It seems that there is no end to the stream of administrative and legal overhead that our Leaders in Washington are prepared to inflict upon patients and providers. The latest in this iron maiden of unfunded mandates is a recommendation of the Adoption / Certification Workgroup of the HHS Health Information Technology Policy Committee, that doctors and patients become the responsible parties when it comes to finding and reporting on computer bugs and other potential safety issues with electronic medical records (EMRs), computerized physician order entry (CPOE) and other healthcare information technologies (HIT).
First a little background. As we’ve discussed previously here and here, the Obama Administration and Democrats in Congress included language in the January 2009 stimulus bill that is intended to force providers into buying EMRs that most of them don’t like, don’t want and can’t afford. In a trend that has come to characterize Democratic healthcare policy, the initiative takes a “you buy it or we’ll tax you” approach. Physicians who spend their own money to purchase EMRs prior to 2014 will receive a partial subsidy from the Federal government. The subsidy decreases with time, so that the longer doctors wait to fork over their cash, the less money they receive. Then after 2014, any providers who persist in not purchasing “certified” EMRs from their friendly corporate HIT vendor will financially punished by Medicare. For each year of non-compliance, CMS will withhold an additional 1% of each provider’s gross Medicare payments for all of the healthcare services that they thoughtlessly provided in good faith. A doctor who resists the Will of Medicare for ten years will receive only 90% of the compensation of compliant doctors who provide exactly the same services. (Note 1)
Despite being mandated by our government Leaders, there is one small non-financial hitch for the doctors and patients who are being forced to use these products: faulty medical software may be killing people. As described here by a fellow physician and expert in medical informatics systems, the FDA has recently been looking into reports of patient injuries and deaths as a result of defective EMR and CPOE software products. There is little if any information broadly available regarding the unintended consequences of the health information technologies that our political Leaders and their corporate HIT contributors are so vigorously promoting.
What better way to solve this problem than to enlist the unpaid services of patients and the physicians who care for them?
Enter the Adoption/Certification Workgroup of the HHS Health Information Technology Policy Committee. You see, it’s not enough to simply purchase one of the expensive “certified” EMRs that the government mandates. Doctors must also show that they are “meaningfully using” the things. What constitutes “meaningful use”? Well, no one yet knows. It’s currently being debated by the regulators at CMS and even members of Congress. What is certain is that the tasks and requirements related to “meaningful use” are going to creep steadily in scope over time. In its initial 169-page draft document outlining meaningful use requirements and definitions. CMS has specified that there will be at least three separate stages of “meaningful use” requirements that are phased in over time. (Although the Stage 3 requirements are still completely undefined, they’ll come into effect in 2015. Of course by then it will be too late for doctors to decide whether – having already bought the software – they are willing to comply with the usage requirements.)
As a new and previously unanticipated part of the meaningful use requirements, the Adoption/Certification Workgroup is now proposing that:
“Stage 2 of Meaningful Use should include a requirement that [“eligible professionals” (EPs)] and Hospitals report HIT-related patient safety issues (“HIT safety organization”) to an organization authorized by ONC to receive HIT-related safety reports. Copies of those reports should be sent to any vendors that might be involved.”
That’s right. CMS is actually proposing that it becomes the responsibility of providers to report bugs and other problems associated with the medical software they’ve been forced to buy and use. Failure to do so would result in reduced payments by Medicare and presumably opens the door to legal liability on the part of the physician.
“Isn’t it true, Dr. Chump, that you had seen this type of error occur previously in the software that you use? Did you report this error promptly as required by Medicare, Dr. Chump? No? Are you always so cavalier about your choice of software and the safety of your patients, doctor?”
Patients aren’t off the hook either. The workgroup is recommending that they take every opportunity to review and report technical problems with their own computerized data. (This is excellent advice, considering that the patient now has yet another part of the healthcare system to distrust as a result of all this great technology.)
Let’s reflect upon some of the implications of these policies and the technologies that they seek to promote, shall we?
First, it is nothing short of remarkable that the government should require healthcare providers to buy and use expensive and potentially dangerous computer technologies with little or no clear economic or medical benefit. Not only do our Leaders wish to mandate the purchase of these technologies, but they’re willing to pony up nearly $20 billion of taxpayer money to subsidize it. This speaks volumes for the relative lobbying power of ordinary healthcare providers and patients, as compared with the industry trade group Health Information Management Society (HIMSS), and the giant HIT corporations involved.
Second, it is apparent that these same Leaders and regulators believe that the importance of HIT technology actually exceeds the value and importance of the medical services that doctors were trained to deliver in the first place. The evidence? Generally speaking, it takes far longer for providers to document a patient encounter while using a computer – time that could have been better spent seeing other patients. (As we’ve discussed previously, this is one reason that many providers are reverting to the 4,000 year-old practice of using scribes to document visits.) Yet doctors are now expected to add hours to their work day with computer busywork in order to qualify for full Medicare payment. Government would rather have fewer medical services – provided that they get delivered with an electronic record – than more medical services delivered without an EMR. The real impact of this preference will become evident as the new healthcare reform law adds millions of Americans to medical waiting lists nationwide.
Under the circumstances it’s hardly surprising that that doctors should now be asked to perform quality assurance services for software vendors as well.
So the next time you see that your doctor is running behind, remember that he’s probably doing lots of more important things than taking care of you. Like typing his progress notes, fiddling with drop-down lists, and accounting for “meaningful use” of his EMR. Oh yes, and reporting on that buggy EMR software.
Note 1: Ironically, while receiving this “extra” Medicare money may seem like a good thing, it’s not at all clear that it’s a winning financial proposition for the providers involved. While the government subsidies may help with purchasing the hardware and software initially, providers are left on the hook for the far larger long-term expense of upgrades, maintenance and service. A typical maintenance agreement for EMR software provides for ongoing “maintenance fees” consisting of around 17%-20% of the original purchase price of the software. For a typical EMR package costing $40,000 per providers, this is about $8,000 per year. Actual version upgrades to the software are, of course, extra. Depending upon the fraction of Medicare patients in a provider’s practice, these costs can easily wipe out all of the financial benefit received by qualifying for full, but already inadequate, Medicare payments.