There is no doubt that information technology has revolutionized the way we treat patients in the United States.
Electronic health records are widespread, and people can schedule a doctor’s appointment on a smartphone app. But with this renaissance in technology has come growing pains, as our regulatory framework has struggled to keep pace with private sector advances.
It’s the ninth anniversary of the Health Information Technology Economic and Clinical Health Act - also known as the HITECH Act - and it’s time to radically overhaul our nation’s health IT policy.
When the HITECH Act was signed into law, the iPad had not yet been invented, and a tenth of the country was still using dial-up internet access. About 22 percent of physicians and 12 percent of hospitals used a basic electronic health record system, and federal recognition of telehealth as a vital tool in patient care was virtually nonexistent.
Today, nearly 90 percent of physician offices use electronic health records. However, research shows that practicing physicians spend about half of their workdays on those records and desk work - including 37 percent of the time they are in the exam room with the patient.
Emergency physicians spend about 44 percent of their time on data entry, compared to 28 percent on direct patient care. Prescriptive regulation created nearly a decade ago is now adding burdens rather than lifting them. This needs to change.
To that end, the Bipartisan Policy Center and Health IT Now assembled a work group of nearly 50 leaders across the health care and technology sectors - names like the American Academy of Family Physicians, athenahealth, Epic, the Federation of American Hospitals, IBM and the National Multiple Sclerosis Society - to come up with a vision for the future role of government in digital health.
We just released our final report, and with it our call for an oversight framework that ensures the government focuses on upholding core consumer safety protections while allowing other health IT functions to rest with the private sector - where they belong.
Our nation’s health IT framework must be flexible and risk-based. It must be rational and patient-friendly. It must further our goals of burden reduction, interoperability, better usability, safety and security, timely patient access to information and support for an evolving health care system. To get there, the federal government needs to:
1) Task private sector bodies with any regulatory activities that span beyond the federal government’s traditional role of assuring consumer protections - or eliminate those regulations altogether. For example, physicians do not use 32 of the 68 requirements for electronic health record certification in Medicare’s Merit-Based Incentive Payment System. Why are they even required?
2) Recognize private sector standards, support them through educational efforts and promote their adoption within federal programs, using incentives rather than technology mandates or penalties.
3) Engage health care organizations and technology experts to identify health IT and digital health-related challenges and solutions.
4) Fund research and development activities to advance the field.
Achieving all that will require some other crucial steps along the way. To start, the Department of Health and Human Services must continue proper and fair execution of the 21st Century Cures Act, which is key to ensuring that our Fitbits are not regulated like our pacemakers and bad actors are held accountable for actions that artificially hinder information sharing.We must also reduce the overly prescriptive technology requirements contained in the Centers for Medicare and Medicaid Services’ quality, improvement, payment and delivery system reform programs.
Finally, it is essential that the Office of the National Coordinator for Health Information Technology reduce the scope of its certification program, transitioning nonessential requirements over to the private sector. Overhauling this unwieldy structure must be a top priority.
For too long, federal regulation of health IT favored reporting and process over care and treatment.
HHS must create a new era in which government rules provide tangible benefit to consumers; doctors see patients, not computer screens; and the private sector propels our health care system into the future without fear of an outdated regulatory framework holding us in the past.
We have envisioned a system that is suited for the health IT challenges and opportunities of tomorrow. We want to make sure Washington sees that vision, too.
Janet Marchibroda is director of the Health Innovation Initiative for the Bipartisan Policy Center. Joel White is executive director of Health IT Now.
The Bipartisan Policy Center is a Washington, D.C.-based think tank that actively promotes bipartisanship. BPC works to address the key challenges facing the nation through policy solutions that are the product of informed deliberations by former elected and appointed officials, business and labor leaders, and academics and advocates from both ends of the political spectrum. BPC is currently focused on health, energy, national security, the economy, financial regulatory reform, housing, immigration, infrastructure, and governance.