Written By: John Cosenza
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.
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.
Written By: John Cosenza
Over the past year, the historical 2016 presidential election ignited an exhaustive campaign that fed on several divisive issues and policies. At the core of this heated debate was the United States’ healthcare system, which under the Obama Administration, underwent a revolutionary transformation. The primary role of the Affordable Care Act (ACA), commonly referred to as Obamacare, was to improve access to health insurance, expand Medicaid eligibility, and provide subsidies for socio-economically disadvantaged citizens. Indeed, the ACA accomplished its primary objective by
“considerably expanding access, with more than 20 million individuals gaining coverage – 60% through Medicaid” (Gostin, Hyman, Jacobson 1).
Yet, it quickly appeared the ACA was a double-edged sword not absent of pejorative consequences. Criticism soon followed when Healthcare.gov failed to launch, employers were forced to provide more costly insurance plans, individuals experienced costly premium spikes, costly deductible spikes, and decreased access to competitive insurance plans (Claxton, Rae, Panchal, Whitmore, Damico, Kenward, Long 1). Additionally, a 2014 study published by the Commonwealth Fund, an organization that strongly supports the ACA, described the U.S. health care system as the most expensive and the worst in quality of 11 nations studied, dropping from fifth in 2004 (Manchikant, Hirsch 3). In wake of these unprecedented events, and as a campaign promise, President Elect Donald Trump pledged to repeal and replace the ACA. Now that Mr. Trump has secured the White House and is backed by a Republican Congress determined to alter or entirely remove the ACA, many Americans can’t help but beg the question; what is in store for America’s healthcare system? According to Gail Wilensky, a health economist and author of The Future of the ACA and Health Care Policy in the United States,
“it is always useful after elections to review what presidents can do and what Congress needs to do. Presidential policies are important because they frequently set the tone or direction of future legislation” (Wilensky 1).
President Elect Trump has certainly set a specific tone during his campaign over the last year. In regards to the ACA however, this familiar tone has evolved into something less subtle. Indeed, Trump’s first meeting with President Obama in November seemed promising as the current and future presidents discussed the benefits of the ACA and the future of America’s healthcare system. Perhaps in somewhat of a surprise, Trump supports existing policies of the ACA including,
“health plans must enroll applicants regardless of preexisting conditions and health plans must keep dependent children on their parent’s plan until age 26” (Gosting, Hyman, Jacobson 1).
However, after a strong era of implementing universal healthcare, what else should Americans, especially the 20 million individuals now covered under Obamacare, expect in the coming months? Trump supports healthcare policies including privatizing VA insurance, “expanding health savings accounts (HSA’s), turning Medicaid into a block-grant program, allowing insurance plans to be sold across state lines, and allowing individuals who purchase their own health insurance to deduct their premiums from their income taxes” (Wilensky 1). The pros and cons of these policies can be analyzed individually to better predict the future of American healthcare.
A benefit of VA healthcare is the guarantee to low cost coverage. Unfortunately, many low-income veterans suffer from limited coverage options and long wait times due to inefficiency and bureaucratic ties. The privatization of VA healthcare may create networks of insurers, physicians, and hospitals that provide better quality coverage and care. Block grant programs are often effective because they allow states to tailor innovative Medicaid programs specific to their populations and underlying circumstances. In turn, innovative cost friendly plans can be replicated throughout the country. However, states with large pools of Medicaid populations such as New York and California would,
“probably reduce Medicaid eligibility and lower benefits, as states try to save taxpayer dollars” (Gosting, Hyman, Jacobson 2).
This may directly impact individuals in those states covered by Medicaid under the ACA. Allowing insurance to be sold across state lines can also be effective as this encourages healthy market competition. This policy may counter potential consequences of block grant programs because middle-low income individuals can seek low cost coverage. Unfortunately, many healthcare organizations and professionals establish networks that don’t accept out of state insurance. If the Trump administration can remove regulations that prevent out of state insurers from creating competitive networks in different states, this may be an effective policy that plays into the hands of all Americans.
