EHR Incentive Program Is Off Track, Senators Say

9 Mobile EHRs Compete For Doctors' Attention

Six U.S. Senators, all Republicans, have issued a report that is highly critical of the Obama Administration's electronic health record (EHR) incentive program, saying that the $35 billion initiative is at risk of not achieving its goals.

"While promoting the use of health IT is a laudable goal, a growing body of objective analysis and empirical data suggests the program needs to be recalibrated to be effective," the paper stated.

The senators -- John Thune (R-S.D.), Lamar Alexander (R-Tenn.), Pat Roberts (R-Kan.), Richard Burr (R-N.C.), Tom Coburn (R-Okla.) and Mike Enzi (R-Wyo.) -- also sent a letter to Department of Health and Human Services (HHS) secretary Kathleen Sebelius, asking her for answers to specific questions about the program by June 16. In addition, they issued an open letter to "health information technology stakeholders and members of the public" seeking comments on the white paper by May 16.

An HHS spokesman told InformationWeek Healthcare that the department had no comment on the senators' report.

Last October, the Republican leaders of four House committees sent Sebelius a letter demanding a halt to stage 2 of the EHR incentive program. They cited examples of what they viewed as weakness in the Meaningful Use stage 2 requirements, as well as a New York Times article about the association between EHR adoption and higher charges to Medicare. Around the same time, four senators -- all involved in the current report -- raised their own concerns about the Meaningful Use program.

[ Medical researchers have their own set of EHR-related concerns. Read EHRs Aren't Ready For Genomics-Driven Healthcare. ]

The new white paper cites five areas where it says that the program is failing and needs to be "rebooted": increased costs, lack of interoperability, lack of oversight, risks to patient privacy and long-term program sustainability.

The 2009 HITECH Act, which authorized the EHR incentive program, was expected to save money, the report said. Instead, it noted, "early reports raise concerns that health IT may have actually accelerated the ordering of unnecessary care as well as increased billing."

The latter point refers to reports in The New York Times and elsewhere that many physicians have been "cloning" EHR documentation to justify inflated charges. HHS's Office of the Inspector General (OIG) announced last October that it was reviewing the role of EHRs in "upcoding" Medicare bills.

The report also asserted that there's still no clear path to interoperability among health IT systems used by different providers. Because care coordination depends on interoperability, the authors said, this failure could lead to the whole investment in EHR adoption being wasted.

While it's true that interoperability remains a work in progress, the report inaccurately stated, "none of the required core or menu objectives in stage 2 requires communication with other healthcare providers." Under the Stage 2 rules, eligible providers must provide electronic clinical summaries at transitions of care and referrals for at least 10% of their patients who go through such transitions. Moreover, at least one of those exchanges must involve a provider that is using a different kind of EHR or a government-designated test EHR.

The report made another error in the section that questions government oversight of the Meaningful Use program. The authors accurately point out that the OIG last November found that allowing providers to attest to Meaningful Use, rather than demonstrate it, could potentially lead to the Centers for Medicare and Medicaid Services (CMS) paying providers that had not actually met the requirements. It's also true that CMS said it would not follow OIG's recommendation that it do prepayment audits of providers applying for Meaningful Use incentives. But CMS has since changed its decision and has begun doing these audits -- a fact not included in this report.

The report also revived perennial questions about whether CMS and the Office of the National Coordinator of Health IT are doing enough to safeguard patient privacy in EHRs. Finally, it pointed out that, at a time when Medicare reimbursements are expected to drop and providers are facing many other regulatory burdens, providers may lack the wherewithal to maintain their EHR systems after government payments end in 2015. Moreover, if their EHR vendor does not keep recertifying for later stages of Meaningful Use, the providers may have to switch EHRs and transfer their data.

The most serious question raised in the paper -- one that has also been leveled by the American Medical Association and the American Hospital Association -- is whether the government is simply moving too fast through the stages of Meaningful Use without doing a proper evaluation of the program. While praising CMS for delaying regulations on stage 3, the report said, "Moving rapidly through the three stages without providing clear and proper oversight of the EHR incentive program is a short-sighted approach."

Regulatory requirements dominate, our research shows. The challenge is to innovate with technology, not just dot the i's and cross the t's. Also in the new, all-digital The Right Health IT Priorities? issue of InformationWeek Healthcare: Real change takes much more than technology. (Free registration required.)