AHIC and E-prescribing mandates
The news reports repeat the clarion call - "let e-prescribing begin!"
iHealth Beat summarizes in a November 14 report:
The American Health Information Community on Tuesday voted unanimously to recommend to HHS Secretary Mike Leavitt that the Bush administration draft federal legislation to mandate the use of electronic prescriptions for Medicare providers, Modern Healthcare reports (Conn, Modern Healthcare, 11/13).
Other sources include Secretary Leavitt's informative blog
The mandate came from the AHIC meeting in Chicago on November 13
Where did this come from? Clearly there were many forces at work to the eyes of this writer (who was in the audience a good part of the time) and there were many concerns expressed.
This writer was struck by the extent to which the group was focused on many other issues at the expense of e-prescribing. But a few individuals kept pulling the agenda back to this critical topic. No one made a stronger impression on this writer than Mr. Craig Barrett, CEO of Intel and a Member of the AHIC Group.
One got the impression that AHIC support for e-prescribing in part came despite the agenda and not as a product of it. The group spent a good part of the meeting hearing of NHIN contracts that have not yet exchanged data, physician surveys that showed (again) the reluctance to adopt EHRs (and why); of a purported need to certify personal health records (because big companies are involved, not because we know what they should be yet) and some comments by the Commissioner of the FCC. Throughout the transcript, one sees an effort to postpone action on e-prescribing till the January meeting.
In the middle of this was the voice of Mr. Barrett, continually trying to bring the group back to focus on e-prescribing. This writer - obviously fixed in the belief that doing something about e-prescribing is more important than many of the other topics on the AHIC agenda - was glad to see one of America's most effective business leaders try - repeatedly - to get action. It seemed painfully obvious that inaction is either because collectively the health care industry is not convinced that full e-prescribing can be pulled off successfully (and many of the spokepersons are therefore misleading) or that the current government body is reluctant to impose mandates. Both, of course, may be accurate statements...or neither...
Enclosed are some quotes from the transcript (bold face added by this writer)
After discussion of current standards initiatives by Secretary Leavitt:
MR. BARRETT: I have a question that may turn into a comment. And the question really is for Kerry and Mark. I heard a lot this morning about the safety and well being of our patients as our highest priority. And Kerry, if I understood what CMS is doing about electronic prescriptions, it's you're creating a standard without requiring usage.
And I'm still looking at all of the data that suggests that thousands or tens of thousands of people in this country are impacted each year because we don't have 100 percent e-prescription. And so my question is, this is the 17th meeting of this august body. We've discussed this at meeting number one, two, three, four, then we went dark, and now we're back at 17. Where are we?
MR. LEAVITT: There may come a time when we require -- right now we don't require it as a condition of writing a prescription, but if you write an electronic prescription, then you must use our standards. And certainly, there is a considerable push out there to do that. I believe Mr. Serota wrote us last week or the week before about that. We are not, you know, completely deaf to those exhortations, but we're not yet in a position to require it.
DR. KOLODNER: But it will happen.
MR. BARRETT: What meeting number do I have to come back to to get there?
MR. LEAVITT: I can't predict that number for you.
DR. KOLODNER: One of the things, Craig, for those of us who have been in healthcare systems, especially large healthcare systems, what we found is that as good as something might be as an idea, that until you have a base in there that in some cases may be up at the 30 or 40 percent range, you haven't worked through all the issues. And if you put an arbitrary date in before having that, at least in the healthcare arena, it has sometimes caused a problem. Now, the question is how you put incentives in, so you can get to that more quickly rather than starting with the stick.
MR. BARRETT: You ought to talk to your friends in the IRS or the EPA. They don't seem to hesitate to put requirements in without the necessary base involved. I'm just -- I go back continually to the issue of patient safety as our highest priority.
This is an obvious issue, and we seem to just be moving ever so cautiously and slowly on it when we could make a giant leap and perhaps facilitate the movement of the infrastructure and the capability. I knew I'd get to my comment. I had to give you a question to get started, though. [laughter] And I did.
DR. KOLODNER: Okay. Chip.
MR. KAHN: I'd just like to reinforce what Craig said. I think in the case of an institution like a hospital, where you've got computerized prescription order entry, you have an institution that can bring people along. And I agree with the sort of reaching the 40 percent. But I think in terms of individual physicians, you're not going to get to 40 percent in this century unless you acquire it, frankly. You're not going to get to 50 percent. You're not going to get to 20 percent. So I think it's really the only way to go. You're going to have some use, but it's not going to happen until you just tell people. And I think this is one area where if you tell them, I think they're going to have to do it.
MR. BARRETT: There may be some parallels in some other aspects of business. For example, Congress, in its infinite wisdom, passed something called Sarbanes-Oxley. Every public corporation in the United States had to immediately change the way it did business, had somebody looking over its shoulder, public auditors, public reports about how you did this, how you did not do it.
It cost us all millions of dollars. I think it cost my corporation something like 25 or $30 million a year for the first three years or so. And documenting every aspect of our doing business, and every decision we made. And how every internal control operated.
