Fred Schulte: "GOP senators call for overhaul of electronic health records program"

Fred Schulte, investigative reporter at the Center for Public Integrity (link to bio), has authored a new article worth reading in its entirety:

GOP senators call for overhaul of electronic health records program
Lawmakers say Obama's $35 billion initiative pushing health information technology isn't working.

Six U.S. Senators are calling for an overhaul of the federal government’s $35 billion plan for doctors and hospitals to switch from paper to electronic medical records, citing concerns from patient privacy to possible Medicare billing fraud.

The report issued Tuesday by the half-dozen Republicans concedes that many lawmakers and medical experts believe the digital systems can reduce health care costs and improve the quality of care by reducing duplicative testing and cutting down on medical errors.  [Eventually, and with great effort the details of which many in the field lacking appropriate education and expertise are painfully unaware - ed.]

But the report asserts that the Obama administration’s push to use billions of dollars in stimulus money helping doctors and hospitals buy digital systems needs to be “recalibrated.”

“Now, nearly four years after the enactment…and after hundreds of pages of regulations implementing the program,” the document says, “we see evidence that the program is at risk of not achieving its goals and that $35 billion in taxpayer money is being spent ineffectively in the process.”

I've been calling for a "recalibration" (i.e., a cessation of putting the cart before the horse) and slowing down, for years.  See for instance my July 2010 post "Meaningful Use Final Rule: Have the Administration and ONC Put the Cart Before the Horse on Health IT?" and its hyperlinks at http://hcrenewal.blogspot.com/2010/07/meaningful-use-final-rule-have.html.

Among the report’s conclusions:

• Despite expectations of cost savings, the digital systems may be increasing unnecessary medical tests and billings to Medicare.
• The government has not demanded that the various digital systems be able to share medical information, a critical element to their success.
• Few controls exist to prevent fraud and abuse. Many doctors and hospitals are receiving money by simply attesting that they are meeting required standards.
• Procedures to protect the privacy of patient records are “lax and may jeopardize sensitive patient data.”
• It remains unclear whether doctors and hospitals that have accepted stimulus funding will be able to maintain the systems without government money.

I have as an even larger concern the quality and fitness (and hence safety) of today's health IT systems.  In what may be the first robust study, the findings as I have pointed out on this blog are of great concern:

Health Leaders Media
April 5, 2013
HIT Errors 'Tip of the Iceberg,' Says ECRI 

Healthcare systems' transitions from paper records to electronic ones are causing harm and in so many serious ways, providers are only now beginning to understand the scope.  [I understood the scope years ago as reflected in my writings - ed.]

Computer programs truncated dosage fields, leading to morphine-caused respiratory arrest; lab test and transplant surgery records didn't talk to each other, leading to organ rejection and patient death; and an electronic systems' misinterpretation of the time "midnight" meant an infant received antibiotics one dangerous day too late.

These are among the 171 health information technology malfunctions and disconnects that caused or could have caused patient harm in a report to the ECRI Institute's Patient Safety Organization. Thirty-six participating hospitals reported the data under a special voluntary program conducted last year.

Karen Zimmer, MD, medical director of the institute, says the reports of so many types of errors and harm got the staff's attention in part because the program captured so many serious errors within just a nine-week project last spring.  [Including 8 injures and 3 possible deaths in just 9 weeks as I wrote at "Peering Underneath the Iceberg's Water Level: AMNews on the New ECRI Deep Dive Study of Health IT Events" here - ed.]

The volume of errors in the voluntary reports was she says, "an awareness raiser."

"If we're seeing this much under a voluntary reporting program, we know this is just the tip of the iceberg; we know these events are very much underreported."

... ECRI is currently evaluating a similar, and much larger list of reports from many of the 800 hospitals that contract with ECRI's PSO services.

The fact that only GOP Senators so far have made this call is perhaps somewhat surprising, considering the abuse that side of the aisle often takes for being pro-business and anti-citizen rights.

On the other hand, hospital accidents are a truly non-partisan issue.  A Democrat or Republican (or member of any other poitical party), and their loved ones, are all in the same boat.

As this point in time, I recommend any patient have a strong advocate following everything done, not done, supposed to be done, not supposed to be done, med and allergy lists and fulfillment, action on lab and imaging reports, etc. -- importantly, not depending on IT-dependent clinicians to do so.

