2012 was a year of much progress for health care IT. An annual survey from CDC's National Center for Health Statistics found that nearly 40% of office-based physicians are using a basic electronic health record system, nearly twice as high as the percentage in 2009, when the meaningful use incentive program was established. Further, an analysis from the Office of the National Coordinator for Health IT noted that more office-based doctors are using EHR systems with the higher-level functionality necessary to meet the meaningful use program's requirements.
As of the end of November 2012, $9.2 billion had been distributed to 177,100 eligible health care providers and hospitals through the meaningful use incentive program.
In August 2012, HHS announced the release of the final rules on Stage 2 of the meaningful use program, and in November 2012, the Health IT Policy Committee announced that it is seeking public comment on proposed recommendations for Stage 3 of the meaningful use program.
A September 2012 report from the Institute of Medicine highlighted advanced technology as having the potential to help address the U.S. health care system's inefficiencies, high costs and poor quality.
The U.S. Supreme Court's June 2012 ruling upholding the major elements of the Affordable Care Act and President Obama's re-election in November 2012 helped remove much of the uncertainty related to the future of federal health IT efforts.
Despite all the progress, concerns about the use of health IT and the effectiveness of the meaningful use program remain.
Four GOP House members in October 2012 sent a letter asking HHS Secretary Kathleen Sebelius to suspend incentive payments for Stage 2 of the meaningful use program. The letter claimed that nearly $10 billion might have been wasted because the rules under Stage 2 are "weaker" than those under Stage 1. It added that certain standards in Stage 2 are "insufficient" or "woefully inadequate." Soon after, four GOP senators sent a letter to Sebelius requesting a meeting with officials from ONC and CMS to discuss Stage 2 of the meaningful use program.
Forty-two percent of surveyed U.S. voters said the federal government should curb health care costs by reducing the amount of money invested in health IT, according to a report from PricewaterhouseCoopers' Health Research Institute.
Meanwhile, Rep. Renee Ellmers (R-N.C.) in November 2012 sent a letter to Sebelius reiterating a prior request for information about whether HHS has taken steps to improve its oversight of health IT systems, as recommended in a 2011 Institute of Medicine report. Currently, no federal agency investigates the safety of health IT systems and no individuals or entities are required to report health IT-related safety issues. In late December 2012, ONC issued a draft plan outlining how the health IT industry should take steps to improve the safety of health IT systems.
A recent Center for Public Integrity investigation, as well as a New York Times analysis, found that EHR systems could be contributing to a rise in upcoding. Attorney General Eric Holder and Sebelius sent a letter to several health care and hospital associations warning that the Obama administration will not tolerate hospitals' attempts to "game the system" by using EHR systems to boost Medicare and Medicaid payments. National Coordinator for Health IT Farzad Mostashari said that his office's Health IT Policy Committee will examine the issue and offer recommendations to address it.
For the second year in a row, we asked a variety of stakeholders to weigh in on health IT progress, disappointments and hopes for the future.
Each health IT expert answered via email three questions about the most significant health IT development in 2012, the biggest disappointment in the past year and how the remaining barriers to widespread health IT adoption should be addressed in 2013.
We received responses from:
- Fred Bazzoli, senior director of communications at the College of Healthcare Information Management Executives;
- Dave deBronkart, a patient advocate and blogger widely known as "e-Patient Dave;"
- Richard Hodge, senior director of congressional affairs at the Healthcare Information and Management Systems Society;
- Regina Holliday, an artist, patient advocate, speaker and social media blogger;
- Janet Marchibroda, chair of the Bipartisan Policy Center's Health IT Initiative;
- Deven McGraw, director of the Health Privacy Project at the Center for Democracy & Technology;
- John Sharp, manager of Research Informatics in the department of Quantitative Health Sciences at the Cleveland Clinic;
- Steven Stack, American Medical Association board chair;
- Tim Stettheimer, senior vice president and regional CIO at St. Vincent's Health System in Birmingham, Ala.;
- Stephen Stewart, CIO at Henry County Health Center in Mount Pleasant, Iowa; and
- Micky Tripathi, president and CEO of the Massachusetts eHealth Collaborative.
