Thursday, January 13, 2011

Why are $640 Million in Federal Funds Aimed at Encouraging EHR Success Anti-Competitive?

Over half of the healthcare information technology regional extension centers (HITREC) are undertaking activities and establishing relationships that don’t appear to support the notion of unbiased advice and avoiding a conflict of interest.  Federal funding of over $640 million to encourage the deployment of electronic health records (EHR) by primary physicians is being used by many HITRECs in ways that will stifle innovation and bar new companies and innovative products from the exposure needed to improve health care.

In addition to $17 billion in incentive payments to adopt EHRs by eligible Medicare providers from the federal stimulus package, $640 million was allocated to fund HITRECs to encourage, advise, and guide primary care physicians in the adoption of EHRs and attainment of Meaningful Use.

The Office of the National Coordinator for Health Information Technology (ONCHIT) told prospective HITREC applicants that:

“Each Regional Center will offer unbiased advice on the systems and services best suited to enable the priority primary-care providers to become meaningful users of EHRs.  Regional Centers will avoid entering into business arrangements creating an actual or apparent conflict of interest.”

(Dec 4, 2009 in a Technical Assistance Call to HITREC prospects by ONCHIT)

At least 30 HITRECs (out of more than 60 nationwide) have selected preferred EHR vendors, and over 12 more HITRECs are in various stages of identifying preferred EHR vendors.  In some cases, only three preferred vendors are being identified.  For example, the Virginia HITREC chose three “preferred EHR partners,” according to its June 15, 2010 press release.

Approximately 8 HITRECs, including Qsource (Tennessee), Chicago HITREC, and Oklahoma Foundation for Medical Quality, are maintaining EHR vendor neutrality.

A HITREC’s preferred vendors will influence, and even limit, the EHR options of providers.  This is not merely an academic question since the HITRECs are choosing market leaders today even before EHR technology and products have evolved to address standards being established by ONCHIT.

Many HITRECs will be focusing tens of millions of federal dollars promoting and supporting preferred vendor EHRs.  The influence and exposure made possible by those federal grants could profoundly impact physicians and other healthcare providers as well as the general healthcare market.

At the most basic level, this situation is important since moving from one EHR to another EHR will be complex, difficult, time consuming, disruptive – and expensive.  Most practices cannot afford a mistake in their EHR efforts since they will not have the money or resources to try again.

The HITREC rush to select preferred vendor EHRs using Washington’s $640 million have a number of serious flaws and strategic implications:

Many HITREC preferred vendor selection processes were completed before the Certification Criteria was released (July 28, 2010) or the authorized testing and certification bodies announced (September 2, 2010).

HITRECs choose preferred EHR vendors even though any Certified EHR product should allow a medical practice to attain Meaningful Use.

Most HITREC selection processes were opaque or worse rather than transparent.

The preferred vendors will gain a substantial foothold with physicians supported by the HITRECs and prevent innovative products from other vendors getting the same exposure and support in the HITREC territories.

If the EHR market is distorted by the HITRECs, providers will be compelled to select and use preferred EHRs that are not appropriate for their practice.  Limited selection options will lead to functional compromises or workarounds that increase the risk of a problem or lapse in patient service.

HITREC preferred vendors will create a vendor that is too big to fail or present a key failure point for regional healthcare.

The initial head start for preferred EHR products focusing on primary care will limit the options for specialists when they are seeking an EHR.  For example, not all EHR products properly manage surgery scheduling, ancillary services or inventory.

In the rush to implement EHRs driven (and distorted) by the incentives and the HITREC program itself, many physicians, with the best of intentions, will be considering a limited group of HITREC preferred EHRs that were not necessarily selected based on the specific needs of particular physicians or their patient base.  Any compromises will have to be managed and dealt with by physicians who are ultimately responsible for patient care.  Such a situation not only puts attainment of Meaningful Use at risk, but could compromise patient safety.

Failure to achieve the goals of unbiased advice and independence could ultimately hurt physicians and expose the entire healthcare system to limited choices and pressure points that could undermine the objectives and benefits of EHRs. 

The implementation of an EHR is a demanding and difficult process.  Physicians need the advice and services that should be available through the HITREC concept. 

In the meantime, the question whether hundreds of millions of federal government dollars should be dedicated to a select group of preferred EHR products and vendors that could inhibit new EHR solutions and innovation in the healthcare industry must be addressed.

 © 2010 Sterling Solutions, Ltd.

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