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New England HIMSS president talks health care reform initiatives

Daniel Feinberg, director of Northeastern University's Health Informatics Graduate Program, offers his perspective on health care reform, HITECH legislation and other topics.

In this exclusive interview, Daniel Feinberg shares his perspective on health care reform initiatives, such as the Health Information Technology for Economic and Clinical Health (HITECH) Act and the recently passed health reform bill. Feinberg, the director of the Northeastern University Health Informatics Graduate Program and president of the New England chapter of the Healthcare Information and Management Systems Society, spoke with at New England HIMSS' 5th Annual Public Policy Forum, held March 31 in Norwood, Mass.

In your mind, how will the recently passed health care reform initiatives affect IT leaders already working on compliance initiatives from the HITECH Act?

Feinberg: As it currently stands, I don't think in a huge way. Having more patients who can be treated -- and getting paid for that treatment -- that's helpful, but I think the major driver for the changes is coming from the HITECH Act in terms of either the reward for having meaningful use of the certified electronic medical record, or the penalties for not having it. Covering the 32 million more Americans, that's great. I don't want to knock that, [but] I don't think that's going to suddenly change EMR adoption at all.

Are you worried about a physician "brain drain" because some docs would rather retire than implement EMR systems at a time when there's a shortage in our health care system?

Feinberg: That's a reasonable concern. I think there are … a lot of physicians who are already slowing down their practice, not seeing as many patients. The smaller practices are doing a smaller volume.

When they finally retire and say, "I'm going to retire instead of go for an EMR, it's too much" -- I don't think you're going to lose as many people as we worry about. Or they're going to move into larger practices. Or they're going to say, "All right, local hospital system, give me whatever you've got, install it here, thank you, I won't try and do my own stuff," and they'll move on with it.

I have no numbers to back this up, but I think we're turning enough people out of medical schools who are ready for EMRs, who will not go away. Pushing a few others toward early retirement is really not going to change it.

You said, emphatically, in your introduction to the conference here that you believe health care IT is going to be the major driver in improving health care quality and realizing the goals of the health care reform initiatives. Why do you believe that so passionately?

Feinberg: Because I'm a health care IT person, that's part of it. To a hammer, everything looks like a nail. I'm sure there are other things that people would do that would make differences, but there are a couple of things that are going to happen on the electronic side:

Covering the 32 million more Americans, that's great. I don't want to knock that, [but] I don't think that's going to suddenly change EMR adoption at all.

Daniel Feinberg, New England HIMSS chapter president

One, it's going to enable us to do things that are not electronic but are enabled by electronics -- disease management [and] group management [for example, understanding which patients are due for tests and getting them in for testing in order to monitor their conditions before they intensify]. It's an enabler, but, alone, that's not going to be enough.

The second part is the metrics. Once we're measuring a lot of things, once we know the average [hemoglobin] A1c of your diabetic patients is 12, you start to go, "Hmm, maybe I'm not doing so well here," or you'll be able to identify subpopulations that are doing better or worse, so you can then come up with ways to give them care that works better for them.

Right after the bill passed, we discussed health care reform initiatives with a physician who has influenced federal policy over the last decade. His take on the HITECH Act and the health care reform initiatives was that it wouldn't improve health care until patients were given incentives to live healthier lives -- i.e., if their health insurance went up because they smoked, more people would quit smoking. Ditto on obesity: If you eat better and your weight goes down, you pay no penalties. Then costs would go down overall in the United States. Some speakers at this conference have said similar things. What's your take?

Feinberg: Changing compliance is an important part of it, but I'm going to be somewhat contrarian and say I think that it's overblown. I think people have a hard time complying often for reasons we can fix, but often [it's] much larger than just [saying], "We need a bigger stick to hit them with, we need to punish them, we need to charge them more."

These are people who don't know how to comply [but] mean to. How many of us say, "Really, I shouldn't have that piece of cake," but still have part of that piece of cake and then come up with reasons why? Then we look at the person who's morbidly obese and say, "Something's wrong with them; I'm a normal person."

It isn't just saying, "Hey, you're a bad person, go control your own weight, it's your own fault, we're going to charge you more." What we need to say is, "We're going to have a nurse check in with you. We're going to have a nutritionist work with you." Because a lot of people don't know how to eat better, or really can't handle it. With some help, with some support, they can. We really need to look at helping people with risk factors, not punishing them for it.

Let us know what you think about the story; email Don Fluckinger, Features Writer.

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