Electronic Health Records: Avoiding eVoting's Mistakes
BY Nancy Scola | Friday, July 24 2009
Sometimes I like to imagine that there's some far off land where words scamper about like ponies. And somewhere in that magical land, there's some configuration of word/ponies that makes the subject of negotiations over legislative definitions of electronic medical recordkeeping into good blog fodder. But it's Friday afternoon, it's hot in my office, I don't live in magical pony land, and sometimes important stuff is just boring. So I'll make you a deal. You read the next short paragraph about how HHS is wrestling with the definition of how doctors and other medical providers qualify for "meaningful use" of electronic medical records and I'll reward you with a fun and uplifting video at the end. Deal?
Excellent.
So, the upside is that electronic health records hold the promise of empowering patients to take more control over their health, that most intimate of matters. Not only might the switch from pen-and-paper to EHRs, as they're known, cut down on medical mistakes and costly and annoying redundant care, but it might also let patients drive their own health treatment -- no longer at the total mercy of doctors, hospitals, and HMOs. Obama put $20 billion in the stimulus package to make the switch to EHRs. That's real money. Starting in 2011, doctors will be able qualify for a few tens of thousands of dollars for making the switch, hospitals for a few million. They'll get more money for Medicaid and Medicare payments if they switch to electronic, less if they don't. The law says that providers must make "meaningful use" of the software to get the benefits. Everyone agrees that it's not enough to simply go to Sam's Club and pick up a copy of eClinicalWorks and stick it on a shelf. The software must actually get used and must actually make both patient care and our health care system better in the end. The sticky wicket is exactly how, though, you define meaningful use, and how long you give health providers to meet that bar.
Okay, my bad. This is actually going to take two paragraphs, but we're almost done. Obama has emphasized that catching the U.S. up to the rest of the world needs to happen fast, as in the next few years. But the danger is that we end up in an electronic voting machine situation. In other words, we blow all our taxpayer dollars on proprietary and kludgy machines that don't work very well and only Diebold and Sequoia understand. When it comes to EHRs, the added wrinkle is that we actually want these systems to be able to talk to one another, to be interoperable. How do we get there? There are no easy answers, and HHS is hammering out right now how you balance speedy software adoption with getting a sustainable system that actually benefits patients, rather than just checking a box that says "I do all my doctoring on a computer." What's less than reassuring is that it's a debate that is happening between government, medical providers, and health IT vendors -- without much input from the open-source community or, for that matter, patients.
All done! Thanks for sticking with it. Here's the amusing video I promised. (Thanks Shaun Dakin for the video link.)