HITECH: Doomed from the start?

Despite $28 billion spent to date, the HITECH Act has failed to boost efficiency, cut costs or improve care quality for patients, primarily due to a lack of interoperability, five Republican senators say.

The senators--John Thune (S.D.), Lamar Alexander (Tenn.), Pat Roberts (Kan.), Richard Burr (N.C.) and Mike Enzi (Wyo.)--also argue in a Health Affairs Blog post that the Office of the National Coordinator for Health IT's draft interoperability roadmap does not go far enough to address the issue. Instead of providing specific goals and deadlines, they say, the roadmap "speaks in generalities" and fails to address all of the concerns raised by the senators in an April 2013 report that calls for a reboot of the Meaningful Use program.

"ONC's roadmap falls short on the nitty gritty technology specifics that vendors and providers need when developing IT products," they write. "We are left with many outstanding questions about how to achieve interoperability and how to address the cost, oversight, privacy and sustainability of the Meaningful Use program."

The senators also argue that the roadmap lacks clarity when it comes to data security of information in electronic health records. "New cyberthreats emerge each day," they say, "this administration must answer these questions quickly."

Brookings Fellow Niam Yaraghi, however, in a blog post following up on the senators' piece, calls their expectations for ONC unrealistic. HITECH, he says, was designed with a lack of insight into how the healthcare market functions; because of that, a gap persists between the program's goals and its strategies.

"Billions of dollars were doomed to be wasted and have no tangible return from the very first day," Yaraghi says.

What's more, he says, blaming HITECH's failures on a lack of interoperability and standards is "naïve." Instead, Yaraghi reiterates his previous call for more "market-driven economic incentives" and "self-regulated, industry-driven certification alliances" to move the needle.

"By demanding ONC to spend taxpayers' money on designing standards and focusing on certification, we will only be doing a big favor for EHR vendors by picking up their R&D tab," he says.

To learn more:
- read the Health Affairs Blog post
- here's Yaraghi's post

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