Electronic health records — we have ways of making you....

When HIPAA (Health Insurance Portability and Accountability Act) was passed in 1996, outlining how government and healthcare providers can use our personal health information without our consent, most of us didn't hear of the ramifications. As the government works to create a national electronic health information network (NHIN) and enact policies for how the government and third party interests can collect, use and sell our personal health information without our consent, few of us are hearing of those ramifications, either. This week brought major developments in the government’s push for a national health information database that we will want to hear about. It’s been a busy week!

Most of what we hear in the news is the possible benefits of national electronic health records and health information technology, and rarely the possible drawbacks. Unbeknownst to most consumers, nationalized electronic health records will further the monitoring and control of doctors’ clinical practice in complying with third party insurer and government guidelines, the medical tests that doctors must perform and the prescriptions they must write, and our compliance with care management determined by the government and third parties. These were just a few of the benefits of electronic health records for business and government interests outlined in the “Health Information Technology Leadership Panel Final Report” prepared by the Lewin Group, hired by the National Coordinator for Health Information Technology. As it explained:

Health information technology (HIT) refers to “The application of information processing involving both computer hardware and software that deals with the storage, retrieval, sharing, and use of health care information, data, and knowledge for communication and decisionmaking.” A central component of HIT is the electronic health record (EHR), a patient’s medical file, which is stored electronically and maintained by a health care provider.

“EHRs are so much more than just putting what is on paper to an electronic form,” said Richard Hillestad of RAND, at the Alliance for Health Reform conference, “HIT: Here, Now and Tomorrow” held on September 16, 2005. Electronic records enable patient tracking and us to bring in personal health records to remind people what they need to do, he said. “We have a population that its obesity rate is about twice what the OECD obesity rate is. People are not taking care of themselves. Personal health records may be one way to get this kind of thing happening.”

Among the other benefits for stakeholders discussed at this conference were those noted by George Halvorson, spokesperson for Kaiser Permanente, who said that HIT is absolutely essential for provider performance measures and having data available on doctors’ practices, and “to remind the doctor to do the right thing at the right time in the right way.” HIT would also enable control over medical information reaching doctors and what procedures, medications and approaches are best.

President Bush signed Executive Order 13335 on April 27, 2004, which created the National Coordinator for Health Information Technology position, charged with the development and oversight of the government’s strategic plan for nationwide health information technology. The Lewin Group report outlined the strategies for eliciting the cooperation of stakeholders in NHIN, by convincing them of the cost and safety benefits. But if electronic health records are so wonderful, it's puzzling why the HIT panel also emphasized that federal leverage would be necessary, and would be welcomed by private sector stakeholders, to “reach a tipping point in HIT adoption.”

The report had concluded:

HIT Leadership Panel members were emphatic that consumer buy-in is essential for successful adoption and implementation of HIT. While health care provider institutions, clinicians, and payers will comprise the bulk of direct users of HIT systems, widespread adoption may not succeed without buy-in from the public as health care consumer, including health plan beneficiaries, patients, and family members.

This week saw these strategies put into play. Several big HIT stories came out this week, although none received wide attention from the mainstream media. But they are important for consumers and healthcare professionals.

HIT adoption linked to physician reimbursements

The first, and most incredible, development this week illustrated how the government can impose “federal leverage” to coerce compliance with HIT.

On Tuesday, December 4th, Secretary of Health and Human Services Michael Leavitt urged Congress to require doctors to use electronic health records by tying it to reimbursement for care provided to Medicare recipients. As Health Care IT News reported, Leavitt’s actions were attributed to pressures from the HHS healthcare IT advisory panel, the American Health Information Community (AHIC), to force adoption of electronic health records. As reported:

“When do you reach the tipping point that you can require the use of this technology,” Leavitt told AHIC members. “There will be a point where we have to go against that divide.”

AHIC is “a quasi-public institution created by the administration, has been establishing health IT standards under HHS supervision since 2005,” said HHS spokesman Kevin Schweers. The Centers for Medicare and Medicaid Services had issued a final rule on November 1st, calling for a 10.1% reduction in payment rates for physicians beginning next year. As The Hill reported on Wednesday, the Administration has tied any legislation attempting to stop this cut in reimbursements to mandatory adoption by doctors of electronic health records and electronic prescriptions. Physicians who don’t adopt HIT should receive lower payment, Leavitt was reported as saying.