Fred Bazzoli, senior director of communications at the College of Healthcare Information Management Executives
What was the most significant health IT development over the past year?
The increasing use of clinical IT systems, prodded by federal stimulus funds, continues to be a positive trend that appears to be accelerating. ONC data suggest that 35% of hospitals had adopted EHRs in 2011, up from 13% in 2008. Recent data on the number of hospitals receiving federal stimulus funds through Medicare and Medicaid suggest that the percentage of hospitals with EHRs should easily exceed 50% by the end of 2012. That's definite progress, but we have to be concerned about advancing the use of higher-level computing, such as for exchanging health information, clinical decision support and enabling the use of data for research that can truly make care delivery efficient, effective and less costly.
What was the biggest disappointment or missed opportunity in the health IT space in 2012?
To me, the biggest disappointment was the furor this past fall over charges that EHRs were being used for upcoding to gain higher reimbursements. While we as a country must get more aggressive in identifying providers who bill for undelivered or unneeded services, these recent charges seemed to paint all of EHR usage by providers with a broad brush. It stands to reason that the IT systems that make care delivery more efficient also will make providers more thorough in documenting care delivery, which tends to increase the ability to charge more under the current reimbursement system. This really points out the need for thorough, intentional reform of the health care system to pay providers for keeping populations healthy, rather than continuing to use a reimbursement system that pays providers for care encounters.
Looking forward to 2013, what are the biggest remaining barriers to widespread adoption and meaningful use of health IT? And, what can be done to help address those challenges?
There are many indications that the digital divide in this country is growing. A recent GAO report found growing evidence that small and critical access hospitals were far less likely than urban facilities to qualify for federal EHR incentives. ONC has announced a challenge to get 1,000 critical access and small, rural hospitals to meaningfully use EHR technology by the end of 2014. CHIME is also taking steps to assist small and rural hospitals. We recently published a case study on a 25-bed critical access hospital that implemented EHRs, and we're offering reduced rate memberships to IT executives of small facilities. The hope of using IT to assist efforts to make care less costly and more effective will be severely limited if we can't find a way to extend EHR capabilities to all providers.
Dave deBronkart, a patient advocate and blogger widely known as "e-Patient Dave"
What was the most significant health IT development over the past year?
The OpenNotes study, hands down. The technology will come along, but for years we've heard skepticism about the sanity of letting patients see the docs' actual visit notes. The study showed that the VAST majority of patients loved it, and it did NOT ruin providers' lives. In fact, when the time came when they could unplug if they wanted, not a single one did. So now we have data saying it does work when patients can see the medical record -- and that will empower a whole new wave of patient engagement as partners with their clinicians.
What was the biggest disappointment or missed opportunity in the health IT space in 2012?
I don't have anything to say on this -- to me all missed opportunities are just next year's agenda. :-)
Looking forward to 2013, what are the biggest remaining barriers to widespread adoption and meaningful use of health IT? And, what can be done to help address those challenges?
On the provider side, too often the software SUCKS: it gets in the way of clinicians doing their jobs. On the patient side, the systems don't yet offer an open architecture to accept plug-ins like data feeds from the booming range of self-tracking devices. And, of course, most providers don't yet offer full access to the record.
Also, we need a well-defined process for patients to say, "This in my record is wrong -- it needs to be fixed." We can do it with our credit card statements, and heaven knows there's more at stake in our medical records!
And that brings up the final point: Many people in health care still don't realize that patients are the ultimate stakeholder -- the ones who have the most at stake in having good accurate information at the point where it's needed. As Warner Slack has been saying since the 1970s', patients are the most underused resource in health IT. And as I said in my TED talk, "Let patients help!"
Richard Hodge, senior director of congressional affairs at the Healthcare Information and Management Systems Society
What was the most significant health IT development over the past year?
The trend of increased adoption and implementation of EHRs since the meaningful use incentive program began in January 2011 continues to be the big story. To date, incentive payments totaling $10 billion have been distributed to eligible hospitals and eligible providers across the country. In addition to expediting the nationwide adoption of EHRs, the incentive program is rapidly achieving a system based on standards and interoperability, the building blocks for health information exchange across the country. A recent analysis of HIMSS Analytics' Electronic Medical Record Adoption Model scale reveals that in the five most recent quarters, beginning with the first Medicare and Medicaid incentive program payment in 2011, U.S. acute care hospitals achieving EMRAM Stage 5, Stage 6 or Stage 7 have increased by 80%. Hospitals at Stages 0, 1, 2 and 3 have seen a decrease of 10%.
