Prominent Politician Views on Health Information Technology

November 20, 2009
Alberto Borges, MD

The powerful vendor-lobbying group, HIMSS, has been extremely successful over the last 8 years lobbying our elected political leaders about HIT.

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The powerful vendor-lobbying group, HIMSS, has been extremely successful over the last 8 years lobbying our elected political leaders about HIT, convincing them that the certified electronic health record (EHR) increases quality, decreases errors, and decreases overall costs even though none of these statements have yet to be proven in a well run study. In fact, in a recent study the effect of the HITECH Act was evaluated at 3,000 hospitals and found that the level of EHR installation so far has not resulted in any significant differences in quality, errors, and overall costs.

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The EHR is the perfect plank for politicians in that it brings them heavy lobbying revenue as well as an issue where a relatively small group of Americans, physicians, end up paying for the massive cost of installing an EHR. For the government-run Medicare program, the unpopular EHR can actually decrease overall Medicare costs if the maximum 5% penalty for not complying with the HITECH Act eventually becomes a reality, since the certified EHR is “significant used” by only 4% of physicians.

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Only a handful of politicians are questioning whether the cost of HIT will actually improve healthcare as promised, which can end up in wasted taxpayer money, and worse, become a slow-moving HIT blunder which puts patient lives at risk. Even President Obama’s staff quietly admits that these statements are unproven. Dr. Ezekiel Emanuel, the brother of White House Chief of Staff Rahm Emanuel, current health-policy adviser at the Office of Management and Budget, and a member of Federal Council on Comparative Effectiveness Research, stated last year that "Vague promises of savings from cutting waste, enhancing prevention and wellness, installing electronic medical records and improving quality are merely 'lipstick' cost control, more for show and public relations than for true change.” In the UK, which has pushed the concept of the EHR for much longer than the US, the conservative opposition party, the Tories, is questioning the idea of continuing the money diversion from the cash strapped NHS into their own similar boondoggle idea of a massive HIT infrastructure. They are seeking to dismantle the current $20 billion National Programme for IT which is currently four years overdue.

The following Congressmen have appeared recently in the news with their pragmatic views of the EHR:

  • Senator Sanford Cobun (R-OK) introduced his new bill recently, S.1099. It states that lawmakers need to look at the “impact of the adoption of HIT on health care quality, cost, and access under each safe harbor."5
  • Senator Chuck Grassley (R-Iowa) recently appeared in the WSJ Health Care Blog after beginning an investigation of the major EMR vendors. He is focusing on computerized physician order entry (CPOE) and EHR safety and whether or not they really do decrease costs, decrease errors, and improve quality.6

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President Barack Obama is the most powerful HIT stakeholder politician, making the EHR the central hallmark of his healthcare agenda. He is surrounded by numerous advisors that represent EHR companies, including the likes of David Blumenthal (GE), Glen Tullman (Allscripts), Nancy-Ann DeParle (Cerner), John Glaser (Partners HealthCare System), Thomas Frieden, MD (eCW), and Jeffrey R. Immelt (CEO, GE).

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Former Speaker of the House and potential Republican presidential candidate, Newt Gingrich is also a leading proponent of the EHR and believes that “the United States could save about $400 billion in health care by implementing HIT and best practices nationwide.” He is the founder of the Center for Health Transformation, which is one of the sponsors of the yearly HIMSS Summit, where he attends and gives a keynote speech. On October 28, he gave a webcast on the ARRA on and a webinar on November 10 discussing the need for privacy/HIPAA in HIT.

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Potential Republican presidential candidate Governor Bobby Jindal (R-LA) has advocated for EHR adaptation on numerous occasions and earmarked $18.6 million in the 2009 state budget for a variety of HIT initiatives, including $3.5 million specifically set aside for “financial incentives” for physicians to use recognized EHR software in their respective practices. Likewise, Governor Mitt Romney recently gave a presentation to a group of Florida physicians where he generally supported the idea of federal incentives to foster more widespread adoption of EHRs. He has been a strong EHR advocate going back to 2004 when he helped launch the new Massachusetts initiative to convert paper medical records into electronic records.

