According to a recent Kaiser Health survey shared by Health Populi, more than half of Americans put off or reduced health care due to sensitivity to copayments and deductibles as a result of the recession.  Also, the rising ranks of uninsured due to mounting job losses adds to the number of patients who are not seeing doctors as a result of the recession.  While the stimulus bill did provide for a 9 month subsidy of COBRA payments to offset 65% the cost of insurance for laid off employees, this will not completely offset the recent increase in uninsured Americans, and won’t encourage those with insurance to see the doctor.  This decline in visits by insured patients provides much of the reason behind the recent financial troubles faced by many U.S. hospitals, such as U of Chicago, as well as the increased cost of floating rate debt due to the credit crunch.

Many hospitals are now facing the difficult decision of whether to cut their budgets in light of tightening operating margins.  We expect that as the economy stabilizes and as the COBRA subsidies kick in, patients will quickly make up for postponed visits.   We hope that economic recovery comes soon for the sake of patients and doctors.  Additionally, we at DocAsap look forward to helping doctors see more patients in the coming months as we launch our service.

One interesting HCIT-related clause in the $787 billion stimulus bill states that the Feds will work toward the “Promotion of the interoperability of clinical data repositories or registries.” While the still-evolving HL7 and other patient data standards are getting the most push from interoperability advocates, there is not currently a universally agreed-upon standard for storing and sending patient data in the U.S. much less internationally.  In W. Ed Hammond’s Health Affairs article on data interoperability, he highlighed the main obstacles of data standardization so far, such as doctor’s idiosyncratic ways of storing patient information, the still-evolving nature of HL7, and the difficulty in getting EMRs to support one data format.   The stimulus bill currently has those issues in mind by letting the CCHIT and HITSP work together under the auspices of the ONC to pick a data standard, and only reimbursing CCHIT-certified EMR purchases.

This data standardization push is welcome, as the current reality is that doctors and patients have a very hard time keeping track of past clinical data unless the patient has stayed in the same hospital network his or her entire life.  Currently, the biggest repository of patient data resides with the payers (i.e., insurance companies and Medicare and Medicaid), as they typically can aggregate data from hospital and doctor visits, pharmacy benefit managers, and wellness/disease management programs across various providers over time.  However, for patients who are part of regional insurance companies who move to a new region, or simply those who switch insurance providers, many will most likely will lose their clinical data forever, as there is no easy way for a patient to record and transfer data their health data to a new provider.   While the EMR and data interoperability initiatives imbedded in the stimulus bill eventually seek to help doctors provide better care by having access to past clinical data and help patients hold on to their personal health record, these benefits will be years in the making.  Still, the stimulus bill gets high marks from us in its extensive protections of data privacy, as those sharing patient data for marketing or non-sanctioned purposes can be severely penalized.

Various analysts have begun to detail how the $787 billion American Recovery and Reinvestment Act (aka the stimulus bill) signed this afternoon will affect healthcare IT.  While some analysts are skeptical regarding the immediate effects of the bill since only a small percent of the $19 billion allocated to HCIT will be disbursed in the next year, the $17 billion in EMR reimbursements will no doubt have a large positive effect on EMR adoption in the long-term (via NextThingsFirst).    Additionally, many of the bill’s provisions surrounding privacy protections will be felt much sooner.

Certainly, the hope inside the Obama administration is that greater EMR penetration will reduce costly administrative burdens and clinical errors (and therefore costs) while giving patients more ownership and security over their personal health information.  Indeed, Dr. Ron Paulus, CIO of Geisinger, stated in a recent Wharton eHealth class how his hospital has used EMR systems to provide better care at cost-efficient levels while protecting patient privacy.  Still, while the stimulus bill addresses the main reason for EMRs’ slow adoption to date – their cost – some are concerned about lengthy implementation times, especially for small practices.  Certainly, having heard from Dr. Peter Gabriel of Penn today regarding the time it takes to fully implement an EMR and get staff trained properly on the systems, we believe that small practices will need considerable help from federal, state and local authorities to realize the promise of EMRs and make successful use of them at their practices.  We believe that the Obama administration should be mindful of assisting doctors with installing EMRs, training doctors on using the systems and incentivizing regular usage of EMRs by doctors, in addition to refunding EMR purchases, in order to spread the benefits of EMRs throughout the U.S. healthcare system.