Better Care Through HCIT 101: Part One, Who Owns the EMR and Why Do They Care?

When Gwen Darling started her Social Media, multipart blog, I appreciated that she was leading something important at Healthcare Informatics. She was taking an important emerging topic, dividing it into bite- (blog-) size pieces, and serving it over time. Brilliant, well done and welcome. Now, it’s my turn. Somewhere along the way, I decided that part of my life should be committed to improving healthcare through better information and information technology enablement. I’m sure there are a lot of kindred spirits reading this. I’m neither alone nor unique. As I shared in the bio that introduces my blogs here, I’ve found some important challenges that really bear group discussion. At times, these challenges can be obstacles. When that occurs, they need to be identified as such so that the three options – go around them, go over them, or go through them – can be framed and evaluated. Notice all my options start with “go” and don’t include apathetic inaction. Again, I’m neither alone nor unique from my readers! My strategy is to post an installment about every two weeks, looking at specific challenges. In contrast to other blog styles, such as closing with a rhetorical question, or deliberately choosing a controversial aspect of a complex issue like privacy, I intend to close with what I take home as a small lesson from the topic. I’ve identified about a dozen of these topics; the next two installments I’ll be posting are entitled “My Garage” and “The Bell Curve.” Suggestions, reaction and dialogue continue to be welcome and important. Today, I’d like to briefly explore ownership of electronic medical records. This question takes on new life in light of the Economic Stimulus Package. In an opinion piece, “ A Health-Tech Monopoly,” the author addresses the motivation for stimulus funding, and it’s not just job creation and/or otherwise fueling the economy --- it’s positioning for government-run healthcare. The stimulus spending on EMRs is dubbed “a down payment on national health care.” Undeniably, this is one proven (by other countries) route to cost control. The opinion continues that, along with political the goal of cost control come price control, and denial of some treatments and drugs. See Nadeem Esmail's " 'Too Old' for Hip Surgery " for several examples of potential implications. My goal is not to address whether government control is good or bad; we’ve obviously struggled with this question and how to structure assuring basic care for the last century. Rather, it’s important to consider this perspective when looking at the economic stimulus for EMRs directly. Both House and yesterday’s Senate bills are explicit about two things: “meaningful use,” and specific financial incentives. These are outlined with specifics for hospitals and physicians. There are also explicit penalties for non-adoption, starting in 2015 or 2016 (Senate vs. House timelines). And of course, the requirement of certified EHR technology and ability to report clinical quality measures (as specified by government). As part of reasonable disclosure, I need to acknowledge that I participate in several organizations that have provided recommendations which were considered in the language of these bills. My conclusion for this post? Although the ownership and related adoption of the EMR is political center stage now with its economic stimulus funding, the tremendous economic impact of healthcare on government is the primary sub-text. When Neal Ganguly and I discussed this last week, Neal framed the question as creating societal value (and avoiding wasteful, non-value spending). The lesson here is that we can never take the goals of EMR adoption for granted, or leave them implicit. It’s possible to achieve significant cost control with zero clinical decision support. Similarly, it’s possible to dramatically improve healthcare with clinical decision support and evidence-based care management, while simultaneously causing healthcare costs to spiral upward. Let’s all keep up our professional leadership to ensure that our vision for better healthcare remains central, while simultaneously moving aggressively toward a sustainable economic model to pay for it, both supported by the EMR.