requirements. He stressed that while rural hospitals have digital hurdles, considering their lack of personnel and financial resources, they are dedicated to delivering high quality patient care. Mr. Fattig warned that because of the short time frame to install compliant EHR systems before the established deadline, vendors have been unable to provide installations for all of the healthcare facilities requesting systems.  

Dr. Banas outlined the current use of EHR technology at the Virginia Commonwealth University (VCU) medical facilities, and discussed the challenges of complying with Meaningful Use standards. First, he explained that EHR technology has assisted in compliance with medical treatment standards. Dr. Banas said that VCU employs clinical decision support methodologies which consist of over 650 customized rules and alerts that help guide appropriate care plans and promote delivery of clinical best practices. He then began to discuss an application of VCU's EHR technology in providing a medical early warning system dashboard on smart-phones –the application provides physicians with real-time updates on hospital patients. Dr. Banas credited the application with a reduction of in-house mortalities of five percent along with a significant reduction in cardiopulmonary arrests outside of the intensive care unit. He later expressed concern that a "perfect storm" of new IT data technologies could overwhelm practices that are already struggling to meet new technology standards. Specifically, he noted that the new ICD-10 mandate combined with the first year of Meaningful Use Stage 2 requirements create an unnecessary burden on providers.

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