Trump, EHR, & Meaningful Use: Continued Investment in Healthcare IT? Or the End of an Entitlement?

The twenty first century is often characterized as the age of information with rapid advances in technology fundamentally altering human interaction and perception. Making up nearly 20% of the U.S. domestic economy, the healthcare industry is naturally adopting new technologies such as Electronic Health Records (EHRs) to achieve a higher standard of efficiency and patient care. Indeed, a 2008 New England Journal of Medicine study revealed,

82% of EHR users report improved clinical decision-making, 92% report improvement in communication with other providers and their patients, and 82% of users report a reduction in medication errors” (Palabindala, Pamarthy, Jonnalagadda 1).

In 2009, the Obama Administration enacted the Health Information Technology for Economic and Clinical Health Act (HITECH) and the American Recovery and Reinvestment Act (ARRA). Since enactment, the federal government has provided tens of billions of dollars to incentivize healthcare facilities to adopt and implement three stages of ‘Meaningful Use’ (MU) based EHR systems. As expected, this initiative has significantly increased EHR implementation across healthcare facilities within United States.

However, President Elect Donald Trump and the dominant Republican Congress view government responsibility and roles entirely differently than the Obama administration. Limited regulatory oversight and government funded projects are at the core of conservative ideology. If conservative thought prevails in Washington, what does this mean for MU standards and EHR implementation, which have been funded by the federal government in accordance with the HITECH and ARRA?

As of now it is unclear whether businessman Donald Trump, a strong proponent of lowering tax rates to stimulate economic growth, will continue to support government funded programs like HITECH. Although improvements to the U.S. healthcare system was a core component of Trump’s campaign, he did not specifically address EHR systems or MU standards. In a series of interviews with MedCity News, healthcare professionals and EHR experts argue it is unlikely a Trump presidency will slow down digital health momentum. Julie Papanek, pharma and digital health venture capitalist at Canaan Partners, argues,

“the election of President Trump is unlikely to derail the future of digital health. Many of the incentives in the government including the HITECH act as well as value based incentive programs are not all tied to the ACA” (Parmar, Baum 1).

In fact, certain individuals argue a Trump presidency will increase the demand and utilization of EHR systems. Indeed, Andrew Danielson, vice chair of licensing at the Mayo Clinic Ventures in Minnesota, confidently predicts,

 “any changes to the ACA will have a relatively small impact on the need/enthusiasm/drive for using digital health. Providers like Mayo, Cleveland Clinic, and others see digital health as a key initiative. I would imagine that whatever replaces the ACA will take this into account and continue the push for IT efficiency gains in healthcare(Parmar, Baum 1).

If these individuals are correct the future of government supported digital health systems are secure. This claim can be further supported with the recent bipartisan passing of the 21st Century Cures Act, which among other healthcare issues, calls for continued efforts in government funded EHR incentivization. Albeit a Trump administration taking office in a couple of weeks,

“the Secretary of Health and Human Services shall issue guidance to further the voluntary transition of health care providers between different certified EHR technology by removing disincentives to such transition” (114th Congress).

However, it is wise to presume Trump will attempt to deliver on his campaign promises and aggressively push for a significant transition of healthcare funding to sectors such as infrastructure or job stimulation. A prolonged era of public tax reduction and a gradual decrease in healthcare expenditures may directly result in healthcare facilities, who previously relied on government funding, to foot much of their own EHR costs. This likely transition may convince healthcare administrators to postpone or even abandon EHR implementation, unraveling years of government funded projects. Is there an alternative method that effectively ensures incentivization independent of federal funding? Possibly.

It is possible the Trump Administration will use a conservative approach similar to the Carrier deal. The Trump administration could potentially implement corporate tax breaks and deregulate MU standards for EHR corporations and businesses. This possibility becomes more realistic with organizations like the American Hospital Association (AHA) pleading the Trump administration to cancel MU stage 3 so hospitals don’t have to spend a fortune “upgrading their electronic health records solely to meeting regulatory requirements” (Slabodkin). Indeed, Richard Pollack, AHA president and CEO quotes,

“We urge your Administration to modify or eliminate duplicative, excessive, antiquated and contradictory provider regulations. Reducing the administrative complexity of healthcare would save billions of dollars annually and would allow providers to spend more time on patients, not paperwork” (Slabodkin).

Deregulation can potentially save EHR vendors and hospitals large quantities of money and result in a significant reduction of costs for their products and services. Perhaps this can create an alternate incentivization program; one that is market based and enables healthcare facilities to shop among competing businesses rather than be entirely dependent on federal funding. This strategy may appear more sensible over time considering,

“Federal investment in EHR implementation across the country as part of HITECH has already reached $25 billion, and without addressing the barriers to successful implementation, this venture threatens to be an ongoing waste of public tax dollars with limited benefit to patients and physicians alike” (Palabindala, Pamarthy, Jonnalagadda 3).

At this rate, the average American tax payer, numbered at approximately 122 million, has already contributed at least $200. On the contrary, deregulation may potentially underpin unprecedented consequences within the digital health industry. Increasing market competition or deregulating MU standards may potentially hinder objectives such as achieving high quality patient care or nationwide interoperability. At this point, it is unclear if this strategy would be more efficient or more cost effective in delivering EHR implementation. Regardless, it is interesting to speculate what may potentially happen as the political shift radically changes with President Elect Trump, his administration, and the 115th Congress taking office in the coming weeks.

 

References:

Kruse, Clemens Scott, Katy Bolton, and Greg Freriks. “The Effect of Patient Portals on Quality Outcomes and Its Implications to Meaningful Use: A Systematic Review.” Ed. Gunther Eysenbach. Journal of Medical Internet Research 17.2 (2015): e44. PMC. Web. 6 Dec. 2016.

Palabindala, Venkataraman, Amaleswari Pamarthy, and Nageshwar Reddy Jonnalagadda. “Adoption of Electronic Health Records and Barriers.” Journal of Community Hospital Internal Medicine Perspectives 6.5 (2016): 10.3402/jchimp.v6.32643. PMC. Web. 6 Dec. 2016.

Parmar, Arundhati and Baum, Stephanie. Is President-elect Trump an Existential Threat to Digital Health? MedCity News, Nov 14, 2016: Web. 6 Dec. 2016

Slabodkin, George. “AHA asks Trump to Cancel Meaningful Use Stage 3.” Health Data Management, Dec. 2nd, 2016.

https://www.congress.gov/114/bills/hr6/BILLS-114hr6rfs.pdf