Removing health IT barriers

The AMA advocates that federal legislation to encourage technology use should incorporate physicians' ideas, particularly in regard to technical standards, privacy and financing.

Editorial. July 7, 2008.

Congress is looking at how it can provide incentives for the rapid adoption of health information technology, thereby bringing the idea of a nationwide, interoperable and connected health IT system closer to reality. Both that positive intention and the potential for problems from poor implementation are well-recognized in the medical community.

Physicians understand the transformative power of technology in health care. When properly put into place, widespread health IT adoption can improve patient safety, advance care coordination and increase administrative efficiency. It can give physicians the power of real-time, clinically relevant patient information and up-to-date clinical decision support, all at the point of care.

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Topic: Electronic medical records

"It will be like going from a horse and buggy to a bullet train," said AMA Board of Trustees Member Steven J. Stack, MD. He spoke June 4 before the health subcommittee of the House Energy and Commerce Committee, which was reviewing a discussion draft of health IT-related legislation.

The AMA's presence at the hearing underscored its commitment to work with Congress to make sure that transition is as smooth and effective as possible. For some time the AMA has said what it believes should be a part of any federal effort regarding health IT. The AMA focuses on three common barriers to health IT adoption: technical standards, privacy and financing.

A lack of standards means that often a physician's health IT system might not be able to access or connect to another doctor's system, or a hospital's system. As work continues to develop a national strategic plan for health IT, including any coordination of the multiple government initiatives already under way, it is essential that doctors have a strong voice. It is physicians, after all, who will be expected to invest heavily in making the system work.

In that light, current government initiatives and advisory committees should incorporate greater physician representation and involvement. That representation should especially include small practices -- the majority of practices in the United States.

Information technology inevitably raises privacy concerns. To boost confidence in an integrated network, the Health Insurance Portability and Accountability Act's privacy and security rules that apply to physicians, as well as other health care professionals and health plans, should be extended to any party that works with confidential health care records. This would include workers' compensation carriers, researchers, life insurance issuers, employers, marketing firms, health IT and personal health record vendors, and health information exchanges.

But there is no need to restrict or impose more requirements on physicians under HIPAA. Currently they are authorized to use and disclose information for treatment, payment and health care operations purposes. This is critical for ensuring that patients' access to care is not impeded or delayed. At issue is the need to make sure that anyone who deals with health information is accountable, not to slow the necessary flow of patient data.

Finally, direct financial incentives to physicians are especially important to encourage health IT use. Initial costs for an electronic medical record alone can start at $37,000 per full-time equivalent physician -- and go way up from there. There are ongoing costs for maintenance and technical support, as well as costs associated with staff training, and converting paper records and practice work flow to conform with the system.

Physician reimbursements already are under intense pressure, and the Congressional Budget Office itself has released a report doubting estimates of extraordinary, health IT-related savings. It's no surprise that many practices, especially small ones, find it justifiable to avoid health IT investment. Meaningful grants, loans and other financial incentives are essential for giving physicians the financial security they need to accept and accrue the benefits of health IT.

The AMA is delivering essential insight on what doctors need from lawmakers to embrace health IT. The well-founded technical, privacy and financial concerns of the medical community must be addressed to achieve the fully wired health care system Congress hopes to create.