Health Records Rule Too Ambitious?

Hospitals and doctors contend the Obama administration is moving too fast in its efforts to promote the use of electronic health records.

At issue is a proposed regulation that spells out what hospitals and health providers must do in order to receive incentive payments for “meaningful use” of electronic health records. Thanks to the economic stimulus legislation, the Centers for Medicare and Medicaid Services (CMS) will pay up to $17 billion beginning in 2011 to hospitals, doctors and other health providers that meet these standards.

That’s the carrot for using electronic health records. The stimulus bill also included a stick: By 2015, hospitals and providers would see their Medicare reimbursements cut if they aren’t “meaningful users” of this technology.

The theory is that expanded use of electronic medical records will improve the quality and efficiency of health care, and improve patient safety. The incentive payments, which will be offered through Medicare and Medicaid, “will accelerate and facilitate health information technology adoption by more individual providers and organizations throughout the health care system,” said Dr. David Blumenthal, the federal government’s national coordinator for health information technology.

A proposed regulation issued December 30 by CMS outlines more than 20 electronic health records standards that hospitals and providers must meet next year in order to qualify for the incentive payments. These objectives focus on electronically capturing health information in a coded format, using that information to track key clinical conditions and coordinate care, and reporting clinical quality measures to the federal government or states.

The American Hospital Association contends the proposed rules are too stringent, and would penalize many hospitals that already are using health information technology to reduce medication errors, track outcomes and collect basic patient health information.

“As proposed, the current regulations may actually make it more difficult for hospitals and doctors to adopt health information technology,” said Rick Pollack, the association’s executive vice president. “Unless significant changes are made and timelines re-examined, it is unlikely that the vast majority of hospitals can meet the proposed standards.”

Pollack said the proposed regulation’s definition of “meaningful use” of electronic health records “is a worthy goal, but it should be a destination point, not a starting point.”

The Medical Group Management Association, which represents doctors’ group practices, expressed similar concerns.

“We encourage the administration to simplify the meaningful use criteria and qualifying procedures to ensure success of the program,” said Dr. William Jessee, the association’s president and CEO.

“Overly burdensome requirements and needlessly complex administration will only discourage physician participation in the program,” Jessee said.

Expectations that electronic medical records (EMRs) will produce a dramatic improvement in health care quality also may be unrealistic. So far, they’ve been most successful at making billing more efficient, according to a recent study by the Center for Studying Health System Change.

“There’s a real disconnect between policy makers’ expectations that current commercial electronic medical records can improve care coordination and physicians’ experiences with EMRs,” said Dr. Ann O’Malley, the study’s co-author and senior researcher at the center.