Health IT industry leaders came to the government's defense in reaction to a report criticizing the federal government's efforts to promote health IT adoption.
In this month's issue of the Heartland Institute's Health Care News, the Chicago-based think tank calls the five-year strategic plan released last month by the Office of the National Coordinator for Health IT "poorly conceived."
Heartland Institute analysts argue that health care reform should come from the private sector rather than the public sector.
"The federal government has a miserable track record when it comes to imposing large information systems, even within its own agencies," Greg Scandlen, director of Consumers for Health Care Choices at The Heartland Institute, said in the report.
However, Neal Neuberger -- executive director of the Healthcare Information and Management Systems Society's new Institute for e-Health Policy and president of Health Tech Strategies, a consulting firm -- said, "You could easily substitute 'private sector' in that quote and have it be just as accurate."
Neuberger and other health IT industry leaders said there is some merit in parts of the Heartland Institute's arguments, but they uniformly rejected the think tank's assertion that IT development should be left to private enterprise.
Consider the Source
"I think their report reflects the organization," said Don Detmer, president and CEO of the American Medical Informatics Association. The Heartland Institute "sees most progress coming out of the private sector, so it's not too surprising to me that government strategy would be less than ideal in their estimation," Detmer said.
The Heartland Institute, whose mission is "to discover and promote free-market solutions to social and economic problems," is perhaps best known for its aggressive contention that the world is overreacting to global warming. The Institute belongs to the Cooler Heads Coalition, which questions the impact of global warming and argues that climate control policies hurt consumers.
In health care, the Heartland Institute's position leans strongly toward the private sector with an emphasis on consumer-driven change.
"Focusing on the consumer side of this is tricky," Detmer said, adding, "Most of the consumer side of health IT is happening out there in a very non-linear, bubbling kind of ferment. The idea that feds shouldn't get involved is, I think, somewhat poorly conceived."
Industry leaders recognize that private and public entities have different strengths in the development and use of health IT.
"One area less likely to be taken up by free market is safety," Detmer said. "Vendors are driven to what they think will sell a product, not toward the greatest safety."
"No question much of what they're saying has some validity," Detmer said. "There is some truth that when the federal government establishes rules and guidelines for its own programs, they become the de-facto standards for the industry. And that can rigidify things."
"But that's the way our system is set up, and you can't fault federal officials for trying to be more efficient," Detmer said.
'Ever Heard of VistA?'
Earlier this summer, the HIMSS Foundation launched the Institute for e-Health Policy to provide educational opportunities for public- and private-sector stakeholders who make, and are affected by, health IT policy decisions.
HIMSS tabbed Neuberger, well-known in federal circles for his track record with health IT, as executive director.
Although Neuberger did not bluntly say it, some of his comments suggest Heartland Institute officials might benefit from the Institute for e-Health Policy's educational offerings.
"Why wouldn't we want the [federal] government, with as many direct patient care responsibilities as it has, to do everything in its power to be as efficient as possible?" Neuberger asked.
"I wonder if they've ever heard of VistA," Neuberger said.
The Veterans Health Information Systems and Technology Architecture is the Veterans Health Administration information system built around one of the most widely used EHRs in the world.
The VHA provides care to more than four million veterans, employing 180,000 medical personnel and operating 163 hospitals, more than 800 clinics and 135 nursing homes.
The Heartland Institute's Scandlen responded to Neuberger's arguments via e-mail.
"The point about government already delivering much of health care is a valid one," Scandlen said, adding, "What government does with its own agencies is its own business. My objection is to imposing those systems on the rest of the industry. By all means, let's test these systems out on government agencies and see how well they do. If they work well, I'm sure the private sector will be eager to adopt them. If they don't work well, the damage will be limited."
Scandlen said he is "somewhat familiar with the VA's VistA system." He said, "I have spoken to a number of physicians who have used it and they tell me that it detracts from patient care and time spent with patients, and it results in inaccurate records as physicians use cut and paste to enter information."
Political Overtones Questioned
The Heartland Institute's libertarian and conservative leanings were questioned in response to the institute's report.
"When I see things like this that politicize it in a way -- make it some kind of social issue or something -- it makes me think they're moving in the wrong direction," Neuberger said. "Nobody in the field views things that way."
Neuberger founded the Capitol Hill Steering Committee for Telehealth and Healthcare Informatics 15 years ago. He still coordinates the committee.
"We work with a bipartisan group of senators and we've not heard this kind of tack before. If this is a proxy for larger debate about health care reform, then they should come out and say it," Neuberger said. "We're talking about tools, not policies, here ... tools that are going to help drive cost effectiveness and quality of care."
"It's a very complex relationship between public and private sector. Until, at a very high level government decides that that relationship is going to change somehow, I can't for the life of me understand why anyone would say the federal government shouldn't get involved in trying to improve its situation," Neuberger said
Scandlen contends politics is not an issue.
"I don't know what any of this has to do with politics," Scandlen said. "I would note that [Sen. Barack] Obama and [Sen. John] McCain, [Sen.] Hillary [Clinton] and [former Speaker of the House] Newt Gingrich are all gung-ho about [health IT], and the Bush Administration has been pushing it hard."
Although he has not specified a position on government's role in developing health IT, McCain is considered a strong advocate of the free-market approach to health care. Obama, in contrast, has pledged to spend $10 billion a year for five years on health IT.
The Heartland Institute's response to federal plans is a sign of changes in the wind, some industry experts said.
"Pressure is building underneath this," Detmer said. "The capacity of health care to eat [gross domestic product] is creating growing pressures for reform," Detmer said.