In February 2009, the U.S. government launched an unprecedented effort to reengineer the way the country collects, stores, and uses health information. This effort was embodied in the Health Information Technology for Economic and Clinical Health (HITECH) Act, which was part of a much larger piece of legislation, the so-called stimulus bill. The purpose of the stimulus bill, also known as the American Recovery and Reinvestment Act of 2009 (ARRA), was to stimulate the economy and prevent one of the worst economic recessions in modern history from becoming a full-fledged depression. Congress and the Obama administration took advantage of the crisis to enact programs that might spur short-term economic growth as well as promote scientific and technical advances with potential long-term benefits for the American people. In the health field, one such program involved a commitment to digitizing the U.S. health information system. The HITECH Act set aside up to $29 billion over 10 years to support the adoption and “meaningful use” of electronic health records (EHRs) (i.e., use intended to improve health and health care) and other types of health information technology.
According to the article, which goes on for pages and has voluminous footnotes, there were only TWO arguments in favor of this program:
1) the conviction (i.e., no facts, no data, no research) that information technology could improve health and health care
2) a need for the government to remedy the perceived but unproven problems inhibiting the spread of health information technology
Looking further for statistics on why this was needed, I found in Blumenthal's puff piece a number of additional arguments for HITECH based on nothing more than intuition, lack of statistics, and a hunger of government officials for more or more.
3) it was “intuitive.” How’s that for hard evidence?
4) the lack of what they wanted--only 17% of physicians and 12% of hospitals had fully functioning electronic health records. (Wow! what a bonanza for the IT industry and its lobbyists!)
5) We already had the most expensive system without IT, and Europe had health IT, so if we heaped this cost on top of that, we could have a “fundamental technological breakthrough.”
6) It would be a benefit to “policy makers” (that means DC law makers) and
7) the “implied” need could improve care if information were shared, and paper records are difficult to share.
8) There was some empirical evidence from the Veterans Administration System and the Kaiser Permanent Health Plan (a tiny puddle in the overall sea of health records) for treating chronic illnesses.
9) The National Institutes of Health (a government agency) wanted it.
Just as the reasons HITECH was necessary to rush through in the stimulus bill in 2009 (to help the economy) were as fragile as a butterfly's wings and its movement of air, so the reasons not to do it were much more substantial.
1) economic--no reward for improved efficiency in medicine--except to patients and insurers--which in government talk means the markets have failed.
2) logistical and technical--it is so complex, that obviously the government needs to step in to help overcome this barrier.
3) the ability to do this is "underdeveloped," so therefore this huge challenge requires something even more huge--the federal government
4) privacy and security of records--no solution is even offered for this one except noting the health record industry is not currently regulated, so you know where they're going with that one.
Wiring the Health System — Origins and Provisions of a New Federal Program
Clever terms only a doctor on the government payroll (Blumenthal was national coordinator) could use:
- "meaningful use" of electronic health records
- meaningful use was a new idea with no precedent in law, policy, or the health care literature
- multiple major new regulations with far-reaching impact with a short deadline
- new programs had to be created from whole cloth (his exact words, folks!)
- targeted public investments
- encourage millions of health professionals and institutions to adopt and use
- justified intervention
- create the need for government remedies
- intuitive rationale
- experts agreed
- policy makers need
- bunches of vague statistics about quality, doctors, sharing information
making available $27 billion
- federal government is correcting market failures
- EHR can create huge databases for local, national and international research
- If left to their own choices/devices providers would "never use them efficiently"
- Congress incentivized, with secretary of HHS allowed to define "meaningful use"
create an opportunity
- the gov't dept charged with all the regulations for HITECH had never drafted a regulation or run a technical assistance or training program and had only 35 employees, so obviously the first job creation of ARRA was to add government staff!
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