Managed Care - February 2009 - (Page 6) LEGISLATION & REGULATION “Don’t just give people a ton of money,” says Luis Castillo of Siemens Healthcare. Consider incentives. Federal money for IT would go a long way to winning over reluctant doctors, says Douglas Henley, MD, of the AAFP. Interoperability will remain a key goal, says David Kendall, senior fellow for health policy at the Progressive Policy Institute. However, he’s been working with a group that includes Google Health and the American Academy of Family Physicians that could allow physicians and patients to get their EMRs without waiting for the digital Gordian knot to be untied. In a letter to legislators, Kendall spelled out a proposal to allow easy export of health care information in text form “and then let patients control where that information then goes. You create an EMR based on the text and you give patients an ability to protect their own privacy.” “A lot of the RHIOs, as well as Microsoft and Google, are going in the direction of health record banks,” says Kendall. “Some states like Washington and Oregon are doing the same. We want to allow for that innovation to come together. “My feeling is that we’re letting the perfect be the enemy of the good; make the standard perfect before we exchange any data,” he adds. “Let’s start with what we can exchange and get the information flowing.” That way, we can more quickly get to the day when someone who goes into the ER on the weekend will have immediate access to important personal health information. Move the process along Setting up centralized databases for electronic health records would move the process along, says Daniel Castro, a senior analyst at the Information Technology and Innovation Foundation, as would $10 billion a year in federal support over five years. People are likely to be willing to pay $1 to $3 a month to maintain an EHR and doctors could be won over if they were paid for every time they submitted information. “Incentives tied to penalties later would be the best approach,” adds Castro, much like CMS’ new e-prescribing rules that went into effect in January, which initially offers incentives to gain upfront adoption and penalties beginning in 2012 to ensure that providers don’t ignore the rule. Health record banks alone, though, aren’t enough, cautions Leavitt. Incentives and penalties might work, says Daniel Castro of Information Technology and Innovation Foundation. “Health record banks can’t substitute for electronic health records in doctors’ offices and hospitals,” he says. “If you don’t use it in the professional setting, there are no data to send.” Luis Castillo, senior vice president of Siemens Healthcare, also thinks the carrot-and-stick approach merits a close look — particularly for small practices. “How are they going to afford a complicated electronic health record?” asks Castillo. “You can make it easy through Medicare, offering an incentive program but not a bailout. Don’t just give people a ton of money and then figure it out.” What everyone needs to see is information technology that improves the way doctors practice medicine, says Kennedy. That will require a customized approach in every region of the country. “I think if states work with local health plans, delivery systems, and physicians, it is the only way to get meaningful solutions,” says Kennedy. “Health plans would save a ton of money if doctors could just have access to lab results,” notes Kendall. “I would hope that the plans would be willing to spend a certain amount of money to make sure that happens, and they’ve started to think in those terms. Once you have an easy, cheaper platform — as a text standard would allow — it would be easy for the plans to see the value, because they’ll save money.” Priming the pump with federal dollars would help make that case. Of course, the health care industry has heard plenty of optimistic government plans about health IT and greater efficiency. Even avid supporters say that Obama’s plans for the next five years offer a daunting challenge. “It’s not impossible, but I would certainly call it a stretch goal,” says Kennedy. “But more important than setting an arbitrary date is creating infrastructure that works.” “A 10-year goal would be more realistic,” Castro offers as a timeline for universal adoption. But you could hit 50 percent to 60 percent by the end of 2013, “and that would be a huge improvement.” “Don’t start over,” warns Castillo. “Don’t reinvent the wheel. But I’ll tell you, we can’t afford not to do it.” MC 6 MANAGED CARE / FEBRUARY 2009
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