The HITECH Gravy Train Is Coming To An End

In case you missed it, the shocking news was that health IT companies that stood to profit from billions of dollars in federal subsidies to potential customers poured in money lobbying for passage of the HITECH Act in 2009.

This explains why electronic health records have thus far failed to dramatically improve quality and lower cost.

The actual scandal is more complicated and scary. It has to do with the adamant refusal by hospitals and doctors to adopt electronic records no matter what the evidence. Way back in 1971, for example, when Intel was a mere fledgling and Microsoft and Apple weren’t even gleams in their founders’ eyes, a study in a high-profile medical journal found that doctors missed up to 35% of the data in a paper chart. Thirty-seven years later, when Intel, Microsoft and Apple were all corporate giants, a study in the same journal of severely ill coronary syndrome patients found virtually the same problem.

That clinical evidence and the way in which the world outside medicine had been transformed by computers did almost nothing to change healthcare. Well into the 21st century, most providers only trusted computers to send out the bills.

Even those hospitals that adopted EHRs rarely bought, or bought and then didn’t turn on, clinical functions related to drug-drug interactions and infection prevention. “Computerized medical records” were used to better document all the small details of care that boosted payment in a fee-for-service world.

And then a wonderful thing happened that we, in our era of polarized politics and bizarre bursts of federal budget cuts, can only look back upon in nostalgia. Republican and Democrat, liberal and conservative, corporate executive and techno-geek all united to bribe doctors and hospitals to do what a minimally functioning free market would have prompted them to do years before.

Since this was a bribe rather than a gift, we taxpayers did demand something in return. When doctors and hospitals (“eligible professionals” and “eligible providers”) doled out the dough – and spending money was the point, since HITECH was part of an economic stimulus bill – they had to demonstrate they used what they bought to improve care. In other words, “meaningful use.”

Now we come to the behavior that really should inspire the outrage. We as a nation paid out billions in bribes because so many physicians simply refused to believe they could benefit from an EHR that the hospitals dependent on those doctors for admissions refused to buy computerized records no matter what the evidence. The vendors, aiming to ease the transition when hospitals did buy, designed clumsy interfaces based on provider habits and inefficiencies from the paper world. When the market finally changed, all the bad stuff got baked in: Difficult interfaces and missing functionality that frustrated physicians; poor customer service from vendors puffed up with profits; and absurd flaws such as a medical record less searchable than a ten-year-old PC.

Fortunately, it’s no longer 2009. “Meaningful use” requirements are gradually attaining real meaning. The rapid growth of high-speed cloud computing and specialized medical apps is starting to break the hold of the old-style EHR thinking. Even true interoperability continues to glitter on the horizon, even if that horizon seems sometimes to continually recede.

The problem with health IT isn’t the politicians and lobbyists, easy targets though they may be. It’s us, in healthcare. It’s the doctors, hospitals, vendors and researchers among us who are not held accountable when our behavior delays and distorts innovation, hurts patients, costs money and impugns our own industry’s credibility

Michael L. Millenson is president of Health Quality Advisors LLC in Highland Park, Ill. He is a member of the Payers & Providers editorial board.