Mark Savage, director of health information technology policy and programs with the National Partnership, takes the consumer's standpoint in EHR adoption and use — meaning he is a supporter of strengthening, rather than delaying, the meaningful use program.
The National Partnership for Women and Families was among the signatories on an open letter responding to the U.S. Senators who called for a “reboot” of the meaningful use program.
Government Health IT Editor Tom Sullivan spoke with Savage about addressing the Senators’ concerns, the remarkable progress achieved since passage of the HITECH Act, and the untold population health management upsides of digitizing the American healthcare system.
Q: The letter to the Senators argues that postponing or delaying the meaningful use program is not the answer. What is the answer?
A: The answer is to continue to try and advance the needs of patients, and providers for that matter, with the meaningful use program. The whole nation is moving pretty quickly, things are arising. The meaningful use program itself has mechanisms for improving efforts when issues do arise so we suggested moving forward, that the program be used to make the improvements that are necessary.
Q: You also call for strengthening the meaningful use program — how would you accomplish that?
A: We are working through the HIT Policy Committee, the workgroups that report to that, the subgroups that report to the workgroups, for example the meaningful use workgroup, to try and improve some of the policy and criteria that are coming up. Since Stage 1 and Stage 2 are already in so at this point, it’s working to try and improve stage 3 to better meet the needs of patients and caregivers.
Q: So it’s more tailoring the stages than trying to change the meaningful use program…?
A: Not changing it. If we step back, under the HITECH Act, we’ve got a six-year transformation of health information exchange in the nation. In 2009, when that bill was passed, there were some health organizations that had EHR systems, but not a whole lot and we’ve seen the adoption and use rates ramping up considerably. It’s a pretty ambitious program to try and meet all of this in six years and meet the congressionally stated strategic goal of every American having an electronic health record by the year 2014 when the healthcare reform provisions go into effect.
It’s actually pretty remarkable that the pieces are fitting together as well as they are and that we're making the kind of progress that we are. We think that should continue, but we have a lot of consumer organizations and patient organizations that we work with who, when they look closely at this, are telling us ways it can be improved to meet their needs, things like making sure that care plans are more integrated into this effort, so recognizing that it’s not just a patient-provider relationship. Take the example of somebody who is caring for an elderly parent, maybe in the same area or maybe from afar. Or a mother who has to take care of herself and infants or children. These kind of broader relationships, we’re working to try and include those, where they haven’t been as fully-integrated as we’d like to see.
Q: Before we get too much further along, I really ought to ask what the National Partnership for Women and Families does and why healthcare is such a big part of that?
A: It started as the Women’s Legal Defense Fund, and changed its name in the 1990’s to the National Partnership for Women and Families. We are working on a variety of health and workplace issues. We were maybe the leading or one of the leading advocates for getting the Family and Medical Leave Act passed — an example of the intersection of workplace and health issues. In addition to leading the Consumer Partnership for eHealth, we also lead the Campaign for Better Care, which is on the Medicare side of things exclusively. We have a variety of different projects to try and address different pieces of healthcare reform.
Q: There is a sense within the healthcare community that the white paper calling for a meaningful use reboot is perhaps more political wrangling than a deep understanding of the problems with MU.
A: That may be. If you take the letter at face value, they say they’ve identified some issues and they’re asking for feedback. Our response took that at its word and tried to provide a fuller understanding of the facts. It may be some political wrangling but we just addressed it on the merits.
Q: Some of the opponents, however, raise the point that the EHR market is undergoing some growing pains…
A: There are some real issues around interoperability. But we can perhaps start with what’s actually there: Within hospitals, within practices, within large health systems, there is a lot of interoperability already happening. The real issue that we’re trying to work on now is interoperability among unaffiliated EHRs. So there’s a whole range of electronic communication that’s successfully occurring but we also want to build a system where when a person is traveling and has to go to an emergency room there is also interoperability with her or his primary care provider back in another state. That’s a part of our goal as well.
The best way to do that is the focus on certified EHR technology, where we have a common set of standards applied across all the states for adoption, upgrade and use. That doesn’t take away from the fact that there a whole bunch of competing products out there, but it's a way to drive people toward a common and a good set of standards, one that’s not just technology for its own sake but is technology designed to improve the health of patients and populations. The program we have in place now is probably the best strategy. We now have, with Stage 2, requirements for being able to transmit to unaffiliated organizations. That’s work in progress right now. The complaint about interoperability is real but in October of this year the meaningful use requirement for being able to transmit with unaffiliated organizations goes into effect for hospitals and then in January for eligible professionals so I am eager to see what happens once those provisions kick in. That will not instantly solve everything but it will be a powerful market driver.
[See also: Sebelius releases new HHS data.]
Q: What is your expectation for EHR adoption rates by the end of HITECH?
A: Expectations are currently being exceeded. From my own experience, when this all started I had a doctor who did not have an electronic health record and I shopped. It was important to me, so I left that doctor, looked for a primary care physician who had one. He was kind enough to spend a little time talking with me about his experience. I asked why he got one and actually his response was very interesting. He said he wouldn’t have done it on his own but he was hearing he could not attract some of the best and brightest young doctors to his practice unless he had one. They just wouldn’t come. So he instituted one for the practice. Now, of course, doing that he began to acquire his own experience with electronic health records and said he would never go back. I got referred to a specialist who did not have an electronic health record, so I talked to him about it, too. He’s probably five years from retirement and he’s not going to do it. It’s really hard for him to make the culture shift and change his work habits.
So coming back to your question: I don't think everybody is going to adopt, but the program is really driving past the tipping point. Not that we’re completely at the tipping point just yet, but we’re going faster than expected and I think we’re going to be there pretty soon and I think it will get better and better, even if it doesn’t get everywhere.
Q: We hear quite a bit about the broad advantages of digitizing the healthcare system, but are there untold upsides? Benefits you encounter that don’t get discussed enough?
A: I think there are. The program thus far — and it’s not limited to this — has been focusing mostly on the individual doctor-patient relationship. There are some groups working on population health issues. Reports are coming out and, in fact, my previous employer Consumers Union was on one of those, about how health information technology can address healthcare disparities. Those are tools that depend upon looking for patterns among the data. With the collection of individual structured patient data and the private and secure aggregation of it for health purposes, we are going to see some important improvements at the population health level. We certainly can’t see those improvements without doing this, where we begin to look at the information more systematically. We’re collecting demographic data at the individual level, we can start stratifying the aggregated data to start discerning patterns. There are discussions in the meaningful use criteria and NPRMs about that but it’s not really getting the same level of visibility and it’s an area where we’re going to see dramatic results down the line.
Q: In most conversations about improving population health management, the cases of diabetes, hypertension and obesity take center stage but are there other examples you can envision easily?
A: I think healthcare disparities will be a low-hanging fruit. Things like catching tests that could have been done at the preventative end of the arc where you realize, based on patient history, that people should be paying more careful attention at an earlier point in time. I think there will be a lot of improvement there.
Q: And what about any untold downsides?
A: I don’t know about untold downsides. This is culture change. It’s necessary culture change but it’s pretty dramatic and ambitious. I personally appreciate the fact that the HITECH Act set it up as a six-year trajectory because if it had been extended we’d be moving much slower and we can’t afford to move slowly. But this is asking a national healthcare system and all the people in it to move pretty quickly and I think we’re going to have to continue to adjust how people experience that. I don’t know the ways we’ll have to adjust it but I recognize that as something we need to continue doing.