A few thoughts from a tumor surgeon

EHR stimulus is not about technology adoption, it is about changing health care delivery: Dr. Blumenthal, ONC Director

May 10, 2010 at 11:57 am Leave a comment

The NY Times recently reported on a Health IT conference attended by many technology leaders.

The story emphasized the tug of war between older, large EHR vendors with major investments in “client-server” technology and newer, web-based vendors who provide EHRs as “software-as-a-service” (SaaS).

Large government spending often goes to large companies, this is not a surprise. This time, however, the community of internet-based modular EHR companies may be organizing effectively to make sure the benefits of small-scale innovation is evident to small and medium sized physician practices with groups such as the Clinical Groupware Collaborative.

What is actually more interesting is when Dr. Blumenthal emphasized explicitly that the use of incentive payment to drive “meaningful use” is actually intended to drive health delivery away from fee-for-service and towards payment based on measurable quality.

The government’s intervention in health information technology market, he said, is justified to correct a market failure. “The market doesn’t reward performance,” Dr. Blumenthal said.

In the current fee-for-service system, doctors and hospitals are paid for doing more – more visits, more tests, more surgeries. Quality and cost are not typically measured and compensated, outside some government pilot projects and a comparative handful of larger physician groups around the country.

In fact, the reporter thinks the ultimate goal is to change the model for payment for medical services.

The electronic health record, in Dr. Blumenthal’s view, is a tool – and yes, a stalking horse – for bringing measurement, data-based decision-making and accountability to the practice of medicine. The computerized patient record, then, is a step toward changing compensation of medicine and the economics of health care.

In this respect, the real story may not be the changes in store for EHR vendors but rather for physicians.

Entry filed under: comment. Tags: clinical groupware, EHR, ONC.