Health savings accounts, tax-advantaged savings accounts one receives from their employer, have become increasingly popular in the U.S. due to cost effectiveness. On average, an HSA is less than traditional health insurance premiums and gives the individual more control over their health care choices. Furthermore, individuals who can purchase their own insurance and keep low cost deductibles via income tax is also a proven method. Consequently, many of the 20 million people covered under Obamacare receive incomes well below the poverty line. Such individuals are reluctant to purchase their own insurance and are not truly applicable to HSA’s. Those who pay little to no income tax receive government subsidies to fund their insurance coverage and thus, may not benefit from traditional conservative policies. Not all is lost however. Indeed, House Speaker Paul Ryan and Republicans in both the House and Senate
“have made it clear that Republicans are not going to repeal the ACA without having alternative strategies in place that will cover approximately similar numbers of the newly insured populations” (Wilensky 2).
What is the American population to make of this unprecedented healthcare crossroad? Furthermore, what alternative strategies will be implemented to ensure those under Obamacare stay covered? Firstly, and regardless of political allegiance, it is clear the majority of Americans
“have been slowly climbing against Obamacare with 54% now opposing the law” (Manchikant, Hirsch 4).
Secondly, it is clear President Elect Trump and the Republican Party are not going to abandon 20 million newly insured citizens. To do so would be entirely detrimental to the conservative image; which is reluctant to be portrayed negatively after securing both the presidency and House for the first time in nearly a decade.
In fact, it is possible the ACA will be modified via legislative action in accordance with the Republican mandate known as the “Better Way” rather than be entirely repealed. It is likely President Elect Trump and the Republican Party will institute a hybrid system that utilizes market based methodologies to support and continue our current system. Congress must garnish the necessary super majority of 60 representatives within the Senate to implement full scale repeal, which is unlikely. If this fails, the ACA may be effectively repealed through a reconciliation process, which is also unlikely. If full scale repeal fails, the ACA will most likely undergo alteration. Ultimately, we must wait and see if market oriented reforms in “A Better Way” will be more or less successful in making healthcare more affordable and accessible than the ACA.
Claxton, Gary. Rae, Matthew. Panchal, Nirmita. Whitmore, Heidi. Damico, Anthony. Kenward, Kevin. Long, Michelle. “Health benefits in 2015: Stable Trends in the Employer Market.” Health Aff (Millwood). 2015;34(10):1779-1788.
In 2011 the EHR Incentive Program set in motion a revolutionary medical adaption that is changing the way healthcare providers care for patients. However, medicine is an ever improving practice with innovation often led by technological advances. EHR’s continue to make healthcare facilities evolve towards a totally paperless and more efficient system where information can be more readily shared by medical professionals. The efficiency of automated, electronic health records can dramatically improve communication, reduce medical errors, and positively affect patient outcomes.
After a strong era of EHR deployment, what’s next on the horizon of using technology to improve healthcare?
As technology advances, we see a prominent shift to mobile devices and wearable technology for all sorts of activities that 10, or even 5 years ago, we would never have imagined. We can now track our steps, make a phone call, and ask an unlimited amount of questions to our phones and smart watches and receive an immediate, accurate response. We can check our bank accounts and send cash on the go at the touch of a button. It can be expected then, that the medical field will not be far behind. Already we can symptom check, get a “Doctor on Demand” and get health insurance information through mobile apps. Incorporating remote monitoring systems into EHR programs and using mobile apps to integrate a national health exchange will be the new future in healthcare IT and EHR advancement.
Some hospitals have already begun to incorporate mobile patient interaction apps. Incorporating technology that can send secure text messaging, submit photos, and check out their symptoms that can be sent directly to their doctor for examination, into an EHR program would be a great advancement in the healthcare IT field. This would allow doctors to directly call patients if they feel further treatment is necessary and it would eliminate purposeless clinician visits. This information, securely sent to the clinicians, could be added into the patient’s profile within the facility’s EHR and can be used to assist healthcare professionals in diagnosing as well as treatment. However, this technology does not need to be utilized solely for post procedure symptoms.
Studies show 1 out of 10 Americans use fitness trackers today. Although a smaller number of people own smartwatches, those who do own them utilize their equivalent fitness functions. This type of wearable technology can track steps, calories, activity level, heart rate, and sleep patterns. Unlike cellphones, wearable technology is in many cases worn even when asleep. This health information is not only extremely valuable for Americans trying to get healthy and lose weight but it can also be valuable for your next doctor or hospital visit. In order to further the Meaningful Use of technology in the American healthcare system, pairing wearable technology with clinician EHR’s can be an extremely efficient and safe outlet to monitor and record patient health data. By utilizing this diagnostic equipment with apps that interface securely with EHR’s we can create an integrated health exchange.