What was the biggest disappointment or missed opportunity in the health IT space in 2012?
We were disappointed that HHS chose to delay the start of the health care community's adoption of ICD-10 from October 2013 to October 2014. ICD-10 is a very basic foundation for other health care transformation efforts. Its more robust and upgraded data classification system will provide impactful data to support quality improvements, increased research capabilities, and public health tracking and reporting. That, with the capacity to include current medical knowledge and 21st century patient procedures, will help improve health care and reduce costs.
Looking forward to 2013, what are the biggest remaining barriers to widespread adoption and meaningful use of health IT? And, what can be done to help address those challenges?
Despite the awesome successes that have been achieved in the less than four years since the HITECH Act was passed, many challenges remain. Just some of the challenges in realizing the full benefits of health IT include:
- Privacy and security of personal health information remain a concern of patients and providers -- Congress needs to clarify its intent on patient identity (as expressed in the Labor-HHS appropriations bill) and HHS needs to move forward on a consistent nationwide patient identity integrity strategy to ensure widespread and effective health information exchange. A nationwide patient data matching strategy will minimize matching errors while protecting patient privacy and security;
- Adopting health IT in a manner that fully engages knowledgeable and informed patients in their own health care, including encouraging a healthy lifestyle;
- Ensuring health care providers fully appreciate and support the system wide adoption of EHRs and achieve full interoperability capabilities, including clinical decision support, quality reporting, and population health management and public health; and
- The economy -- Even with the meaningful use incentive program, EHR systems are very large investments for providers and hospitals; the weak and uncertain economy can only add to decision makers' dilemmas. There is a natural organizational resistance to making the kinds of large investments required for EHR adoption in these times of uncertainty, but the EHR incentive program is helping to keep implementation moving along, which in itself is supporting the economy and job growth.
Regina Holliday,
an artist, speaker and social media blogger who has dedicated her life to sharing the patient story
What was the most significant health IT development over the past year?
Blue Button going mainstream was the most significant development in health IT in 2012. This move, if enacted fully, could have the greatest impact on third-party application development, and patients could have greater accessibility than ever before.
What was the biggest disappointment or missed opportunity in the health IT space in 2012?
Patients are being invited to take part in greater numbers in health and technology policy discussions, but for many venues this has been a seat at the table but not necessarily parity in the discussion. I do hope to see greater partnerships between patients and technology start-ups as they seem to provide great hope for rapid change, which is almost impossible for entrenched institutions that benefit from the status quo.
Looking forward to 2013, what are the biggest remaining barriers to widespread adoption and meaningful use of health IT? And, what can be done to help address those challenges?
We need to see more individuals focused on big data, the members of quantified self movement, socially networked patient community facilitators and futurists attending health policy meetings nationwide. So many decisions that affect the adoption of health IT are being made without these forward thinkers joining the discussion.
Janet Marchibroda, chair of the Bipartisan Policy Center's Health IT Initiative
What was the most significant health IT development over the past year?
The most significant health IT development in the past year has been the considerable expansion of patient engagement requirements within Stage 2 of CMS' Medicare and Medicaid EHR incentive programs.
Beginning about a year from now, patients who are either discharged from the hospital or seen by an eligible professional will be able to view online, download or transmit to a third party health information contained in their record. Many will also be able to send a secure message to their clinicians. Meaningful use requires that a certain percentage of patients actually do so in order for providers to receive their incentive payments.
This is important for many reasons. First, it's just the right thing to do. Patients have a right to their health information -- a right that has actually been established by previous law. Providing this information electronically will enable patients and all of those who deliver their care to better coordinate care, which has a positive effect on cost and quality. Patients who are more informed and engaged in their health and health care are better able to manage their health. Importantly, research also shows that patient engagement and communication are associated with lower health care costs, improvements in functional status and better outcomes.