-- SS

Fred Schulte on Investigative Journalism: "Race to electronic health records may come with a price"

Investigative reporter Fred Schulte of the Center for Public Integrity has written up his experiences on his investigation of upcoding and Medicare billing inflation due to the effects of EHRs.

The piece is of interest in regard to, at the very least, the personal recollections of how an investigation comes to be and is conducted.

I thought his piece would be of interest to HC Renewal readers.  It is at the site of the American Association of Healthcare Journalists and entitled "Race to electronic health records may come with a price."

(The result of the investigation is the series entitled "Cracking the Codes.)

Fred Schulte

This work contributed substantially and materially to a reluctant HHS and ONC deciding it was time to actually investigate the issue.

(Perhaps sometime soon HHS and ONC may also seriously investigate health IT safety, and take more than Milquetoast action.)

-- SS

Cybernetik Über Alles Again: HHS and Sebelius - Hospitals And Their Computers Have More Rights Than Patients

A Nov. 29, 2012 New York Times article by Reed Abelson entitled "Medicare Is Faulted on Shift to Electronic Records" observes that:

The conversion to electronic medical records — a critical piece of the Obama administration’s plan for health care reform — is “vulnerable” to fraud and abuse because of the failure of Medicare officials to develop appropriate safeguards, according to a sharply critical report to be issued Thursday by federal investigators [the report from HHS OIG is here - ed.] ... Medicare, which is charged with managing the incentive program that encourages the adoption of electronic records, has failed to put in place adequate safeguards to ensure that information being provided by hospitals and doctors about their electronic records systems is accurate. To qualify for the incentive payments, doctors and hospitals must demonstrate that the systems lead to better patient care, meeting a so-called meaningful use standard by, for example, checking for harmful drug interactions. [I note that meeting EHR "meaningful use" standards does not necessarily signify better care; the "standards" are experimental - ed.]

Hospitals and doctors are lying about their EHR efforts, in order to gain incentive payments, it seems.

In an article "IG says program is 'vulnerable' to abuse, better oversight needed", Fred Schulte at the Center for Public Integrity notes:

... the Centers for Medicare and Medicaid Services has since paid out more than $3.6 billion to medical professionals who made the switch without verifying they are meeting the required quality goals, according to a new federal audit to be released today

Observes the CEO of the American Health Information Management Association:

“We’ve gone from the horse and buggy to the Model T, and we don’t know the rules of the road. Now we’ve had a big car pileup,” said Lynne Thomas Gordon, the chief executive of the American Health Information Management Association, a trade group in Chicago. 

More Horse and Buggy than Model T.  At least the Model T was reasonably dependable. 

Also mentioned is this:

House Republicans echoed these concerns in early October in a letter to Kathleen Sebelius, secretary of health and human services. Citing the Times article, they called for suspending the incentive program until concerns about standardization had been resolved. “The top House policy makers on health care are concerned that H.H.S. is squandering taxpayer dollars by asking little of providers in return for incentive payments,” said a statement issued at the same time by the Republicans, who are likely to seize on the latest inspector general report as further evidence of lax oversight. Republicans have said they will continue to monitor the program.

In her letter in response, which has not been made public, Ms. Sebelius dismissed the idea of suspending the incentive program, arguing that it “would be profoundly unfair to the hospitals and eligible professionals that have invested billions of dollars and devoted countless hours of work to purchase and install systems and educate staff.”

I was taught "first, do no harm."  Fairness to patients injured and killed by this technology in its present "Horse and Buggy" state (buggy being a particularly apropos term) seems not a matter of particularly high concern to HHS.   A suspension of incentives would slow the adoption rate down, necessary in order to "get the bugs" out of the technology before mass deployment and develop safety, validation and surveillance standards (currently non-existent), as I wrote in my Oct. 24, 2012 "Letter To U.S. Senators and Representatives Who've Sought HHS Input On EHR Problems."

This is despite the fact that FDA, IOM and others have indicated the level of harm is not known, due to systematic impediments to diffusion of that knowledge (see IOM statements in the midsection of my post on health information technology hyper-enthusiasm at this link, and an internal FDA memo on HIT safety at this link). 

HHS seems to care not about health and human services, or at best to be severely misguided.  "Cybernetik Über Alles" seems their current credo.

-- SS