Penny wise or pound foolish: The Montana EHR debate

Montana is known for many things--its Big Sky beauty, its national parks, and its rough and tumble history. But this month it is standing out over what has become a battleground over the funding of electronic health records (EHRs).

On March 14, the GOP-led state legislature passed House Bill 2, which denied the state's Department of Public Health and Human Services the authority to accept $35 million in federal meaningful use incentive payments for hospitals to adopt EHRs.

While many state governors and legislators are faced with considering belt-tightening strategies in a weakened economy, this has become a polarizing issue between the Montana legislative and executive branches. And, it has become a challenging issue for healthcare providers and patients as well who are being inserted into the middle of this debate.

The Republican lawmakers said they were making a statement regarding uncontrolled deficit spending. "Every one of those federal dollars that we spend, a taxpayer somewhere has to come up with," said Rep. John Esp, quoted in the Billings Gazette. "A drop in the bucket in the right direction is a drop in the bucket in the right direction."

Governor Brian Schweitzer, a Democrat, has countered that the legislators instead are increasing the cost--and lowering the quality--of healthcare in the state by refusing funding for EHR technology.

"If Montana rejects the money, it will be distributed to other states, and Montana providers would be left holding the bag-- requiring them to use their own funds for the technology or be left behind," said Schweitzer in a statement several days after the legislature voted.

"This harms patients and drives up costs. Electronic health record systems save money and improve care through eliminating the need for duplicative testing," he said. In addition, the removal of the EHR funding from the healthcare sector will result in an estimated loss of 504 Montana jobs, he added.

Schweitzer has also noted that the state has 47 critical access hospitals in smaller communities statewide--and most likely all will qualify for the funding, according to the governor.

As of now, Montana is the only state that has refused the federal incentive payments. "The legislature has stalled and delayed and now, even if they decided to give the Department authority, we are not sure the money will be available," Schweitzer said.

Missing from much of this dialogue are providers' reactions to losing funding for installing EHRs--especially in a state such as Montana where much of the care is spread out over a large geographic area. How will it affect them and their patients--who may not want to think of themselves as drops in a bucket?

So while it's important to think frugality in a tight economy, it's also important to think practicality: how does a government best serve its citizens? When it comes to best serving our health needs, should we be penny wise--or will we become pound foolish? - Jan

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