E-medicine To Help Health Reform But Are New Rules Enough?

Last week the Department of Health and Human Services (HHS) announced new requirements for implementation of electronic health record (EHR) systems in physician offices throughout the U.S. These directives - revised since an initial list was circulated months ago - emerged to mixed reviews. Although praiseworthy since they will further health reform and provide incentives to providers that use EHRs in "meaningful" ways, the requirements deserve criticism for their lax approach to collecting race and ethnicity data.

Included in last year's economic stimulus package were provisions allotting up to $27 billion for doctors to adopt EHRs over the coming decade (WSJ Health Blog). To receive these funds, physicians must demonstrate "meaningful use" of some type of electronic patient tracking and care management system. To define "meaningful use," federal regulators published an initial list of desired changes for doctors. After accepting critiques from industry groups, the regulators offered a final list with a descriptive brief published in the New England Journal of Medicine on July 13.

The final list of "meaningful use" objectives includes 15 required elements, and 10 optional items from which providers must choose 5 to implement. On the required list are things that HHS views as essential functions of EHR systems such as recording smoking status for patients aged 13 or older and maintaining an active medication lists for patients. The optional items include other important tasks such as incorporating lab results and providing care summaries for patients transitioning between care settings.

After the HHS announcement, industry insiders published reactions. Some were pleased by the document and the added motivation for providers to further health reform. Others were less positive about the requirements and warned that they will challenge providers throughout the country. Prominent industry groups including the American Medical Association (AMA), American Hospital Association (AHA), and American Association of Medical Colleges all broadcast misgivings about providers' ability to achieve the objectives on time (WSJ Health Blog).

Although the HHS might deserve some criticism for setting unattainable goals, they also should be faulted for setting some bars too low. The requirement for collecting demographic data, in particular, only mandates providers record information for 50% of their patient panel. With such a narrow understanding of their patients, providers will find targeted interventions to address healthcare disparities difficult to design and implement. How will an insurer alert their African American hypertensive patients that reducing salt intake is important if the company only knows the demographics of a 50% slice of their patients? (African Americans are advised to consume a lower amount of daily sodium to reduce cardiovascular disease risk).

Despite leaving room for ongoing criticism, the HHS rules are a step forward for health reform. These requirements provide motivation for providers to adopt EHRs and thereby modernize their medical practice. Unfortunately some of these requirements are idealistic and others are not idealistic enough.

Photo credit: Ano Lobb