Meaningful Uses of HIT?

A diverse group of HIT professionals – including physicians, academics, developers and entrepreneurs – gathered at Sudler & Hennessey’s Health and Technology Summit in New York City to discuss the challenges related to health information technology implementation, and the ways to move forward.

Five billion dollars has been paid out so far to physician practices and hospitals that qualify under the meaningful use provision of the Health Information Technology for Economic and Clinical Health (HITECH) Act, but close to half of all ambulatory – or outpatient – care providers are still using paper charts, not electronic health records. It’s likely that adoption will increase closer to the 2015 deadline; if a physician practice hasn’t shown “meaningful use” of an electronic health record (EHR) system, then CMS will cut reimbursement rates under Medicare by 1%.

But will the healthcare business model change to such an extent that, by 2015, a critical mass of physicians won’t have to think twice about whether to purchase an EHR for their practice, or simply pay the fine? Opinions vary dramatically on this question. For some of the presenters at the summit, the business model has already changed, and an EHR’s ability to capture data on the real-world performance of a drug or device is already saving money by reducing the number of adverse events, hospital readmissions, and other bad health outcomes. But the problem, as bluntly stated by Kalipso Chalkidou, founding director of NICE International, at last week’s Financial Times US healthcare and Life Sciences Conference, is that “identifying waste in the healthcare system” – like unnecessary adverse events, preventable hospital readmissions, or duplicate tests paid for by Medicare – is also “identifying someone else’s revenues.”

In other words, full adoption of EHR systems in the US won’t happen until physicians can be sure about a positive return on investment, meaningful use incentive or not. At the moment most aren’t sure, and neither are consumers – personal health records (PHRs) have not been terribly successful to date. Despite this fact, everyone participating in the summit acknowledged that EHRs and PHRs are critical tools for the future, and will be absolutely necessary for organizations moving in the direction of value-based payment models, and away from fee-for-service. Many attendees suggested that the barriers to implementation – interoperability, robust, base-line standards, and cultural factors among physicians and their organizations – can and should be overcome by market forces. But market forces are also currently an impediment to EHR adoption; under the traditional model, the more services a physician provides, the better.  “The Kaisers and Geisingers of the world aren’t replicable,” one attendee noted. “Just because you put all of the components together into one group – physicians, hospitals, a health plan – doesn’t mean that they’ll work together. It took years and years for Kaiser to get to where it is today.”

True, but bundled payments, medical homes, ACOs and other new payment models are shifting the focus from patient volume to patient retainment, one speaker said. For example, “there will be a pay-for-performance measure associated with systolic blood pressure” for cardiovascular patients, “that’s here to stay,” he said.

There are a lot of challenges around EHR implementation and HIT more broadly – cost and education are near the top of the list – but as one speaker said, “it’s better to light a candle than to curse the dark.” For now, pharma has three key opportunities with respect to EHRs, according to one summit presenter:

• Accelerated clinical trial enrollment. Also, tracking patients through EHRs is infinitely easier than using paper.

• Medication adherence. Most physicians don’t have time to call a pharmacy to see if their patients have been picking up prescriptions. With an EHR, adherence data will show up in a patient’s file.

• Real-world evidence. In addition to FDA’s Sentinel Initiative, pharma can use EHRs to harness data for comparative effectiveness data, to help distinguish products in the market.

For a closer look at pharma’s play in EHRs, and a forecast on physician adoption, see this article.