This is not a new issue. Every other business in the United States has done this. As I keep trying to remind this audience, I know that medical care is different. Everybody says their industry is different, but there are innumerable instances where massive changes have taken place almost overnight in the way we do business. Somehow, we're more resistant in this area than every other business that I know of.
There ensued additional discussions and the Secretary left the meeting, as it continued and drew to a break, the following conversation took place....
MR. HUTCHINSON: I don't know if we want to take this topic on before the break, but going back to this e-prescribing conversation about the benefit incentives and how do you drive it and should it be mandated. You know, there's -- we don't need any more studies. There's plenty of data out there that suggests the value and the benefit that comes out. Most recent ones that came out from Henry Ford Medical Center that spent well over a year looking at this issue, and where the benefit lies. And the fact is, all the participants in the prescribing process benefit by automating this process.
DR. KOLODNER: Let me bring us to a close at this point. I think there are a couple of things that we know of. First of all, the Secretary wanted us to engage in a further conversation about e-prescribing, and we, I think, don't have the energy to do that today. But what I would like to do is to, in fact, make sure that we do that in January. Lillee, maybe the EHR Workgroup can spend a little time helping to frame that. It will align with David coming back with the full report, and not based on 400, but based on 3,000 responses. And yes, Craig, they are mail survey, and the problem is, did we --
MR. BARRETT: We've discussed this on and off for 17 meetings. The issue is, if you believe Kevin's numbers, and he's quoted those numbers every damn time, they haven't changed. I have to believe they're right. Thirty percent of the doctors do 80 percent of the work. You want a tipping point. Go up to 30 percent of the doctors. By the way, what we do here means nothing.
It's what you guys do that means something. You have the purchasing power. You have the control to say -- not these are the standards, but these are the standards and you will be reimbursed if you do it this way. Period. I mean seems to me this is the simplest possible decision that somebody has to make. It's not a discussion topic. We've discussed this painfully several times.
If I sound like I'm frustrated, yeah, I'm frustrated. In the business world, this would have been a done deal 17 meetings ago. Slam dunk. Get on with it. Falls in your guys' court.
DR. KOLODNER: I think one of the things, and Kevin, maybe you can work with the EHR Workgroup and I'm not sure who else. But one of the issues about the 30 percent is how many actually are Medicare versus pediatrics and versus other chronic illnesses. Because they may or may not be the federal Medicare dollars, and it may be more widespread. But if we -- I think if we can begin to tee up the data to have this discussion continue in January, I think that we -- hopefully, we'll put it at the beginning of the -- or near the beginning, because we're also going to have AHIC 2.0, but to have it when we have the energy and we can have more data that we can see about driving forward, as you'd like to drive forward, Craig.
iHealth Beat summarizes in a November 14 report:
The American Health Information Community on Tuesday voted unanimously to recommend to HHS Secretary Mike Leavitt that the Bush administration draft federal legislation to mandate the use of electronic prescriptions for Medicare providers, Modern Healthcare reports (Conn, Modern Healthcare, 11/13).
Other sources include Secretary Leavitt's informative blog
The mandate came from the AHIC meeting in Chicago on November 13
Where did this come from? Clearly there were many forces at work to the eyes of this writer (who was in the audience a good part of the time) and there were many concerns expressed.
This writer was struck by the extent to which the group was focused on many other issues at the expense of e-prescribing. But a few individuals kept pulling the agenda back to this critical topic. No one made a stronger impression on this writer than Mr. Craig Barrett, CEO of Intel and a Member of the AHIC Group.
One got the impression that AHIC support for e-prescribing in part came despite the agenda and not as a product of it. The group spent a good part of the meeting hearing of NHIN contracts that have not yet exchanged data, physician surveys that showed (again) the reluctance to adopt EHRs (and why); of a purported need to certify personal health records (because big companies are involved, not because we know what they should be yet) and some comments by the Commissioner of the FCC. Throughout the transcript, one sees an effort to postpone action on e-prescribing till the January meeting.
In the middle of this was the voice of Mr. Barrett, continually trying to bring the group back to focus on e-prescribing. This writer - obviously fixed in the belief that doing something about e-prescribing is more important than many of the other topics on the AHIC agenda - was glad to see one of America's most effective business leaders try - repeatedly - to get action. It seemed painfully obvious that inaction is either because collectively the health care industry is not convinced that full e-prescribing can be pulled off successfully (and many of the spokepersons are therefore misleading) or that the current government body is reluctant to impose mandates. Both, of course, may be accurate statements...or neither...
Enclosed are some quotes from the transcript (bold face added by this writer)
After discussion of current standards initiatives by Secretary Leavitt:
MR. BARRETT: I have a question that may turn into a comment. And the question really is for Kerry and Mark. I heard a lot this morning about the safety and well being of our patients as our highest priority. And Kerry, if I understood what CMS is doing about electronic prescriptions, it's you're creating a standard without requiring usage.
And I'm still looking at all of the data that suggests that thousands or tens of thousands of people in this country are impacted each year because we don't have 100 percent e-prescription. And so my question is, this is the 17th meeting of this august body. We've discussed this at meeting number one, two, three, four, then we went dark, and now we're back at 17. Where are we?
