Carrots & Sticks

Depending on your viewpoint (and the pertinent issue), government regulation either:

  1. snarls the wheels of commerce and chokes American competitiveness OR
  2. enables us to live productive, happy, equitable and safe lives. [As Oprah says, "Live your best life..."]

Medicine is full of regulations. For the most part, this is good. Certification and licensure of doctors means that there’s an explicit level of vetting and trust that a patient can bring to any encounter.  Agencies like the FDA test and certify the safety of medications and devices for the public’s good. Controversy abounds in its decisions, but for the most part the agency is looking out for us.

The computer mouse fairy?

Which brings me to medical records.

For hundreds of years, medical records were inscribed on paper, and locked away inside health care institutions and doctors’ offices. With the advent of computers, it made sense to keep these records electronically. For one thing, this saves paper and space. And now your doctor’s crappy handwriting is less of an issue–for you, the insurance company, or the pharmacist.

In theory, the computers (servers, really) housing electronic medical records could be connected for purposes of data sharing (epidemiology) and research. Moreover, if you are enabled to view your own records and lab results online, you (well, let’s say the average patient) might be more inclined to take initiative with regard to your own health. Such opportunities would make the doctor-patient relationship much more of a two way street.

Whose information is it really, anyway? Does it belong to you or your doctor (or your HMO or medical home or “provider” or whatever you want to call it…)?

The Feds in their role as regulators-in-chief and encouragers of best practices passed something called the HITECH Act, as part of the 2009 stimulus package (“ARRA“). The idea is simple: entice medical practices into going electronic by subsidizing the cost. Practices that “meaningfully use” electronic records can get up to $44,000 in payments. Sounds like a good deal, right?

Anything is certainly better than nothing…

Here’s the rub: How is meaningful use defined? The government has issued it’s first stage of criteria in this regard, with stages 2 and 3 expected in 2013 and 2015, respectively. The rules make some intuitive sense: What good is computerizing medical records if you can’t collect and measure basic data to show that you’re providing quality health care? Also, if computers simply become just large cul-de-sacs of information that don’t communicate or allow data retrieval/submission, then what will implementation have really accomplished?

Okay; so far, so good.

Up until now, the vast majority of doctors have stayed on the sidelines, perhaps awaiting these incentives. Most were probably taking  the “No, I insist, you go first!” approach. Why would a doctor or practice invest in the major costs of hardware, software, maintenance, and security not knowing if a product would be adaptable for future use and/or meet the government’s performance criteria?

Now comes the big news: According to the most recent national data, more than half of office-based doctors have now adopted electronic medical records! The carrots (or at least the promise of future carrots) seem to be working!

And though we like to gripe about regulations, these new ones regarding electronic medical records level the playing field to a certain extent.

What’s most impressed me, however, is how amidst the maelstrom of change the regulations have unleashed, new market players have sprung up to fill the void. Take as a prime example Athenahealth.* This New England-based company started by doing electronic claims (billing) for doctors’ offices and groups. Anticipating the direction that health care was taking, they invested heavily in programming platforms that would appeal to doctors looking to make the jump to electronic medical records with a minimum of hassle.

At one point, they were running ads boldly guaranteeing clients that they’d qualify for “all of” the stimulus payments, though I haven’t see those ads running for some time. The idea is compelling: What busy doctors’ group has time to research, trial and invest in value-conscious but appropriate medical information technology? Instead, outsource it! Let it live in the Cloud! Pay a monthly subscription only (without the huge startup cost) and rely on a vendor to deliver updates, promise security, and offer compliance.

From regulation springs rules but also blossoms major new markets. Perhaps this is why America is able to keep re-inventing (and investing in) itself over and over. Maybe there is some hope our economy will soar once again.

Or I am merely drinking from the IT world’s Kool-Aid? The pessimist in me can see a “tethered” future. See here. And here.

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*Please know that I have never used their products, have received no consideration from them, and have not spoken with anyone affiliated with the company. My comments are merely as an interested observer.

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From the e-Mailbag:

A reader sent me this regarding last week’s post on VP Cheney’s need for a new heart:

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