According to a recent article in Health Affairs the share of U.S. hospitals with basic or comprehensive electronic health records (EHR) rose by 3.2 percentage points to 11.9 percent in 2009. However, only 2 percent of those EHRs will meet the federal government's "meaningful use" criteria for 2011 and 2012. Anyone want to bet on the likelihood of an integrated electronic health record system by 2012?
How, one could ask, could performance fall so short of the objective? Stated simply, it is because when the opportunity was present years ago, our country followed the conservative political philosophy to fight big government and oppose the adoption of national standards for EHR development. So market forces prevailed and every IT vendor developed its own unique product and assured health providers they could buy the "best of breed" and count on the vendor to integrate the application with those of other vendors. The result is reflected in the statistic quoted above.
I am, however, an equal opportunity critic. Look what happened when government control moved to the party of more liberal persuasion. In an attempt to atone for the EHR sins of the conservatives, it has followed its own political dogma that anything can be rectified with the right plan. So it sets unrealistic goals and financial consequences for not meeting them, failing to accept the fact that a health system representing 18 percent of the GDP can't be turned around on a dime.
This brings me to ACOs. When I first learned of the concept, I thought, too simply, as it turned out, that this was a basic attempt to provide a legal safe harbor for physicians and hospitals to have a common financial incentive to drive the federal government goals of bundling of payments and reducing hospital readmissions.
Not so, it appears. In fact, federal officials developing funding sources for emerging ACOs are talking in terms of provider organizations that take responsibility for a defined population within a geographic area – not too large or too small to measure results – that will demonstrate improved health outcomes for a specific group of patients. If this becomes the standard for ACOs, will a 2 percent achievement rate be the ultimate result?
As a nation we allowed the opportunity to develop a true and authentic integrated healthcare system to pass by. We can "bend the curve" and introduce some important changes to achieve that goal, but the Obama administration needs to be practical and realistic – might I say pragmatic – in doing so as regulations are put into place. If we continue with politics as usual, the Obama administration and others who follow will only achieve the 2 percent solution, and to me, that is not much of a solution.
Mike Stephens blogs regularly at Action for Better Healthcare.