President Donald Trump’s proposed budget to congress effectively cuts $22 million from the Office of the National Coordinator for Healthcare Information Technology (ONC) and millions of dollars from other federally funded health IT organizations. Although this budget has led many industry leaders to question the future of healthcare IT in an era of political uncertainty, strong resentment already exists between health IT vendors and bureaucratic agencies who continue to roll out strict provisions.
Healthcare IT, especially in regards to Electronic Health Records (EHR), has revolutionized clinical practices. The reduction of medication errors, the ability to communicate pertinent patient information across health care communities, and overall improved patient outcomes associated with EHRs are a testament to the recent advances in health care technology. Indeed,“Health IT can engage and support health care providers, patients, and consumers with access to timely and accurate clinical information from Electronic Health Records (EHRs) and other sources” (Basch, McClellan, Botts, Katikaneni). This notion has been widely accepted by the U.S. government and received bipartisan support with the passing of the 21st Century Cures Act in December of 2016; legislation requiring further provisions for health IT vendors to meet. Yet, research suggests most clinicians are dissatisfied with EHR systems and health IT products that cater more to government mandates than to specific needs of hospitals and private practices.
In the wake of Trump’s budget proposal, individuals such as Thomas Payne, MD, the board chair of the American Medical Informatics Association expressed their disappointment. Payne quoted
“This budget request stops progress in its tracks. The ecosystem that entices young scientists and clinicians to pursue their passion to help patients will be severely damaged, resulting in a downward spiral of innovation, delayed or forgone investment in new treatments, and a stagnant patchwork of IT-enabled patient care” (Sullivan).
Individuals from other organizations including the Healthcare Information and Management Systems Society (HIMSS) and the American Health Information Management Association (AHIMA) also expressed concern over the proposed budget.
AHIMA CEO Lynne Thomas Gordon quoted“The bipartisan passage of the Cures Act by Congress last year made clear that investment in our nation’s health IT infrastructure is critically important if we are to advance new drugs and devices and fully realize the benefits of a learning healthcare system” (Sweeney). Many now fear the budget cuts will slow, if not prohibit, the implementation of provisions outlined in the 21st Century Cures Act, which among other provisions, include improving interoperability and maintaining EHR standards under Meaningful Use (MU). However, it can be argued strict legislation has already enabled a downward spiral of innovation.
Additionally, one must question what is more essential to patient care; addressing health IT concerns physicians believe are most important to their patient’s health or tasking vendors to meet endless government mandates that diverts attention from such concerns and product innovation? So, what is next for Healthcare IT in the US, and more importantly, what sort of role will the government have throughout Trump’s presidency? The appointment of Scott Gottlieb, M.D. as Commissioner of the Food and Drug Administration (FDA) might provide an inkling of what’s to come.
Gottlieb’s nomination was supported by his close ties to the pharmaceutical industry and impressive resume; serving as the deputy commissioner for medical and scientific affairs at the FDA during the Bush administration. Gottlieb argues regulation of healthcare IT is “scaring away digital entrepreneurs” and will push a deregulation agenda (Sweeney). Deregulation may attract talent to an industry riddled with onerous mandates stemming from HITECH, ARRA, the 21st century Cures Act and MU. Yet, it should not be assumed deregulation will counter all unforeseen consequences of budget cuts. The correct solution will most likely have to incorporate a healthy balance. Although it is essential for the government to participate in a mission to advance healthcare IT, bureaucratic agencies may not necessarily be the proper body to dictate terms.
Indeed, deregulation has long been sought by both health IT vendors and physicians; many organization are now calling for the cancelation of MU Stage 3. Moreover, Evan Sweeney, author for FierceHealthcare argues,
“Those in the digital health industry are hoping for a behind-the-scenes shift that emphasizes collaboration and removes barriers to innovation” (Sweeney).
If Trump’s budget is approved, coupled with deregulation, it will be interesting to see how the health IT industry reacts. Will this inspire the private sector to shift focus from meeting federal mandates to improving patient care and innovation? Will MU Stage 3 be canceled and enable health IT vendors to work closely with their customers rather than work for the government? Although it is still too early to tell, the 115th US Congress will have to determine the fate of an industry that yearns to enhance technological innovation for those who need it most, America’s patients.