Thursday, November 27th, 2014

The Obameter

Invest in electronic health information systems


"Invest $10 billion a year over the next five years to move the U.S. health care system to broad adoption of standards-based electronic health information systems, including electronic health records."


Updates

Electronic health systems got stimulus help, but not much else

During the 2008 presidential campaign, part of Barack Obama's health reform agenda was investing and expanding electronic health information technology.

He promised to spend $10 billion per year over five years to "move the U.S. health care system to broad adoption of standards-based electronic health information systems, including electronic health records.”

Electronic health systems share data on patient characteristics, doctors' notes and instructions, nurse assessments, lab reports and test results. In 2008, proponents in Congress said the computerized systems would cut down on medical errors, paperwork and unnecessary medical tests or procedures. For example, doctors could click medications on a screen and send data to a pharmacy; these "e-prescriptions” reduce the chance of giving a patient the wrong medication, according to recent public health studies.

The Obama administration has paid for digital health systems through the American Recovery and Reinvestment Act, better known as the economic stimulus. At the start of 2012, the U.S. Department of Health and Human Services had spent $25.9 billion on electronic health information systems, with another $6.1 billion left to spend.  

More money is available through the government health care programs Medicare and Medicaid, which encourage the adoption of electronic health records by doctors' offices and hospitals. By January 2012, incentive payments had reached slightly more than $2.5 billion, according to a recent budget summary to Congress.

In addition to stimulus money, Congress appropriated roughly $184 million in the past three years for the Office of the National Coordinator of Health Information Technology -- a division of Health and Human Services -- and the White House has requested another $66 million for 2013. Much of this money also goes to supporting the adoption of electronic health technology.

Although Health and Human Services seems to be playing the lead role on electronic medical systems, we should note that the departments of Veterans Affairs, Defense and the Social Security Administration have launched a joint initiative to share online health records.

Finally, the campaign promise was about more than investment -- the policy was supposed to encourage broad use of electronic medical records. We found some progress here as well. An estimated 26.6 percent of hospitals had some kind of electronic health record system in 2011, up from 15.1 percent in 2010, according to Health Affairs. An estimated 58 percent of office-based physicians used digital prescription systems in 2011 -- up from 36 percent the year before -- according to Surescripts, a private organization that maintains a nationwide clinical health information network.

We should note that the expansion of electronic health records hasn't been entirely a success story. A recent government oversight report revealed medical professionals and hospitals are exploiting electronic systems to overbill Medicare. The government is taking steps to crack down on those practices.

For our purposes here, though, we're looking at the funding and expansion of electronic health information systems.

Obama promised to invest $50 billion over five years -- and we found roughly $34.5 billion invested so far. Most of that came from a one-time infusion of economic stimulus, with steady but relatively small financial support since the 2009 law. Given those investments and the growing use of electronic health records, we rate this a Compromise.

Sources:

Email interview with Fabien Levy, spokesman for the U.S. Department of Health and Human Services, Nov. 23, 2012

U.S. Department of Health and Human Services, Fiscal Year 2013: Budget in Brief(accessed on Nov. 28, 2012)

Health Affairs, Small, Nonteaching, And Rural Hospitals Continue To Be Slow In Adopting Electronic Health Record Systems, April 2012 (subscription)

U.S. Department of Health and Human Services, HHS Secretary Kathleen Sebelius announces major progress in doctors, hospital use of health information technology, Feb. 17, 2012

The New York Times, Chicken Scratches vs. Electronic Prescriptions, April 28, 2012

The New York Times, Medicare Is Faulted on Shift to Electronic Records, Nov. 29, 2012

The New York Times, Medicare Bills Rise as Records Turn Electronic, Sept. 21, 2012

U.S. Department of Health and Human Services, Office of Inspector General, Early assessment finds that CMS faces obstacles in overseeing the Medicare EHR incentive program, November 2012

The Journal of General Internal Medicine, Electronic Prescribing Improves Medication Safety in Community-Based Office Practices, June 2010

The Joint Commission Journal on Quality and Patient Safety, Electronic prescribing within an electronic health record reduces ambulatory prescribing errors, October 2011

U.S. Department of Veterans Affairs, Medical Programs and Information Technology Programs, FY 2013 Funding and FY 2014 Advance Appropriations Request (accessed on Nov. 28, 2012)

Surescripts, The National Progress Report on E-Prescribing and Interoperable Health Care: 2011(free subscription)

Congressional Quarterly Weekly, A Battery of Tests For Health Concepts, Nov. 16, 2008 (subscription)

Push for electronic health records moves ahead using stimulus money

The last time we checked on this promise, we noted that the American Recovery and Reinvestment Act (better known as the economic stimulus) had sent approximately $20 billion to projects involving health information technology. There has been no major additional funding since then, so President Obama is still short of his promise to send $50 billion over five years to the effort. However, the five years have not yet elapsed.