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Three potential Republican presidential candidates who lack a position on HIT/EHR include former Governor Sarah Palin, Sen. John McCain (R-AZ), and Rep. Ron Paul (R-TX). Another Republican, former Arkansas Governor Mike Huckabee lacks a comprehensive healthcare plan. Although his support for the certified EHR is weak, Huckabee said, “We need to do medical records electronically. Instead of doctors just having a paper chart when you visit, they would maintain electronic records.”

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There are many other potential presidential candidates who have mentioned statements in favor of HIT/EHR. Secretary of State Hillary Clinton--“Electronic medical records could save annually $165 billion in health care.” Vice President Joe Biden believes that the potential savings to the healthcare industry from full adoption of electronic medical records can be substantial. He wants 100% adoption of EHR software by 2015.During the recent presidential elections in 2008, Mayor Rudy Giuliani pledged to invest in HIT to reduce medical errors, improve efficient and detect health threats, noting that thousands of hospital deaths each year are attributed to preventable medical errors.Former Senate Majority Leader Bill Frist in 2006 endorsed the concept of the EHR, but advocated that the government supply a free open source solution like is seen in the VA’s VistA EMR. In 2008 he advocated a system where physicians are rewarded for using EMR; s.a. increasing Medicare payments to providers who use and/or adopt this new technology.

There are four directions that the US can take in regards to the EHR:

  1. Continue to push a decentralized system with doctors and hospitals buying and maintaining their own expensive “certified” EHR systems, and partially subsidizing the EHR installation with a monetary grant through the HITECH Act.
  2. Have Congress fully subsidize a major single, centralized system. Some have mentioned using the already available in the Department of Veterans’ Affairs EMR called Vista which can be disseminated free of charge.
  3. Allow physicians to buy their own basic EMR software systems and/or to use hybrid systems then provide a health information exchange (HIE) that would allow for easy sharing of patient information.
  4. Continue a laissez-faire approach to EHR waiting until studies show that the EHR can lead to cost savings, error reduction, and/or quality savings.

Physicians need to lobby their political representatives to advocate for a common-sense approach to HIT/EHR where the physician is not saddled with the cost of an electronic healthcare infrastructure. Politicians need to begin questioning the HIMSS mantra that the EHR is a cure-all for our healthcare crisis. The push for HIT/EHR should go slow and taxpayer money should be spent judiciously. We cannot afford another "cash for clunkers" debauchle, with unproven "enterprise" EHR systems being pushed accomplishing little to improve healthcare and possibly putting patients at increased risk.

References:

1. Little Benefit Seen, So Far, in Electronic Patient Records

2. Electronic Health Records in Ambulatory Care — A National Survey of Physicians http://content.nejm.org/cgi/content/full/NEJMsa0802005, 2b. www.washingtonpost.com/wp-dyn/content/article/2009/10/24/AR2009102400967.html?sid%3DST2009102400981&sub=AR

3. http://tomfaranda.typepad.com/folly/2009/08/rep-michele-bachmann-on-.html

4. NHS computer chaos deepens NHS computer chaos deepens

5. S.1099 - Independent Health Record Trust Act of 2009

6. Chuck Grassley Has a Few Questions for the Health IT Industry

7. http://histalk2.com/2009/07/09/news-71009

8. www.healthtransformation.net/cs/speaking_engagements_2009

9. www.newsreview.com/sacramento/content?oid=903229

10. www.e-mds.com/News/release_archives/Bennet%20Case%20Study2008.html

11. http://electronic-medical-record.blogspot.com/

12. www.masstech.org/ehealth/pr_12_6_04.htm

13. www.thehealthcareblog.com/the_health_care_blog/2008/09/sarah-palins-li.html

14. http://electronic-medical-record.blogspot.com

15. www.siftingsherald.com/opinions/x1101620348/Open-Forum-Mike-Huckabee-on-health-care-reform

16. http://cafeteriacatholics4huckabee.blogspot.com

17. http://electronic-medical-record.blogspot.com

18. www.e-mds.com/News/release_archives/Bennet%20Case%20Study2008.html