Empowering patients through the use of electronic tools creates whole new opportunities for promoting wellness and management of chronic conditions, accountability and coordination, and research on what works and doesn't work in health care. When combined with increased accessibility to genetic tests, electronic tools can lead to a set of patient-centered platforms that can begin to deliver personalized medicine based on our personal DNA and other factors that determine how we respond to diet, exercise, medicines and various modes of treatment.
Clinicians, hospitals and other providers also have a lot to gain from investments in the work flow changes and technologies that will enable further patient engagement. Better outcomes in cost and quality -- which will be required under rapidly emerging delivery system and payment reforms -- are probably the largest benefits for providers over the long term. Providing these services will also result in happier and more loyal patients. Finally, the research does show that better patient communication is associated with fewer malpractice claims, which will have a direct impact on costs for providers.
What was the biggest disappointment or missed opportunity in the health IT space in 2012?
Concerns about rising costs and uneven quality of care in the U.S. have spurred the launch of several new delivery system and payment reforms. In addition to a multibillion dollar investment made by the Center for Medicare and Medicaid Innovation, a majority of states and a significant number of provider organizations and health plans have launched accountable care arrangements and/or medical home initiatives. As noted in our recently released report, these new models of care require a robust IT foundation to be successful, which includes effective methods for sharing information among those who deliver care and services to patients, strong data and analytical tools, and robust use of electronic tools that are designed to engage, communicate with, and even monitor and deliver care remotely to patients.
While many aspects of meaningful use align with the needs of new delivery system and payment models, we have still fallen short of truly aligning our investments in health IT with these new models of care on the ground as these various efforts are operationalized. This alignment will require a holistic and broad, strategic approach towards the use of information and IT for all aspects of health and health care, with leadership by both the public and private sectors at the national and local levels.
One of the most pressing priorities for the U.S. health care system is to find ways to enable information to flow electronically, while effectively managing privacy and security, across the many settings in which care and services are delivered, including primary care providers, specialists, hospitals, laboratories, pharmacies, health plans, long-term care organizations and even the patient. Despite the critical role that information mobility plays in improving the cost, quality and patient experience of care and these new models of care, there is very little information exchange occurring in the U.S. today. It is imperative that we address this issue -- as an industry and a society -- in a substantial way in 2013.
Looking forward to 2013, what are the biggest remaining barriers to widespread adoption and meaningful use of health IT? And, what can be done to help address those challenges?
The most recent EHR adoption and meaningful use payment figures show that we've made great progress over the last year with respect to both. However, gaps in adoption particularly among small physician practices -- where a majority of U.S. health care is delivered -- remain. There are also gaps in adoption among specialists and small community and rural hospitals. While a majority of clinicians wish to share information electronically and believe that it will have a positive impact on health care, they lack the ability to do so.
Government leaders at the federal and state levels and private-sector leaders should come together and collaborate on the development and implementation of strategies that will support this transition, particularly among small physician practices and small hospitals. This can come in the form of training and education, development and widespread dissemination of best practices and on-the-ground implementation support. Programs that support health IT adoption and delivery system reforms should be integrated. Innovative new approaches that can scale and be widely deployed quickly should be considered. Ideally, public- and private-sector investments should be aligned.
Deven McGraw, director of the Health Privacy Project at the Center for Democracy & Technology
What was the most significant health IT development over the past year?
The most significant health IT development in 2012 was the emphasis on patient engagement in the final meaningful use objectives and EHR certification criteria for Stage 2. The requirement for both providers and hospitals participating in the HITECH incentive program (1) to make comprehensive health information available to patients (or their designees) online, to be viewed, downloaded or transmitted to a third-party per the patient's wishes, and (2) to ensure a certain percentage of patients actually use these tools will be game-changing. The work going on now to establish standards and policies to enable the Automated Blue Button will create further momentum behind these efforts to empower patients.
The results of these initiatives are hard to predict, and won't be fully realized until 2014 and beyond, but use by patients of the view/download/transmit functionality is likely to spark more -- many more -- conversations between patients and their clinicians about the information in their records; more patients will be enabled to take greater control of their health care; the market for more effective, consumer-facing digital health tools and services will exponentially increase; and policymakers will feel increased pressure to establish baseline privacy protections for health data collected, stored and shared by entities not covered by HIPAA.