Still, efforts to implement electronic health care records are moving full steam ahead. The stimulus provided funds to create an Office of the National Coordinator for Health Information Technology as part of the U.S. Department of Health and Human Services. That office helped develop standards for the meaningful use of electronic health records so that doctors and hospitals can apply for payments from the federal government to help them make a transition to using electronic records. Those standards were announced in July 2010, and on Jan. 3, 2011, physicians and hospitals were able to begin registering for incentive payments from Medicare and Medicaid.

Whether Congress decides to spend more money for health information technology remains to be seen, particularly given the national budget situation and calls to freeze discretionary spending. Money from the stimulus is still being spent. A number of major grants were announced in 2010 for what are known as "Beacon" communities, for health care groups that intend to aggressively implement electronic records and use them to improve outcomes for patients.

At a Congressional hearing in September, Rep. David Wu, D-Ore., asked the national coordinator if more funding would be required beyond the stimulus to implement the transition to electronic health records.

The coordinator, Dr. David Blumenthal, said he was optimistic that the private sector would continue the implementation.

"I think the investment that the Congress and the administration have made was meant to correct a market failure, which stemmed from the fact that we don't sufficiently reward providers of care for high-performance, lower- cost, higher-quality. We pay them by piece work, whether it's a high-quality or high-cost product or a low-quality product," Blumenthal said. "We will very soon, I think, see that (health information technology) becomes an essential part of doing body care to the American people, one that physicians, nurses, health care institutions don't feel they can afford not to have. And at that point I think the federal government and my office can pass the baton to the professional community, to the hospitals, the nurses of the country, and the market will take off and do its own work for the American people."

Despite progress toward the goal, for now, we're leaving this promise at In the Works.

Sources:

Office of the National Coordinator for Health Information Technology, Registration for EHR Incentive Programs Starts January 3, 2011: Are You Ready? A Message from Dr. David Blumenthal, the National Coordinator for Health Information Technology, Dec. 27, 2010

Office of the National Coordinator for Health Information Technology, Meaningful Use

Office of the National Coordinator for Health Information Technology, Beacon Communities

Interview with Kelly J. Devers, senior fellow, Urban Institute Health Policy Center

Federal news service, Congressional testimony of Dr. David Blumenthal, Sept. 30, 2010

Health care law sends more money for electronic health records

When we last examined this promise in January of 2009, we reported on the status of President Obama's efforts to invest in electronic health information systems and electronic health records.

At the time, we rated his promise In the Works, since House Democrats had only just released an outline of their 2009 stimulus bill, which called for the allocation of an initial $2 billion for electronic health records, to be followed by another $18 billion. We wanted to see how much funding Congress would give for electronic health records before issuing our final ruling.

On February 17, 2009, President Obama signed the American Recovery and Reinvestment Act of 2009 into law. Within the bill is the Health Information Technology for Economic and Clinical Health Act, or HITECH Act, which specifically addresses the use of health information technology and electronic health records. The bill allocated $20 billion for the development of health information technology, according to a summary from the House Ways and Means Committee. Of that total, $17 billion is intended to provide Medicare and Medicaid fiscal incentives to encourage health providers to implement electronic health records and technology systems.

Although a $20 billion investment in modernizing the health care system clearly demonstrates President Obama's commitment to this promise, he is still $30 billion and three and a half years away from fulfilling his $50 billion campaign pledge. Until we see a clear commitment to the continuation of those funds, we'll keep this promise rated In the Works.

Sources:

American Recovery and Reinvestment Act, published February 2, 2009 and accessed June 21, 2010.

House Ways and Means Committee, HITECH Act Summary Sheet, January 16, 2009.

Kaiser Family Foundation, Medicaid and the Uninsured Summary Sheet, March 2009.

Centers for Medicare and Medicaid Services, Fact Sheet, June 16, 2009.

Stimulating electronic health records

Certainly no one is happy that the U.S. economy is in such dire straits that policymakers are talking about a stimulus plan that could cost more than $500 billion. But an unintended benefit for Barack Obama is that the bill gives him a chance to make good on a number of his more expensive campaign promises.

Obama discussed the broad outline of his hopes for the bill in a speech at George Mason University on Jan. 8, 2009.

"It is not just another public-works program," Obama said. "It's a plan that recognizes both the paradox and the promise of this moment — the fact that there are millions of Americans trying to find work even as all around the country there's so much work to be done. That's why we'll invest in priorities like energy and education; health care and a new infrastructure that are necessary to keep us strong and competitive in the 21st century."

Democrats in the U.S. House released a broad outline of what they hope to include in the 2009 stimulus bill and it contained many ideas Obama promised during the campaign, including $2 billion (with a promise of $18 billion more to come) for the electronic exchange and use of health information.

Granted, this is still a proposal, but it's concrete enough that we're moving the Obameter from No Action to In the Works.

Sources:

New York Times, Barack Obama speech on the economy at George Mason University , Jan. 8, 2009

U.S. House of Representatives Appropriations Committee Web site, Summary: American Recovery and Reinvestment , Report Text , and Bill Text, (pdfs) published and accessed Jan. 15, 2009