Wearable technology can be utilized as a remote monitoring system that can relay messages back to clinicians in real-time or before their next doctor’s appointment. This will speed up the process of check in paperwork and medical questions. All of the information would be readily available to the clinician before the apt and much more information would be available for the clinician to analyze based of the information the technology picked up that the patient would not remember or be aware of. It can also set health alerts for when blood pressure or other vulnerable health levels are in a compromising and potentially fatal range. It can even be programmed to contact emergency services when necessary. The purpose of this EHR integrated technology would not only be to assist clinicians with time management and safety but also to assist their patients in everyday life.
With today’s rate of EHR clinician frustrations rising to 83%, and 34% of clinicians without a current EHR refusing to integrate despite penalties, how can we move forward to an even more digital healthcare innovation that currently would not include software reimbursement?
The first step would be not following the traditional routes when selecting EHR vendors simply because of popularity. EHR satisfaction must be improved before even newer advancements are integrated. This can be accomplished when health enterprises work with innovative vendors who have demonstrated a willingness to work with clients and develop solutions to better promote healthcare.
At a time of year when America celebrates those men and women who have served our country through military service, Meta is honored to have among us a military hero among our newest team members. Javier Tarazona spent 14 years helping to make our world a safer place through his military service, and is now transitioning to civilian life with a focus on improving patient safety through healthcare IT. It is a privilege for us to have him on Meta’s team.
Javier Tarazona has been with Meta since January 2016 as a Quality Assurance intern. His responsibilities include testing different versions of Meta products to ensure they work properly and writing reports for programmers. He works alongside them to fix any issues that arise. We asked Javier how he likes his job here at Meta, he replied,
“Meta is a company that I can grow with. Since coming to Meta I have been able to expand my skills professionally and as I grow with the company, I will continue to do so.”
Although before joining the Meta family, Javier had a very different set of job responsibilities.
In 2000, Javier joined the United States Army. Instead of computer work, he jumped out of planes, trained soldiers and fought for our country every day; It was not your average 9-5 type of job. For 14 years Javier worked as a paratrooper, Staff Sergeant and Section Leader. He was stationed in many places throughout the United States and abroad, however, his favorite station was in Germany.
“In Germany, all the people are nice and welcoming. I spent a total of six years in Germany with the Army. The lifestyle is very different there.”
Javier was also stationed in Korea and during his time overseas has visited other countries including Italy, Poland, and Austria. He also served several combat tours of duty, two in Iraq and one in Afghanistan.
Originally from Lima, Peru, Javier moved to the United States in 1994. Currently, Javier lives in Franklin Square, Long Island, a mere 10 minutes away from Meta, with his wife and two children. In his spare time, he enjoys playing soccer and spending time with his kids, Tiago and Ana. He is a senior at St. John’s University in Queens, New York with a major in computer science and a minor in healthcare informatics.
“After the completion of my degree at St. John’s, my goal is to get a full-time job here at Meta to continue to increase my skills and knowledge in the healthcare IT field. In the future I hope to attend nursing school to eventually become a clinical nurse. I may eventually go back into the military but for now these are my plans”
In the interview Javier expressed how thankful he is for what the military has helped him achieve. He has gotten to see the world and attend St. John’s University tuition-free under the G.I. bill, but really, it was not free. He has served our country in the most respectful and honorable way possible and that is what makes him Meta’s own hero. We asked Javier how serving our country has influenced his work ethic and schooling. He replied,
“The military has ingrained determination, commitment, dedication, discipline, and integrity in my personality. It has made me who I am today. The aspect of my time in the military that had the most impact on my life was the opportunity to train soldiers. I was able to be a role model for them. I directly impacted their life. Just like a father figure, I taught them to be a good person as well as a good soldier. Those would be my proudest moments”
On a less serious note, we wanted to get a feel for who Javier really is. We asked him to answer two questions with the first thing that came to his head.
If you could visit anywhere in the world where would you visit?
“I would visit Machu Pichu, Peru. Even though I am from Peru, and I go back there often to visit family, I have never made the hike up to Machu Pichu. It is truly said to be one of the seven wonders of the world.”
Name one thing on your bucket list.
“I would have to say I would want to go on a cruise. I have never been on one before. All I can think of is Titanic when I imagine a big ship so I haven’t wanted to push my luck after two tours but one day I will go on a cruise.”