What was the biggest disappointment or missed opportunity in the health IT space in 2012?
The biggest disappointment in 2012 was the failure of the Administration to issue the final regulations to implement most of the changes to the HIPAA Privacy and Enforcement Rules required by HITECH. President Obama signed HITECH in February of 2009, and HHS proposed regulations in July of 2010 to implement most of the privacy provisions in that legislation. To date, those regulations are still not final, and the Office for Civil Rights, which enforces HIPAA, has pledged not to enforce the HITECH provisions until some period of time after the final regulations have been issued. As a result, the nation is a full year into implementation of the EHR incentive program without the benefit of the improved privacy protections that Congress intended to address legitimate public concerns about the privacy risks raised by electronic health information exchange.
Although some of these privacy provisions are controversial, controversy should not be the obstacle to progress. There is no "meaningful use" without effective privacy and security protections. The failure to finalize these regulations breeds uncertainty in the marketplace and has the potential to jeopardize public trust, creating unnecessary barriers to leveraging digital health information to improve health.
Looking forward to 2013, what are the biggest remaining barriers to widespread adoption and meaningful use of health IT? And, what can be done to help address those challenges?
Two of the biggest remaining barriers to widespread adoption and meaningful use are regulatory uncertainty and lingering concerns about lack of interoperability. With respect to the former, it is critical that the administration move to issue the final HITECH privacy regulations as soon as possible and that HHS continue to issue more guidance about how to comply with such regulations.
With respect to interoperability, the certification criteria -- collectively the 2011 and 2014 criteria -- require certified EHR technology to use a fairly robust set of standards, which are a critical component of interoperability. In the 2014 final certification criteria, ONC committed to assuring that EHRs are rigorously tested for the "ability to transmit and receive according to transport, content exchange and vocabulary standards." The necessary foundation for basic interoperability appears to be in place (at least among providers participating in the HITECH incentive program). Yet there remains uncertainty about whether providers and hospitals using different EHR systems will be able to share patient information easily. Perhaps only time, collaboration and experience will ease concerns or better specify where technical or policy work remains.
John Sharp, manager of Research Informatics in the department of Quantitative Health Sciences at the Cleveland Clinic
What was the most significant health IT development over the past year?
The one that stands out for me is the broadening of the development and adoption of mobile health. This includes the exploding number of health apps, the extensive use of pairing smartphones with new mobile devices (everything from scales, Fitbit and portable imaging devices) and the shift from the concept of home monitoring to remote or mobile monitoring. Major conferences in mHealth are expanding and the launch of mHIMSS from the largest health IT organization is evidence of this shift in mindset. The growing adoption of tablets by physicians is another indicator of this trend, which will only expand in the coming year. Eric Topol's book, "The Creative Destruction of Medicine," supports this premise as mobile health being one of the game changing trends in health care.
What was the biggest disappointment or missed opportunity in the health IT space in 2012?
The major disappointment is how all of the hype around cloud computing in health care failed to materialize. While there are some experiments in using the cloud for genomic analysis, in general, two barriers popped this balloon -- having fast enough connections to transfer large quantities of data quickly to and from cloud data centers and the difficulty of ensuring the privacy and security of the data. The exceptions to this are cloud-based EHRs, which may be a small part of the EHR market but are good solutions for some providers and cloud-based imaging storage. In the meantime, many large health care organizations are creating their own private clouds.
Looking forward to 2013, what are the biggest remaining barriers to widespread adoption and meaningful use of health IT? And, what can be done to help address those challenges?
I think in general the barriers to meaningful use are dropping. The EHR adoption rates are climbing steeply and vendors are helping customers with meaningful use reporting. Also, ONC is showing some flexibility with the Stage 2 requirements and listening to provider comments. The biggest challenge is the potential for upcoding using EHRs, and the recent directives to pre-audit meaningful use payments. This may discourage some providers and organizations from pursuing meaningful use.
Steven Stack, American Medical Association board chair
What was the most significant health IT development over the past year?
Mobile health, or mHealth, is poised to take on an increasingly important role in patient engagement. The proliferation of mobile devices creates new opportunities for promoting wellness initiatives and for chronic disease management in an aging population. The opportunity for clinicians to track important clinical measures of even the most underserved patient populations will be an important contributor to efforts to bend the cost curve. However, increasing focus needs to be placed on patient privacy and securing health information.
