U. S. Electronic Health Record Initiative: A Backlash Growing?

Robert N. Charette | IEEE.org | March 7, 2013

There seems to be a slow but steady backlash growing among healthcare providers against the U.S. government’s $30 billion initiative to get all its citizens an electronic health record, initially set to happen by 2014 but now looking at 2020 or beyond. The backlash isn’t so much about the need for, or eventual benefits of, electronic health records but more about the perceived (and real) difficulties caused by the government's incentive program and a growing realization of the actual financial and operational costs involved in rolling out, using, and paying for EHR systems.

The backlash began to publicly surface last September when the U.S. government accused healthcare providers of “upcoding,” i.e., claiming with a single click on a field in a electronic health record to have provided a medical service or procedure when it wasn’t really performed. Kathleen Sebelius, the current HHS Secretary, and Eric Holder, the Attorney General, sent a letter to five major hospital trade associations (pdf) warning them that electronic health records were not to be used to “game the system” and “possibly” obtain “illegal payments” from Medicare. The letter said that Medicare billing is being scrutinized for fraud, and implied that those using EHRs to bill Medicare will be scrutinized even more carefully.

Healthcare providers were outraged by accusations in the letter, and said that the reason for the increased billing was that EHRs facilitated billing for services they used to provide to the government without charging for them.

About the same time, professors Stephen Soumerai from Harvard Medical School and Ross Koppel from the University of Pennsylvania wrote an article for the Wall Street Journal contending that EHRs don’t save money as claimed. They wrote that, “…. the most rigorous studies to date contradict the widely broadcast claims that the national investment in health IT—some $1 trillion will be spent, by our estimate—will pay off in reducing medical costs. Those studies that do claim savings rarely include the full cost of installation, training and maintenance—a large chunk of that trillion dollars—for the nation's nearly 6000 hospitals and more than 600 000 physicians. But by the time these health-care providers find out that the promised cost savings are an illusion, it will be too late. Having spent hundreds of millions on the technology, they won't be able to afford to throw it out like a defective toaster.”...