Commentary: 5 points congressmen missed in call to end MU

By Tom Sullivan
02:04 PM
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Timing being everything and all, the four Republican congressmen who on Oct. 4 sent a letter asking HHS Secretary Kathleen Sebelius to stop distributing meaningful use incentives probably should have attended the Oct. 3 Bipartisan Policy Center event instead. 

The day was packed with doctors, politicians, healthcare industry heavyweights, state and local health officials, who were all essentially agreeing that health information exchange and interoperability are gaining purchase in the industry. 

Farzad Mostashari, MD, the national coordinator for health IT, was at the BPC event, where the group unveiled two reports on electronic data sharing and ever-enthusiastic as he is, said of the results BPC presented, “the report, the way it starts off, the first finding is dead-on, in terms of the centrality of every conversation we’re having, that a business case is emerging,” for exchanging health information, Mostashari added. And he’s not the only one.

Shortly afterward Mostashari, who along with acting CMS director Marilyn Tavenner is cc’d on the letter, said that during Stage 2 of meaningful use, “you’re going to see a major difference in your vendors not having to negotiate with each other,” over things like what coding system to use, how to package patient information, what secure protocols to use for exchanging data over the Internet.

At issue for the congressmen who sent the letter are what they identify as $35 billion in Medicare and taxpayer funds potentially distributed to providers for purchasing EHRs that are not interoperable with other vendors EHRs.

“The Stage 2 rules fail to achieve comprehensive interoperability in a timely manner, leaving our health system trapped in information silos, much like it was before the incentive payments,” the authors wrote.

The letter is signed by Dave Camp, chairman of the Ways and Means Committee, Wally Herger, chairman of the Ways and Means Subcommittee on Health, Fred Upton, chairman of the Energy and Commerce Committee, and Joe Pitts, chairman of the Energy and Commerce Subcommittee on Health; Republicans, all.

“More than four and a half years and two final Meaningful Use rules later, it is safe to say that we are no closer to interoperability in spite of the nearly $10 billion spent,” the authors continued.

Now, in all due respect, they are missing a number of points, not least of which:

  1. The final Stage 2 rule doesn't kick in until 2014
  2. Real-world interoperability is already happening in places, think Healtheway, formerly NwHIN-Exchange, with 25 private and public partners not only improving care by exchanging records but also saving millions of dollars in the process
  3. Instead of achieving anything, suspending payments would actually make it harder for providers and vendors to strive for that interoperability
  4. As we’ve witnessed with ICD-10, healthcare entities naturally backburner unfunded mandates as there’s only so much room on their stove tops
  5. And it would be that much harder for ONC to keep its momentum alive. The very force that is bringing together government with industry to drive not only the interoperability standards the congressmen's letter calls for, but also the three tenets so prevalent in the Oct. 3  Bipartisan Policy Center event: quality structured data, exchange, and patient engagement.

“The importance of common standards can’t be overstated,” Karen Ignagni, CEO of America’s Health Insurance Plans said during a BPC session. “We need to be rowing the boat in the same direction.”

None of this is to say that vendor-to-vendor EHR interoperability is happening as frequently as it needs to. It’s not, and Mark Barner, CIO of Ascension Health offered himself as an example at the BPC event, a living consumer who after coming against the system is looking forward to widespread exchange of health data -- a day when the interoperable flow of data across the digitized health system enables clinicians to make better decisions, both at the point of caring for individual patients and in bolstering population health management.

“We’re in the early stages of one of the fastest transformations of any industry in history," said Doug Gentile, MD, chief medical officer at Allscripts Healthcare also speaking at the BPC meeting. “As we make the shift to value-based care, the business case for information sharing becomes front and center,” continued Gentile, adding that the policy challenge is to turn “interoperability into an ecosystem for innovation.”

And that, Messrs. Congressmen, is what you propose stalling by asking HHS Secretary Sebelius to “immediately suspend the distribution of incentive payments” for meaningfully using EHRs?