What was the biggest disappointment or missed opportunity in the health IT space in 2012?
AMA continues to raise concerns over the number of regulatory requirements, including health IT, that are placing significant burdens on physician practices. Physicians face current and future financial penalties if they do not successfully participate in multiple Medicare programs all under way at the same time, including electronic prescribing, the meaningful use program, the Physician Quality Reporting System and value-based modifier programs. AMA does not support financial penalties associated with these programs. The compounding effect of these potential penalties is made worse by the up to two-year lag time between the periods for measuring performance and applying penalties -- making it impossible for physicians to learn about and correct errors to avoid penalties.
The number of financial, technological and operational pressures physicians are facing today could also adversely impact physician participation rates in new delivery and payment reform models intended to support higher quality, lower cost and better coordinated care. A roadmap outlining the various competing health IT, quality and other regulatory requirements needs to be developed to ensure that the timelines are synchronized to the greatest degree possible to minimize the burdens.
Looking forward to 2013, what are the biggest remaining barriers to widespread adoption and meaningful use of health IT? And, what can be done to help address those challenges?
AMA continues to advocate for building in more flexibility in the Medicare and Medicaid EHR meaningful use program requirements to increase physician participation rates. We remain concerned that physicians have to meet all of the required measures and failing to meet just one measure would cause a physician to miss out on incentives and even face financial penalties that start on Jan. 1, 2015. Not all physicians practice in the same specialty or treat the same patient population, and physicians should meet measures that make the most sense for their clinical practice and patients.
Technological barriers need to be addressed as well. A survey released by the Bipartisan Policy Center in October 2012 revealed that more than 70% of surveyed clinicians identify lack of interoperability, lack of an information exchange infrastructure and cost of setting up and maintaining interfaces and exchanges as major barriers to health IT use. More needs to be done to develop a national health IT infrastructure that facilitates effective, efficient and secure exchange of health information among health care providers who deliver and support care for patients.
Tim Stettheimer, senior vice president and regional CIO at St. Vincent's Health System in Birmingham, Ala.
What was the most significant health IT development over the past year?
In 2012, the U.S. health care system experienced considerable change. The continued influence of the 2009 American Recovery and Reinvestment Act on the expansion of meaningful use of EHRs was significant. The delay of the transition of documentation, coding and reimbursement systems to ICD-10 was met with many cheers and a number of groans. However, the most significant development in 2012 was the growing impact of the Affordable Care Act. The various provisions of this act, while taking increasing effect over almost a 10-year period, have begun to have substantial influence already. One example is the move toward accountable care organizations. These changes are significant for health care IT because they demand an entirely new set of technical capabilities for organizations. Interconnectivity and data exchange requirements are exponentially increasing, the ability to support personal/consumer devices is advancing and the security enhancements necessary for the privacy of these interactions is challenging. And these combined technical requirements often have unintended consequences on storage, processing and bandwidth. The intended benefits lead to additional opportunities with "big data," analytics and iterative intelligence. For 2012, it is all about data.
What was the biggest disappointment or missed opportunity in the health IT space in 2012?
In 2012, we experienced continued challenges in security and privacy. Many high-profile incidents occurred across industries, with health care unfortunately leading the way. The additional disclosure requirements of the HITECH Act brought greater awareness of weaknesses within our systems and processes. Our experience was disappointing, and the opportunity for improved capability is still outstanding.
Looking forward to 2013, what are the biggest remaining barriers to widespread adoption and meaningful use of health IT? What can be done to help address those challenges?
Even with the incentive payments for the meaningful use of health IT, the most significant barrier to widespread adoption is cost. The value of the technology is still debated by many, but this debate is intensified because of the relatively high costs of technology and the opportunity costs of investment -- when health care organizations invest millions in technology, they are not investing in other resources. And while most providers operate on a low margin, most technology companies realize a high net return on sales and continued maintenance. What can be done? While providers must continue to improve efficiencies, health care IT companies also must find ways to reduce costs and pass along savings. Otherwise, either their customers will no longer be able to afford their products and services, or these companies will encounter regulatory pressure to change their business models.
