HIMSS Blog: Does Obama’s HIT initiative come with trap door

April 7, 2009

The makers of electronic medical records have never been happier. For the first time, their technologies are glitzier than MRs and CTs. The federal government is gearing up to reimburse the use of HIT products with an entitlement program that will award fees similar to those given the users of high tech medical scanners. And the result could be an enormous boon to the adoption and use of healthcare IT. But as vendors get ready to slide new servers and archives into place, are they also unwittingly laying the plans for a trap door that will lead medical practice down a path no one would consciously choose?

The makers of electronic medical records have never been happier. For the first time, their technologies are glitzier than MRs and CTs. The federal government is gearing up to reimburse the use of HIT products with an entitlement program that will award fees similar to those given the users of high tech medical scanners. And the result could be an enormous boon to the adoption and use of healthcare IT. But as vendors get ready to slide new servers and archives into place, are they also unwittingly laying the plans for a trap door that will lead medical practice down a path no one would consciously choose?
When I lived in Washington, DC, I repeatedly heard the joke – “I’m from the government and I’m here to help you.” The joke is the punch line for anyone who has ever had any experience with the U.S. government.
When the Feds say they want to make medical practice in the U.S. more efficient, what they mean is less expensive. HIT vendors and hospitals may be hearing what they want to hear – that savings will come from improved efficiency. It will. But that might not be all the Federal government has in mind.
Medicare spending is poised to swamp the treasury in a decade or two with more bills than it can handle. EMRs will make the healthcare system in this country work better by improving efficiency. But it will also gather an enormous trove of data that, if wrongly applied, could channel the practice of medicine in ways the government wants at the expense of patients.
A long standing complaint by medical practitioners is the reluctance of Medicare to cover new applications and technologies, even when convincing evidence has been documented to support patient benefit.  A recent example is virtual colonoscopy, whereby CT data are reconstructed into 3D images of the colon to spot potentially cancerous polyps.  Critics of Medicare say the agency is not willing to pony up any more money than it absolutely has to and, consequently, is dragging its feet on reimbursing for this noninvasive, easy to perform procedure.
If saving money is what the Obama HIT initiative is all about, it’s anyone’s guess what will happen when Medicare gets hold of detailed information about exactly how medicine is practiced in the U.S. The government won’t have to tell doctors how to practice medicine. They just won’t pay for ways they “believe don’t work.” And third-party payers will follow suit.
Avoiding this trap door will take vigilance. It will require HIT vendors and the users of their products to use intelligent tools not only to improve efficiency but to document best medical practice and how those practices can be best applied under different conditions.

As Francis Bacon said, “Knowledge is power.” Healthcare providers can turn the information they gather into knowledge that reduces cost and improves patient care. But they must not be satisfied with these achievements, as they may be fleeting.  Advances in patient care must be documented with incontrovertible details. Cost reduction, the underlying agenda of the Obama Administration, cannot be the sole reason for medical decisions. Best medical practices must not be held hostage to financial expedience.
The HIT initiative can be a win for everyone involved from the makers and users of medical equipment to the patients they serve. But it is not a certainty. It will not come easy. And it must not be based on faith that the government is really there to help.