Ray Campbell, head of the Massachusetts Health Data Consortium (MHDC), probably didn’t surprise many people last week at his organization’s annual meeting in Boston when he outlined the many ways the HITECH Act-fueled national health IT infrastructure may not get done in the time frame and with the market penetration federal leaders are hoping will be the return on their $50 billion investment. After all, Campell admits himself that in the past he hasn’t been exactly sanguine about how far the government can push the development of the health care sector’s data infrastructure.
Some people might consider him a naysayer, and others might consider him a skeptical realist. But he’s not alone in wondering how realistic it is to expect a national, interoperable network of health data exchange to be built in five years.
Our site will be posting more in-depth excerpts of his address to MHDC members, but here’s a taste: He thinks that the national goal of 80% penetration for electronic health records (EHR) might be laudable, but 60% EHR and 40% paper is probably more likely — and while Campbell stopped short of predicting the latter scenario would be the outcome of the current federal initiatives, he can imagine the possibility of it playing out and sustaining itself for a number of years.
His logic? There’s a shortage of primary care physicians (PCP) right now. Government — be it the feds or, in the case of Massachusetts, state health authorities requiring that doctors demonstrate EHR competence as a condition for license renewal — will damage the health care system, perhaps irreparably, if it drives away PCPs who’d rather quit than geek out with technology. And oh, by the way, health IT or not, the situation will become more dire as the baby boomer generation hits the age where it needs more care, because of the numbers game: There are fewer people in the generations following the baby boomers, therefore fewer people to serve their elders’ growing health care needs. The government eventually will have to back down on embattled docs, implement payment reform, or do both.
Campbell isn’t the first leader to voice such concerns; he just happens to be the latest. We’ve been hearing echoes of these ideas from podiums and in the aisles of trade shows and conferences. Campbell et.al. are not to be confused with other leaders pessimistic about other facets of the health IT buildup, who believe that technology won’t necessarily solve efficiency problems, reduce errors or boost the quality of care. Heck, John Moore of Chilmark Research last week was throwing dirt on Google Health’s grave, a demise Google told us was untrue.
But Moore brings up a salient point, which has also been made by Barbara Rabson, executive director of the Massachusetts Health Quality Partners: Are personal health records (PHR) ready for prime time? Will they ever be?
These healthy skeptics are probably right in pointing out there’s not as much blue sky up there as the more rah-rah health IT leaders would have us believe. There’s a big difference between saying the health IT buildup will happen eventually, just not on the ONC’s timetable vs. saying it’s not going to happen, period. The former is realistic, because we’re starting to see that HITECH’s stimulus funding is just that — stimulus — and not full funding of anything. The latter, we hope, is unrealistic. We can’t just leave our health care IT world marooned in the paper workflows of the 1960s and 1970s. We owe it to our patients, families and fellow citizens to innovate. Despite the naysayers.