Stephen Stewart, CIO at Henry County Health Center in Mount Pleasant, Iowa
What was the most significant health IT development over the past year?
There were several actually: The delay of ICD-10, the U.S. Supreme Court upholding most of the Patient Protection and Affordable Care Act and the election results. At the end of the day, the election results are probably the most important, as it would appear that the ACA will be implemented in substantially the same form as it stands now. There are, of course, positives and negatives to that, but at least we have some level of clarity of direction for the next few years, and that is good overall.
What was the biggest disappointment or missed opportunity in the health IT space in 2012?
The biggest disappointment was the delay of ICD-10. While I understand the arguments and actually can see some advantages to a year's postponement, it has certainly made it more difficult to martial resources to continue the drive to implementation. In my mind, there is a false sense of security from the delay, and my fear is that, as an industry, we will fail to act soon enough. My organization made no changes in ICD-10 conversion plans, even after the delay. We chose to stay the course, but I know many that had not begun to prepare now feel they have more time. They do, but they are already late, even to the new deadline.
Looking forward to 2013, what are the biggest remaining barriers to widespread adoption and meaningful use of health IT? What can be done to help address those challenges?
The biggest barrier to meaningful use adoption is still going to be costs and the unwillingness of some to change. As the interoperability world evolves, it is beginning to look like only a few EHRs will be standing in a few years, so that could beget more cost and more change for many. For some, especially eligible professionals, it may not be cost-effective -- even with the incentive payments -- and for a small practice, it may not be worth the ongoing operating costs and headaches. That is disconcerting. Achieving interoperability in today's environment may prove more difficult than anticipated. The solution can only lie in standards and time -- standards against which to perform interoperability and time to get there. We have made a really good start, but probably have only pushed those who would have done so anyway to get there now. The remaining unautomated providers are the challenge. Combine that with other entities in the continuum of care that have not even begun, and the issue gets larger. As a simple matter, just getting a national person identifier, similar to a Social Security number, could reduce a lot of issues and their associated costs.
Micky Tripathi, president and CEO of the Massachusetts eHealth Collaborative
What was the most significant health IT development over the past year?
- Re-election of President Obama -- undermining of the ACA and HITECH at this point would have been a shock to the health care and health IT industry that would have set both back for years.
- Continued growth of EHR vendor Epic Systems in the market, and the positive and negative implications this will have for health information exchange specifically and care delivery overall.
- Strategic focus by provider organizations on accountable care, though we don't know exactly what it will really look like and whether it will really be feasible.
What was the biggest disappointment or missed opportunity in the health IT space in 2012?
- Lack of any serious competitor to Epic. Though there are many short-term aspects of this dominance that are good for the industry and for health care overall, market hegemony is not good for anyone over the medium- and long-term, including the hegemonist.
- Slow pace of innovation by EHR vendors, especially in health information exchange.
- Slow pace of innovation in the market for consumer-facing health IT applications.
Looking forward to 2013, what are the biggest remaining barriers to widespread adoption and meaningful use of health IT? And, what can be done to help address those challenges?
- Lack of a nationwide framework for "accountable care" -- organizations are investing heavily at present in approaches that are directionally fine for now, but at some point those investments will need to be pointed at something more specific.
- Lack of nationwide framework for health information exchange, which forces every health care delivery organization and every CIO to have to figure it out on her or his own.
- Need to rethink current view on balance between federal direction, state-level direction and market innovation. The market needs more structure to be able to meaningfully and rapidly innovate.
- The biggest barrier to widespread adoption will be trying to accomplish too much in meaningful use Stage 3. We should zero in on a VERY focused set of EHR capabilities to enable flexibility in future payment and organization models and give providers what they need at the ground-level to improve care: 1) import and export a standardized, machine-readable medical record summary on demand across disparate EHR systems to support transitions of care, aggregation of data for population health management, and authorized queries for information; and 2) import and export electronic measure definitions and clinical/administrative decision-support rules to enable coordinated performance measurement and care management across disparate EHR systems. Everything else -- such as complex care plans, end-of-life support, importing patient-generated data, medical device integration, etc. -- is best left to the market.