MR. LEAVITT: There may come a time when we require -- right now we don't require it as a condition of writing a prescription, but if you write an electronic prescription, then you must use our standards. And certainly, there is a considerable push out there to do that. I believe Mr. Serota wrote us last week or the week before about that. We are not, you know, completely deaf to those exhortations, but we're not yet in a position to require it.
DR. KOLODNER: But it will happen.
MR. BARRETT: What meeting number do I have to come back to to get there?
MR. LEAVITT: I can't predict that number for you.
DR. KOLODNER: One of the things, Craig, for those of us who have been in healthcare systems, especially large healthcare systems, what we found is that as good as something might be as an idea, that until you have a base in there that in some cases may be up at the 30 or 40 percent range, you haven't worked through all the issues. And if you put an arbitrary date in before having that, at least in the healthcare arena, it has sometimes caused a problem. Now, the question is how you put incentives in, so you can get to that more quickly rather than starting with the stick.
MR. BARRETT: You ought to talk to your friends in the IRS or the EPA. They don't seem to hesitate to put requirements in without the necessary base involved. I'm just -- I go back continually to the issue of patient safety as our highest priority.
This is an obvious issue, and we seem to just be moving ever so cautiously and slowly on it when we could make a giant leap and perhaps facilitate the movement of the infrastructure and the capability. I knew I'd get to my comment. I had to give you a question to get started, though. [laughter] And I did.
DR. KOLODNER: Okay. Chip.
MR. KAHN: I'd just like to reinforce what Craig said. I think in the case of an institution like a hospital, where you've got computerized prescription order entry, you have an institution that can bring people along. And I agree with the sort of reaching the 40 percent. But I think in terms of individual physicians, you're not going to get to 40 percent in this century unless you acquire it, frankly. You're not going to get to 50 percent. You're not going to get to 20 percent. So I think it's really the only way to go. You're going to have some use, but it's not going to happen until you just tell people. And I think this is one area where if you tell them, I think they're going to have to do it.
MR. BARRETT: There may be some parallels in some other aspects of business. For example, Congress, in its infinite wisdom, passed something called Sarbanes-Oxley. Every public corporation in the United States had to immediately change the way it did business, had somebody looking over its shoulder, public auditors, public reports about how you did this, how you did not do it.
It cost us all millions of dollars. I think it cost my corporation something like 25 or $30 million a year for the first three years or so. And documenting every aspect of our doing business, and every decision we made. And how every internal control operated.
This is not a new issue. Every other business in the United States has done this. As I keep trying to remind this audience, I know that medical care is different. Everybody says their industry is different, but there are innumerable instances where massive changes have taken place almost overnight in the way we do business. Somehow, we're more resistant in this area than every other business that I know of.
There ensued additional discussions and the Secretary left the meeting, as it continued and drew to a break, the following conversation took place....
MR. HUTCHINSON: I don't know if we want to take this topic on before the break, but going back to this e-prescribing conversation about the benefit incentives and how do you drive it and should it be mandated. You know, there's -- we don't need any more studies. There's plenty of data out there that suggests the value and the benefit that comes out. Most recent ones that came out from Henry Ford Medical Center that spent well over a year looking at this issue, and where the benefit lies. And the fact is, all the participants in the prescribing process benefit by automating this process.
DR. KOLODNER: Let me bring us to a close at this point. I think there are a couple of things that we know of. First of all, the Secretary wanted us to engage in a further conversation about e-prescribing, and we, I think, don't have the energy to do that today. But what I would like to do is to, in fact, make sure that we do that in January. Lillee, maybe the EHR Workgroup can spend a little time helping to frame that. It will align with David coming back with the full report, and not based on 400, but based on 3,000 responses. And yes, Craig, they are mail survey, and the problem is, did we --
MR. BARRETT: We've discussed this on and off for 17 meetings. The issue is, if you believe Kevin's numbers, and he's quoted those numbers every damn time, they haven't changed. I have to believe they're right. Thirty percent of the doctors do 80 percent of the work. You want a tipping point. Go up to 30 percent of the doctors. By the way, what we do here means nothing.
It's what you guys do that means something. You have the purchasing power. You have the control to say -- not these are the standards, but these are the standards and you will be reimbursed if you do it this way. Period. I mean seems to me this is the simplest possible decision that somebody has to make. It's not a discussion topic. We've discussed this painfully several times.
If I sound like I'm frustrated, yeah, I'm frustrated. In the business world, this would have been a done deal 17 meetings ago. Slam dunk. Get on with it. Falls in your guys' court.
DR. KOLODNER: I think one of the things, and Kevin, maybe you can work with the EHR Workgroup and I'm not sure who else. But one of the issues about the 30 percent is how many actually are Medicare versus pediatrics and versus other chronic illnesses. Because they may or may not be the federal Medicare dollars, and it may be more widespread. But if we -- I think if we can begin to tee up the data to have this discussion continue in January, I think that we -- hopefully, we'll put it at the beginning of the -- or near the beginning, because we're also going to have AHIC 2.0, but to have it when we have the energy and we can have more data that we can see about driving forward, as you'd like to drive forward, Craig.
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