At Meta, we take time out this Memorial Day weekend to remember those who made the ultimate sacrifice while serving our country. We are so thankful to have a hero such as Javier on our team of committed professionals and we thank Javier for all he has done for the U.S.
After his speech at the J.P. Morgan Annual Health Care Conference,
and the ensuing tweet that rocked the #HITsm sphere:
In 2016, MU as it has existed– with MACRA– will now be effectively over and replaced with something better #JPM16
— Andy Slavitt (@ASlavitt) January 12, 2016
CMS Acting Administration Andy Slavitt, along with ONC Director Karen DeSalvo, released their latest declaration on the future of Meaningful Use. However, while the message boasted progress and promised reform, the ‘grand’ gesture left many unanswered questions. At face value, their strategy glazes over many of the more important criticisms pundits have launched against the EHR incentives program.
If we read between the lines, however, perhaps we can begin to decipher their clichéd ideology:
Where We’ve Been
As we mentioned in a speech last week, the Administration is working on an important transition for the Electronic Health Record (EHR) Incentive Program. We have been working side by side with physician organizations… [and] while we will be putting out additional details in the next few months, we wanted to provide an update today…
Okay, but getting to the point…
[Congress passed t]he Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which considers quality, cost, and clinical practice improvement activities in calculating how Medicare payments will be determined moving forward… [and] continues to require that physicians be measured on their “meaningful use” of certified EHR technology for purposes of determining their Medicare payments…
Sure, that sounds great—but what does that all mean? Give us something concrete.
As we move forward under MACRA, we will… be guided by several critical principles:
1. Rewarding providers for the outcomes technology helps them achieve with their patients.
2. Allowing providers the flexibility to customize health IT to their individual practice needs. Technology must be user-centered and support physicians.
3. Leveling the technology playing field to promote innovation, including for start-ups and new entrants, by unlocking electronic health information through open APIs…
4. Prioritizing interoperability by implementing federally recognized, national interoperability standards and focusing on real-world uses of technology…
This all sounds really familiar… Didn’t you say essentially the same thing back when this whole “Meaningful Use” was started, almost seven years ago?
1. “Measuring and reporting CQMs helps to ensure that our health care system is delivering effective, safe, efficient, patient-centered, equitable, and timely care.” – gov [Clinical Quality Measures Basics]
2. “Promote technical innovation using adopted standards” – July 22, 2010 [ONC for Health Information Technology Supporting Meaningful Use]
3. “Promote interoperability” – July 22, 2010 [ONC for Health Information Technology Supporting Meaningful Use]
4. “Encourage participation and adoption by all vendors, including small businesses…” – July 22, 2010 [ONC for Health Information Technology Supporting Meaningful Use]
If that’s the case, then how exactly we are ‘transitioning’ away from the current program?
The approach to meaningful use under MACRA won’t happen overnight. Our goal in communicating our principles now is to give everyone time to plan for what’s next and to continue to give us input…
We encourage you to look for the MACRA regulations this year; in the meantime, our existing regulations – including meaningful use Stage 3 – are still in effect.
So, for those of you following along at home, this is the brilliant plan to improve EHR usage: first, announce a ‘new’ strategy (which is basically a recycled version of the old strategy); then, have everyone adhere to the same old guidelines?
How will Meaningful Use be effectively ended and “replaced with something better,” if we can see no recognizable direction from the federal government?
Congress gave us new authority to streamline the process for granting hardship exception’s under meaningful use. This will allow groups of health care providers to apply for a hardship exception instead of each doctor applying individually.
Unfortunately, this doesn’t address any of the real problems. We need a concrete plan of action, not just principles and reiterations. What does it take to initiate a plan that actually works, instead of just making a patch job of what we have now?
I sense stall-tactics on the part of the CMS and the ONC. Maybe we have become complacent. Have we not put enough pressure on our leaders to take action? Whatever becomes of this ‘shake-up,’ surely the nonsense must end.
However, I can almost guarantee that the process will not be quick; and it certainly will not be painless.
The accompanying cartoon is property of the University of Pennsylvania, as it appeared in the Pennsylvania Gazette in February 2014.
[Slavitt, Andy, and Karen DeSalvo. “EHR Incentive Programs: Where We Go Next.” The CMS Blog. 19 Jan. 2016. Web. 04 Feb. 2016.]