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Why is healthcare IT under fire?

Brian Eastwood | Nov. 11, 2014
It's been a rough year for the Office of the National Coordinator for Health IT -- and it's unclear when things will get better.

It's been a rough year for the Office of the National Coordinator for Health IT — and it's unclear when things will get better.

On Oct. 23, the Department of Health and Human Services tapped ONC head Dr. Karen DeSalvo as acting assistant secretary for health, primarily to lead its Ebola response team. DeSalvo rose to national prominence helping reshape healthcare in New Orleans following Hurricane Katrina. She's expected to bring valuable (and needed) disaster response know-how to HHS.

However, DeSalvo's departure prompted Deputy National Coordinator Dr. Jacob Reider to resign as well. ONC and HHS later backtracked, saying DeSalvo isn't leaving ONC after all and will serve as HHS acting assistant secretary and "high-level policy" leader at ONC. Lisa Lewis, formerly the ONC's COO, was named acting national coordinator.

Even so, Modern Healthcare notes, ONC has gone through five coordinators since it was established in 2004. Reider's departure also means ONC has lost five key officials in the last six months. That's not good for business. Neither is a rather damning report suggesting that the meaningful use incentive program — ONC's raison d'etre — may prove to be a waste of money.

Meaningful Use Had Only 'Casual Effect' on EMR Adoption

Absent meaningful use incentives, the National Bureau of Economic Research says, the healthcare industry would have seen electronic medical record (EMR) adoption levels reach 77 percent by 2013. That's the level of EMR adoption the industry saw, with incentives, in 2011.

The NBER report's authors — a quartet of professors from Northwestern University's Kellogg School of Management — therefore suggest that the HITECH Act of 2009 had a "casual effect" on stimulating EMR adoption and that the meaningful use incentives were "not particularly cost-effective."

The authors estimate that, without incentives, EMR adoption would have reached 67 percent by 2011. Compare that to the 77 percent adoption rate achieved by 2011 under meaningful use, they say, and it becomes clear that the vast majority of meaningful use payments actually went to early adopters, not the providers who may have been lagging behind.

"Given that hospitals are still trying to figure out how to systematically use HIT to boost quality and reduce costs, briefly accelerating adoption at this juncture is not obviously desirable," the NBER report states. "Thus, it may be better to ultimately judge HITECH on the impact of meaningful use requirements on outcomes such as costs and quality, something that has yet to be determined."

Finally, the sheer cost of EMR implementation — in the hundreds of millions for facilities such as Duke Unversity and Maine Medical Center — likely outweighs any benefits the new technology may bring, now or in the future, NBER says. "Absent an increased use of bundled payments or more effective shared savings programs, hospitals are unable to fully capture the value created by their spending on EMR."


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