Editor’s Notebook: Stimulating Discussion

Editor’s Notebook

Stimulating Discussion

It will be some time before we know if President Obama’s Stimulus Plan revives the economy, but there’s no doubt it has stimulated debate about health IT in general and electronic health records in particular. The Health Information Technology for Economic and Clinical Health (HITECH) Act, which is part of the American Recovery and Reinvestment Act (ARRA) that Obama signed into law on February 17, designates $17 billion (of $19.2 billion) to supporting implementation of electronic health records in hospitals and physicians’ offices.

Well before ARRA became law, interested parties were debating the effect of this huge influx of cash: What is the most effective use of the investment? Will the bill support the use of web-based systems, which many feel are more nimble, efficient, and physician- and patient-centered than traditional enterprise EHRs. Will requiring “certified” EHRs discourage innovation? How will “meaningful use” — a requirement for payment of incentive funds — be measured? Matthew Holt’s The Health Care Blog (www.thehealthcareblog.com) is a good place to monitor the debate, the March/April issue of Health Affairs explores some of these topics, and there are many opportunities to discuss these issues at live events.

I took advantage of such an opportunity just 10 days after ARRA became law. The H.I.L. Forum (www.hilforum.org) presented a program called Transforming Healthcare 2009, which offered networking and a top-flight panel discussion for a modest price on a Wed evening and drew more than 600 health IT junkies from the Boston-Cambridge area. Moderated by Scott Kirsner, technology journalist and Boston Globe columnist, the panel included James Roosevelt, Jr., president and chief executive officer of Tufts Health Plan and a member of the Obama Presidential Transition Team; Charlie Baker, president and CEO of Harvard Pilgrim Healthcare, former Massachusetts secretary of health and human services, and prospective candidate for governor; John Glaser, CIO of Partners Healthcare; and Jonathan Bush, co-founder, president, and CEO of athenahealth. Prior to the panel discussion, Roosevelt gave a keynote address about healthcare reform, which he believes must focus on delivering quality and effectiveness; strengthening primary care; increasing transparency, especially regarding cost and quality; and eliminating disparities that are based on race and income.

The panel had the tone you’d wish for all family dinner-table discussions — spontaneous, friendly, and humorous — informed by expertise and experience. They explored many questions about the HIT stimulus: How will it add value to the provider-patient relationship? What do physicians need? When will we see ROI? Should we even be thinking about ROI? What are we trying to accomplish? Will the $17.2 billion stimulus trigger a feeding frenzy? How can we avoid the feeding frenzy?

The recurring theme was that, in healthcare, change happens incrementally. That’s what we can hope for and expect from the HITECH Act: real change may occur but not overnight and only if we avoid pitfalls that at least we’ve begun to identify and discuss.