The US Department of Health and Human Services, in the interest of advancing the adoption of electronic health records (EHRs), sponsored a report released by the Institute of Medicine back in 2003. The report identified a set of 8 core care delivery functions that EHRs would be capable of performing to promote greater safety, quality, and efficiency in healthcare delivery. The key capabilities of an EHR system described include heath information and data, result management, order management, decision support, electronic communication and connectivity, patient support, administrative processes and reporting, and reporting on population health.1 The obstacles to implementing EHR systems have been funding, training, and lack of consensus on the clinical and administrative benefits outweighing the risks.
Those who have adopted health information technology (HIT) can attest to multiple clinical benefits of using this new approach. Use of a point-of-care (POC) electronic data capture system has served as an excellent starting point for some. These types of documentation systems do not replace existing clinical systems but instead function as a front-end application that simplifies and improves the process of documentation with regard to completeness and accuracy of patient assessment data, for instance. They may be handheld, wall-mounted touch screens, or other portable devices that prevent lost paper forms, illegible entries, and copycat charting.2 Another benefit of the technology is real-time access to information otherwise inaccessible in a paper record format or manual environment. Access to timely, accurate information about a patient's condition can improve the quality of care by supporting clinical decision making. Increased reimbursement and lower liability risk may also result from use of POC systems.
At the time of President Obama's inauguration, Americans were ranking actions on healthcare high on their list of priorities. Healthcare leaders have successfully made the case that the country's economic crisis has created an unprecedented window of opportunity for health reform as part of efforts to stem the impact of the economic recession. One of the first actions taken by the Democratically controlled Congress was to expand the State Children's Health Insurance Program reauthorization and provide insurance for an additional 4 million children, for example. Furthermore, the "American Recovery and Reinvestment Act of 2009," better known as the economic stimulus package, includes an estimated $19 billion in funding for the HIT coordinator tasked with ensuring that every American has an EHR by 2014.
Critics of the stimulus package generally raise myriad concerns and, in relation to the healthcare provisions, have raised eyebrows. With the publication of her Bloomberg op-ed, titled "Ruin Your Health with the Obama Stimulus Plan," Betsy McCaughey,3 a former New York lieutenant governor, has caused a great stir. Specifically, her criticism is that the HIT job is evidence of a new bureaucracy that will strip physicians of their clinical decision autonomy. In her opinion, the national coordinator of health technology will be monitoring treatments to make sure physicians are uniformly doing what the federal government deems appropriate and cost-effective. Her concern is for those instances when your clinical condition is atypical or deserving of an experimental treatment. However, the facts demonstrate that President Bush, with bipartisan support, established the national HIT coordinator position with an executive order back in April 2004, and the coordinator position is not "new." The coordinator has served as lead advisor to the secretary of health and human services on multiple health IT issues, and the Bush administration's last budget called for implementing EHRs by 2014.
Interestingly, David Brailer, former national coordinator for HIT, has offered his own criticism of EHRs. In a press release issued January 19, 2009, the Institute for Health Freedom4 quoted the former coordinator as saying that the 1996 Health Insurance Portability and Accountability Act privacy law never anticipated the emergence of Web-based records and was not designed for the digital age. Analysis of the privacy law by the Institute indicates that it has too many loopholes to satisfactorily protect Americans' computerized health records and that it would need to be fixed by Congress prior to creating EHRs for all Americans within the next 5 years. The Institute warns the American public that Obama's spending plan poses a threat to privacy, and the provisions ought to include an "opt-out" mechanism or a measure for acquiring individual consent before opting in.
The American Medical Association believes that commentaries have mischaracterized the HIT provisions of the stimulus package. The bill does not create a federal system for electronically tracking patients' medical treatments or for monitoring compliance with federal treatment standards.5 The AMA does not believe that the HIT system will create a bureaucracy that will determine whether treatment decisions made by providers are appropriate or cost-effective. Once the funding begins to roll out of Washington, DC, healthcare providers can expect to experience enhanced access to POC devices and other HIT changes in clinical practice.
Craven & Ober Policy Strategists, LLC, is a full-service Massachusetts-based government relations firm dedicated to credible, assertive advocacy and to the dissemination of reliable public policy information.
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