Healthcare IT: Even the Experts Can't Figure Out What's Going On

Trying to follow the ins and outs of healthcare information technology -- a complicated morass of electronic health records, patient and medical-management systems, federal subsidies and mandates and a whole lot more -- has been like assembling a giant jigsaw puzzle whose pieces are delivered in random order. It's some comfort, though not much, to realize that this mess baffles the experts, too.

A recent Microsoft (MSFT) press conference that included David Brailer, the first national health IT czar, put the current state of this jigsaw puzzle in a high-level perspective. But it was only slightly less confusing after Brailer and Peter Neupert, vice president of Microsoft Health Solutions, expounded on their views.

Let's start with electronic health records, or EHRs. Last year's stimulus bill included incentives for physicians and hospitals to acquire EHRs -- but healthcare providers first have to show they'll be using the information systems in "meaningful" ways. The draft "meaningful use" regulations, published in January, drew negative comments from many medical societies and other healthcare organizations. Providers believe it will be too difficult for them to meet the criteria within the specified time frame, and they feel it's unfair that they have to satisfy every requirement to get the government funds.

Brailer, like a number of other observers, believes that federal overseers at the Department of Health and Human Services will lower the bar when the final regulations are published next month. "I expect the final rules will be softer, more developmental and incremental," he said.

That would be good news for doctors and hospitals. Still, many physicians are reluctant to make the leap into health IT because they have to invest in it upfront, before getting any subsidies, and they worry that it will kill their productivity.

In response, Brailer noted a five-year-old study of EHR implementation that found doctor productivity dropped 10 percent on average in the first year after an EHR was introduced. In the second year, productivity was flat to slightly up, and thereafter, it increased 3 to 5 percent a year. That seems like cold comfort to anxious doctors who are contemplating a 10 percent loss in productivity for two years. But physicians whom I've interviewed about their EHR experiences say they were seeing as many patients as they did before the EHR within a few months.

The other topic of discussion was Microsoft's own healthcare business. For the second year in a row, Neupert declined to say how many healthcare organizations were providing clinical data to Microsoft HealthVault, the company's Web-based consumer health platform. But he made it clear that connecting consumers and providers online was no longer Microsoft's main focus. "It's not a top priority for providers today, although they know that's where they're going," he said. So Microsoft is now emphasizing Amalga, a web-based health information exchange that's designed to help healthcare systems connect online with their own physicians and other community providers.

Why aren't healthcare organizations more interested in providing medical records online to consumers, either directly or through a third party like Microsoft HealthVault? Neupert offered some mumbo-jumbo about "deep integration" with workflow. But it seems more likely that too few patients are using these online systems for hospitals and doctors to go to the trouble of transferring their clinical data for individual use.

The percentage of consumers who use PHRs recently jumped to about 7 percent; that's a significant increase from two years ago, but still a trifling percentage. Nevertheless, Neupert insisted that many patients with chronic diseases are vitally interested in PHRs. In any case, meaningful use will require physicians to provide records electronically to patients. Maybe that will jump-start their interest in PHRs -- or maybe not.

I follow this area closely, and I'm as perplexed as many of you probably are. The only thing that's certain is that the health IT field will keep changing, and that the changes will accelerate.

Image supplied courtesy of Robert Scobie at Flickr.