The Politicalization of Health Information Technology
The views and opinions expressed in this blog are mine personally, and are not necessarily representative of Texas Health Resources (THR) or its subsidiaries.
Admit it. Health information technology (HIT) deployment is headed nowhere fast. Despite the evidence and supply-side rhetoric, demand wanes. Depending on whose study you believe and their definition of HIT, industry adoption of CPOE is languishing in the low teens at best. We can do better for our patients.
Before we dive in, I want to acknowledge the Office of the National Coordinator for Healthcare Information Technology (ONC). The National Coordinator plays a central role in how information technology transforms our care delivery system. The leadership is strong, and the ONC is blessed by a greater level of funding and authority than in the past. ONC is the principal federal entity charged with coordinating nationwide efforts to implement the use of the most advanced health information technology, including the electronic exchange of health information. The position of National Coordinator was created in 2004 through an Executive Order and legislatively mandated in the Health Information Technology for Economic and Clinical Health Act [HITECH Act] of 2009.
Next to the ONC, the Centers for Medicare and Medicaid Services (CMS) is another powerful division of the Department of Health and Human Services. The CMS mission is "to achieve a transformed and modernized health care system." A key tool for success in the CMS workbench is leveraging information technology. CMS, a professional bureaucracy, was clearly the driver for federal HIT direction and investment until recent legislative changes codified ONC. The ONC and CMS will need to work in concert, finding unity of command and vision, in order to achieve their unsynchronized goals.
Complicating the situation is the legislative branch attempt to control health care reform and policy via HIT. On one hand, you have ONC laying out a firm HIT direction; they have the necessary framework, but it's juxtaposed to the quagmire of health care reform. Congress and the White House are materially on different sides of what to do, when to do it, and how. The only certainty is that HIT will be a key component. Unfortunately, due to the lack unity of vision and clarity of goals, HIT is quickly becoming a political lever. And that scares me. HIT is the means, not the end.
Morphing into a government program, HIT could rank with cash for clunkers. We're incentivized to turn in the old and adopt the new. Although I'm a serious advocate of care transformation via IT, I fear that the motivation is becoming more political than substantive. Where the cash-for-clunker strategy is a onetime event, we should be investing long term (10-plus years) in HIT and looking for sustainable advocacy with demonstrable support. Incentives are misaligned.
We need to push for challenging meaningful-use criteria. What started out provocative and game-changing has since been watered down to a welfare-like program. The bar is set too low. Everyone qualifies! That means we're not demonstratively leveraging HIT. Instead of reaching high, expectations are lowered, thus removing the incentive to progress materially.
Advocacy groups are also part of the equation. Although active dialogue is essential and everyone deserves a seat at the table, too much politicking will derail HIT. Potential is lost in the quagmire of uber-engagement, and special-interest groups tend to lower expectations and standards. Each group claims to represent a large number of constituents, but at the end of the day, hospital leaders are the ones who will need to make the tough decisions, and execute.
While I appreciate the private/public approach to forming advisory committees, we must intentionally set aside our personal biases to favor the common good. If you look closely at the outcomes derived thus far, you can trace the DNA back to some of the participating organizations. I face the same challenge at the state and city level. It takes a degree of maturity to set aside personal thoughts, prejudices and organizational goals to pursue the common good. Keeping the patient benefit foremost in our minds will yield the best outcome.
What can we do to help ensure ideal outcomes and prevent the politicalization of HIT?
- Actively support the ONC leadership.
- Contact senior staff of the House Committee on Ways and Means.
- Contact senior CMS leadership.
- Advocate for more meaningful meaningful use.
- Provide feedback to advisory committee members and pushback on tailor-made recommendations that may be of a minority interest.
- Lead by example by ensuring your organization is ahead of the curve.
- Actively participate in your region and state HIT efforts.
- Keep pressure on for health care reform
Do it while we still have the freedom to make these choices and influence government decisions.
Editor's note: Mr. Marx encourages your interaction through this blog. (Use the "add a comment" function at the bottom of each post.) You can also connect with him directly through his profile pages on social networking sites LinkedIn and Facebook, and you can follow him via Twitter - User Name "marxists."