As The Hill also noted, the drug industry has aggressively led the push for the prescription side of electronic health records:

This year — driven in part by an aggressive lobbying campaign spearheaded by the Pharmaceutical Care Management Association (PCMA) — electronic prescriptions have garnered the most attention. PCMA and allies such as Sen. John Kerry are pushing for a requirement that doctors use e-prescriptions for all their Medicare patients. Kerry, who sits on the Finance Committee, has advocated including that mandate in this year’s Medicare bill.

Congress Daily reported that Senators John Kerry, Debbie Stabenow and John Ensign are each “expected to introduce a stand-alone bill that would require adoption of e-prescribing for Medicare beneficiaries by 2011.” The bill would offer a 1% bonus for every e-prescription doctors write and those who don’t adopt the technology by 2011 would face financial penalties.

HITTRUST

A press release was issued on December 5th, announcing the creation of a new organization called the Health Information Trust Alliance (HITRUST), which was described as an alliance of major healthcare organizations and employers involved in the development of electronic health records who will work together to create common practices “to allow for more effective and secure access, storage and exchange of personal health information...and who are united by the core belief that standardizing will build greater trust in the electronic flow of information through the healthcare system”

The founding businesses included CVS Caremark, Cisco Systems, Highmark Inc., Hospital Corporation of America, Humana, Johnson & Johnson, Philips Healthcare, and Pitney Bowes (a direct mail provider). According to the press release, “we will not achieve the full potential of information technology if we don’t first establish widespread confidence in the security of electronic information.”

Two key points may escape the casual reader. First, it carefully notes that privacy and security are two distinct concepts and this new alliance is “singularly focused on the latter.” The HIT stakeholders in this alliance are working to protect the security of their interests, and control who can use and exchange the information in their electronic databases. It is not securing the privacy of doctors or patients.

Second, this is a lobbying organization made up of HIT stakeholders who will “drive the adoption and widespread confidence in the framework through education, advocacy and other outreach activities.” A key component of its policy advocacy is to lobby against government-mandated security measures. Their private sector effort, they say, will result in better security “solutions” that will recognize the needs of businesses. As the Wall Street Journal reported this week, the alliance “hopes that the new security practices will provide health-care organizations with a common set of standards that will eliminate the need for these audits.”

RWJF coordinator lands national HIT position

On December 6th, the Office of the National Coordinator for HIT announced the appointment of Charles P. Friedman, Ph.D., as deputy national coordinator for HIT in the Office of the National Coordinator for HIT. Prior to serving as Senior Advisor to the National Coordinator for HIT at the U.S. Dept. of Health and Human Services, he was Institute Associate Director for Research Informatics and Information Technology at the National Heart, Lung, and Blood Institute; was Senior Scholar at the National Library of Medicine; and “collaborated with the Robert Wood Johnson foundation to develop a public-private partnership for training in Public Health Informatics.” He currently serves as Associate Editor of the Journal of the American Medical Informatics Association.

What many consumers and healthcare professionals may not realize is that electronic health records and HIT have been major initiatives led and funded by RWJF for years. Project HealthDesign: Rethinking the Power and Potential of Personal Health Records, for example, is a $4.4-million project of RWJF to fund development of HIT and personal health record systems.

Upcoming predictions

Next week, we’ll likely be hearing all types of positive stories of the panacea of benefits of HIT, as the 4th Nationwide Health Information Network (NHIN) Forum meets on December 11-12th and the 3rd Annual World Healthcare Innovation & Technology Congress meets on December 9-11th.

Just as I was about to post this, however, Health Care Renewal, sponsored by FIRM (Foundation for Integrity and Responsibility in Medicine) compiled some excellent references with the other side of the “electronic health record exuberance.” As it said: “There’s science, then there’s fiction — and then there’s science fiction.” Electronic health records are not the slam dunk that government and special interests want us to believe. There are some troubling findings reported in these risk analyses and international experiences concerning financial costs, medication errors, unanticipated quality consequences, malpractice liabiilty, patient deaths, and IT difficulties and failures. Well worth reading! Healthcare professionals and consumers deserve to hear all sides of the issue, not just the claims from stakeholders’ well-financed lobbying efforts.

© 2007 Sandy Szwarc