(PS–I’m wondering if it makes sense to cannibalize our already inadequate physician workforce re: numbers at a time we have a developing physician shortage and a demographic tsunami of aging baby boomers developing diseases ?)

Mark Leavitt’s letter to our leaders in Washington touches on an important aspect of health IT missing in recent legislative talks – interoperability.

While moving to electronic medical records is an important first step towards improving the health care system and reducing spending, reforming health care through information technology will take more than converting paper file cabinets to electronic ones. Our patchwork system of health information exchange cannot, and will not support the required transformation of U.S. health care. An electronic medical record in the absence of connectivity and sharing of clinical knowledge is a bridge to nowhere.

The Obama administration and Congress have acknowledged a health information technology gap through the HITECH Act, a $20 billion health information technology investment included in the economic recovery package. Yet, much of the dialog in Washington surrounding how to spend these dollars has centered solely on digitizing physician office records and fails to mention interoperability. Investments must require combining a patient’s medical, pharmacy, and laboratory information and deploying this integrated health record to the patient’s entire care team. Research has projected this type of “informed” health information technology system could save more than $160 billion annually.

The HITECH Act investment must connect physicians, patients, and health information to better inform health care decisions…at the hospital, in the emergency room, and in physician offices across the country. With an aging population and rapidly increasing shortage of primary care physicians, our country must invest in a health information system that delivers a patient’s complete health record at the point-of-care to guide better informed decision making by physicians and patients.

Charles Kennedy, MD
Vice President, Health Information Technology
WellPoint, Inc.

I have read this letter both at EHR Decisions and Health Affairs, and concur with a lot of what you have mentioned. However, being an EMR user for nearly 7 years in solo clinical practice, I beg to differ on some of the suggestions. For example neither BTE nor the Medicare EHR Demo programs are appropriate for small practices that wish to provide evidence of high quality, value-added care using IT (a lot more IT than just EMR). CMS has completely ignored small practices in all its demo projects. BTE is far too complicated and expensive for a solo practitioner to complete.

Although I pushed for and got my EMR to be CCHIT certified in 2006, most practicing physicians have a very poor opinion about CCHIT. They believe that it is too expensive for small vendors to certify (including many physicians that have developed their own software that meets their practice needs better than CCHIT-certified products). They also see an intrusion into privacy and a potential liability issue when CCHIT mandates that software be able log every entry in an EMR. Unless these concerns are appropriately addressed, physicians will be very unwilling participants in the health IT structure. Furthermore, having seen multiple EMRs I still don’t believe that IT serves the needs of medicine as well as it should. Further, the costs of achieving interoperability are just not within the budgets of even large organizations, let alone small ones.

My challenge to the new government is:
Can you make interoperability happen without mandates?
Can you establish a level playing field between physician practices and IT vendors?
Can you create or modify regulations that will facilitate linking of IT systems of hospitals with those of physician offices?
Will CMS ever recognize the value of non-face to face physician-patient interaction using IT and reimburse appropriately for such services?
Is CMS willing to get rid of the rigid CPT structure that makes no sense in the 21st Century?

My final (and perhaps most important but least plausible) wish is: will physicians ever be able to work in a true free market system where each service can be priced based soley on its value to the individual receiving such service, without the current method of price-fixing by the government? I truly believe that such a drastic action will separate out those that provide timely, value-based care from those that just provide volume-based services. It will eventually lead to substantial reductions in utilisation of services as well as improvement in physician-patient relationships.

Finally, I agree with the idea of a “clinican champion”. Based on my own experiences – trying to informally help other physicians evaluate IT, I believe I could easily play such a role since I have operated an electronic office for nearly 7 years, and set local standards for care coordination and effective chronic disease management. However, highly paid “consultants” appear to have a stranglehold in this arena due to their expertise in the technical jargon, so physician-champions are left out in the wilderness. I am also wary of what government involvement in all this will bring. Would love to see if the President replies to your letter.