Whose Cost?

As each state prepares to launch Health Information Exchanges (HIEs), it is important to keep in mind the goals of the effort.  I believe this is more difficult than one may think at first blush. But, trustees of these HIEs need to move beyond a “motherhood and apple pie” approach of saying the purpose of an HIE is to reduce cost and improve quality and safety.

The cost question is very complicated. After all, one stakeholder’s expense is another’s revenue. Is the goal to reduce the cost to the State? The Patient? The Payors? The Providers of healthcare?

Take duplicate testing. Certainly an HIE has the ability to enable the reduction of duplicate testing by giving providers instant access to results stored in other providers Electronic Health Records. That is a win for the Patients, States and Payors. But, that will have an impact on provider revenue. If the HIE requires all parties to mutually support initiatives there is a strong potential for stalemate.

To complicate this even further…just because a provider has access to the results from another provider does not prevent the provider from ordering a duplicate test. I have overheard other organizations leaders suggest that they should not trust results from other providers and that re-ordering expensive tests is the best care. Unless the HIEs tackle that concern they may not achieve the benefits that they seek.

EHR Certification – Time to Kill it

After 14 months ONCHIT has still not been able to define the EHR certification process. It is time to kill it dead.

The original intent of certification, as I understand it, was to ensure that purchasers of EHRs would buy systems that met a certain level of capability (presumably meaningful use). Now ONCHIT is contradicting the original spirit of that concept by encouraging healthcare providers to proceed with their meaningful use projects on products without certification criteria. Providers are understandably reticent since they don’t want all of their efforts to go to waste if they cannot be assured that their products are certifiable.

It is possible, maybe even likely, that providers will achieve meaningful use with a combination of applications. So why should any one of them have to be certified as having the ability to meet all of the meaningful use criteria?

Certification is blocking EHR progress.  There is one rational solution: BANG.

What do you think? Do I have my facts right?