The 1,500-member American Alliance of Orthopaedic Executives (AAOE), which represents the people who run the business end of orthopedic practices, has accused electronic health record (EHR) vendors of “questionable” pricing tactics.
The group wants the federal government to crack down by establishing a “data bill of rights” for medical practices in dealing with EHR vendors.
The organization’s views were among 208 comments received by the Office of the National Coordinator for Health Information Technology (ONC, also known as HealthIT.gov) on its 74-page proposed “Strategy on Reducing Regulatory and Administrative Burden Relating to the Use of Health IT and EHRs.” (https://www.healthit.gov/sites/default/files/page/2018-11/Draft%20Strategy%20on%20Reducing%20Regulatory%20and%20Administrative%20Burden%20Relating.pdf)
The American Academy of Orthopaedic Surgeons (AAOS) and several other organizations representing surgeons and other physicians also are dissatisfied with the proposed strategy.
The “Strategy” and What It’s All About
As usual with the federal government, it’s complicated. There’s the “Strategy” cited above, and then there is regulation proposed March 4, “Interoperability, Information Blocking, and the ONC Health IT Certification Program,” and there’s also the “21st Century Cures Act,” the federal law under which the strategy and the proposed rule are moving forward.
The simple explanation (and you don’t really need full details unless you’re involved in your organization’s information technology) is that the law, the Strategy, and the proposed rules attempt to deal with these issues:
- Far too much data must be input into EHRs, with many surgeons being forced to spend not only a typical two hours of office time per hour of care-rendering time, but also evenings, entering data; and
- Many EHR user screens and sequences of screens are designed badly, adding to the work burden; and
- Exchanging data with other caregivers and with insurers, and giving data to patients, is rudimentary, clumsy, or nonexistent; and
- Some vital or required systems external to the EHR aren’t connected, such as state prescription data management programs, forcing the clinician user to exit the EHR to check other data.
Also, AAOS and AAOE both want the rules to force EHR vendors to interface with qualified clinical data registries (QCDRs).
AAOS expressed “regret” that “the Strategy did not identify clinical data registries, such as qualified clinical data registries (QCDRs) or qualified registries (QRs), as a useful tool or recommendation for reducing Health IT and EHR burden.”
AAOS (and about 20 other caregiver organizations) want to do something very smart to reduce federal electronic reporting burdens for organizations paid under the Merit-Based Payment System (MIPS): have the Department of Health and Human Services (HHS) “allow eligible clinicians utilizing a certified electronic health record to participate in a clinician-led qualified clinical data registry (QCDR) to qualify them as fully achieving all points for the Promoting Interoperability category” of MIPS.
Disappointment at EHR Fees!
AAOE expressed disappontment at the fees EHR vendors are demanding to link physician practice EHRs to its patient registry. Like AAOS, it says its registry is a “solution for musculoskeletal health providers to collect data” for MIPS, “send patient-reported outcomes surveys, and collect patient satisfaction data.”
In meetings, “vendors have indicated that they will charge each practice wishing to connect upwards of $15,000,” AAOE said. “These costs are assumed not because they are necessary to compensate the vendor for $15,000 worth of work but simply because the vendors can charge it.”
AAOE also expressed concern about the costs of EHRs overall:
“Unfortunately, the cost burdens of health IT have not been adequately addressed in the draft strategy … ONC, CMS [Centers for Medicare and Medicaid Services], HHS, and Congress must address the questionable practices of health IT vendors that treat healthcare providers as never-ending sources of income.”
“Electronic health record (EHR) vendors have utilized business tactics that would be questionable in any other industry … For example, many vendors include exorbitant costs to extract patient data from the EHR when a clinician wishes to switch vendors … The … practice is abusive and designed merely to pad the pockets of these vendors seeking to enrich themselves at the expense of patient care. This is data about our patients, data that we are responsible for and we should be free to extract it as we need to for whatever legal purpose we see fit.”
“Further, the costs of EHR use increase each year. In an environment of decreasing reimbursements from Medicare and third-party payers year-over-year, it is getting harder for our members to justify the investment in health IT.”
What’s Next
The final version of the Strategy will be published in late 2019. As for the proposed regulation on interoperability and information blocking, the only date or deadline at this point is the deadline for comments, May 3.
