When the federal government's traveling show extolling the virtues of electronic health records rolls into town, there's usually at least one in the crowd who remembers Ronald Reagan's nine most terrifying words in the English language: "I'm from the government and I'm here to help."
Troops of federal health officials are on the road across the country this spring trying to help physicians go digital. It's the kick-off of a five-year demonstration project aimed at showing the economic and medical advantages of EHRs. HHS and CMS officials are visiting dozens of communities to drum up interest in the project and to proselytize for rapid adoption of IT.
They're usually met with open ears, if not arms.
"The dog and pony show? It came to our town and we were pretty impressed," Lodewyk (Lody) Zwarensteyn, president of the Alliance for Health in Grand Rapids, Mich., said. The Alliance for Health is a community organization representing employers, insurers, patients and health care providers.
"We're getting our people together to say, 'Hey, is this a good thing to do? What's the risk? What's the reward? Any hidden obligations anywhere?'" Zwarensteyn said.
"But I have to say, anytime you're faced with an offer that looks too good to be true -- and this one looks to be fantastic -- you have to step back and think twice. That's especially true if it's coming from the government," Zwarensteyn added.
Dozen Demo Sites
The project will involve doctors in 12 areas around the country and affect an estimated 3.6 million patients. Federal health officials hope the project will show that EHRs result in a marked improvement in the quality of patient care.
Depending on the number of standardized EHR functions a practice uses, the program will pay participating doctors up to $58,000 and group practices up to $290,000 in incentive and bonus payments over the five-year life of the demonstration project.
CMS officials expect to select four communities this year and the remaining eight next year.
"We are looking for communities which have strong ties to primary care physicians and are willing to assist CMS in education activities and the recruitment of physician practices for the demonstration," acting CMS Administrator Kerry Weems said in a prepared statement.
According to federal officials, eligible communities must:
- Demonstrate active community collaboration with a broad group of stakeholders, including providers and medical professional groups, consumers, health plans and employers;
- Show private-sector support, with the likelihood that similar programs will be implemented among employers or health plans in the region;
- Be geographically large enough to recruit a sufficient number of small- to medium-sized primary care physician practices; and
- Not already be part of an existing CMS demonstration similar to the EHR project.
So far, HHS and Medicare officials have met with community leaders in Atlanta; Kansas City, Kan.; Cleveland; Portland, Maine; Providence, R.I.; Austin, Texas; Cheyenne, Wyo.; Philadelphia; and Grand Rapids, Mich.
Posterboy in Michigan
During the public meeting in Grand Rapids, a mother stood up and told a cautionary tale about her son's medical experiences -- and records.
Her high school-aged son suffered a head injury in a snowmobile accident in Utah. Salt Lake City trauma center doctors treated him and sent him home ... with a disk. The disk contained digital records of the boy's treatment, including images of his brain.
When mother and son checked in with medical professionals back at home, they found neurosurgeons in Grand Rapids had not made the leap yet to digital records and could not open the disk. The mother went home, got her own laptop and brought it back to the doctor's office. The records were opened, rehabilitation started and the 17-year-old is back in school, recovering nicely.
The family's experience demonstrates the need for standardized records, HHS Deputy Secretary Tevi Troy said at the Grand Rapids meeting earlier this month.
"What we're trying to envision is a world where doctors, hospitals, labs and pharmacies are all connected electronically," Troy said. He predicted EHRs will minimize errors, reduce costs and save lives. "This is the promise of health information technology. I think we're close to achieving it," Troy said.
One Project Leads to Another
The Grand Rapids visit, like many stops on the tour, served a dual purpose. Troy was also in town to honor the Alliance for Health as a Chartered Value Exchange. After initially identifying 100 health care communities across the country, HHS sifted through 38 applications for the CVE program and chose 14 winners based on efforts to improve care by bringing together employers, insurers, patients and health care providers.
The CVE designation gives local health planning agencies access to Medicare records to assess the performance of the area's doctors and other health care providers. CVEs also gain access to a nationwide learning network sponsored by HHS' Agency for Healthcare Research and Quality. The network provides peer-to-peer learning experiences through seminars, as well as access to management tools, experts and an ongoing private Web-based knowledge management system.
Despite initial skepticism and wariness, health care providers in Grand Rapids are warming to the demonstration project.
"In general, health care is way behind the times when it comes to information technology," Zwarensteyn said.
"This industry has a lot of catching up to do, and this is one way to start. We have a lot of people here who are saying this makes sense -- offering incentives to physicians to do what everybody pretty much acknowledges will be what all health care providers will be doing some day," Zwarensteyn said.