July 1, 2010 By Russell Nichols
can be used to bring the providers and plans to the table to begin to focus on delivery system changes like bundled payments, capitation in how we reimburse and expanded use of managed care."
In addition, states could use their exchanges to implement quality and efficiency measures that would reduce health costs, he said. But those benefits will require significant effort. Exchanges must link with Medicaid eligibility information, IRS data for income verification, and the U.S. Treasury for subsidy payments and tax credits.
Health-care reform also could drive adoption of EHRs, which has lagged thus far in the U.S. According to Forrester Research, health-care enterprises in North America spend just 22 percent of their IT budgets on new IT initiatives, compared with 28 percent for businesses in other sectors.
With a goal for Americans to have EHRs by 2014, the U.S. government wants to implement an interoperable nationwide network, where health records - test results from labs and radiology, disease and symptom records, CT scans, etc. - can be accessed online from anywhere. The Obama administration set aside $19 billion in the American Recovery and Reinvestment Act to fund adoption of EHR systems that meet specific criteria.
Scheppach said states could demand that health providers adopt EHRs as a condition of joining insurance exchanges. But for hospitals, health-care reform's massive expansion of coverage might be incentive enough to move toward EHRs.
"With 30 million new records to enter, even skeptical physicians may decide that it makes sense to jump on the EHR bandwagon now in order to better manage new patients," said Jon Oltsik, a principal analyst at Enterprise Strategy Group, an IT analyst and consulting firm.
The new law, Oltsik added, might also motivate health-care firms to form partnerships to extend networks for "more data sharing and IT services over a greater pool of health-care providers."
But skeptics say it's too soon for governments to use EHRs to hedge their bets. A national health-care project in the U.K. using experimental health IT as a pillar for reform has been disastrous, according to Scot M. Silverstein of Drexel University, a physician and health IT expert.
To support his stance that EHRs have been overhyped, Silverstein cites studies concerning health IT (HIT) cost overruns and failed systems. He also points to Jeffrey Shuren, director of the U.S. Food and Drug Administration's Center for Devices and Radiological Health. At a health IT safety meeting in February, Shuren said, "In the past two years, we have received 260 reports of HIT-related malfunctions with the potential for patient harm - including 44 reported injuries and six reported deaths." In terms of health IT-related problems, he added, these incidents may represent only the tip of the iceberg.
"It's mystifying why they think this technology is ready to plug and play," Silverstein said. "It really isn't ready for prime time. While health-care reform is a great idea, if you depend on health IT as one of its pillars, you end up with project failure, lack of acceptance, information systems that are impossible to use, and you end up killing people."
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