December 6, 2010

Tom Sullivan, M.D.

A Few Thoughts About Meaningful Use: An Interview with Thomas Sullivan, MD

Q: The use of electronic health records (EHRs) is growing more popular in the U.S., but they tend to be used mostly by large practices and institutions. Why do you think EHR usage has not shown similar growth in smaller clinics or practices where most of Americans receive their care?
A: The main reason EHRs are not as common in small practices is their available capital, whereas large groups have considerably more financial resources. There is also a greater need for large practices to effectively manage the clinical needs of large panels of patients, store, organize and rapidly disseminate the many clinical documents, results and datasets generated by the physicians caring for that many people through an EHR. The care of a large population of patients is especially inefficient without an electronic means of organizing and managing the data.
Q: What are the benefits physicians and the physician groups will receive from choosing Rcopia-MU?
A: The most obvious benefits of Rcopia-MU are its cost effectiveness and the fact that the software is certified to meet the meaningful use requirements of the HITECH Act. Another major advantage of Rcopia-MU is that it allows a practice to more gradually introduce workflow changes into the daily routine without the potential of a major disruption. Medical practices — particularly certain specialties – have very widely different workflows that are often well established to maximize efficiency. Thus, they are difficult to alter in a major way. Rcopia-MU minimizes that alteration, but at the same time prepares a staff in a less threatening way for future changes as IT systems and documentation online will gradually encompasses the entire practice records at some point in the future.
Q: Are meaningful use requirements too rigid?
A: ONC received considerable feedback to ease off, modify and simplify the objectives after they were first proposed in January 2010. The final results (the Rule) in late June are still controversial, but represent a considerable easing of the requirements.
Q: It appears that meaningful use reforms in healthcare are going to generate the largest most expensive bureaucracy in healthcare. Do you agree?
A: While there will be some costs associated with the meaningful use reforms, in terms of the bigger picture, it will replace what is already an expensive paper based bureaucracy with an electronic one. This reform will greatly improve the timeliness of analysis and constructive feedback. Congress has decided that healthcare that does not demand quality and value reporting is no longer acceptable since healthcare in the U.S. is consuming an ever greater percentage of the GDP. Compared to other OECD nations and their percentage of GDP spent on healthcare, we are about 5 percentage points higher. Healthcare in the U.S. is about 14% of GDP in 2010 and still growing at an unacceptable rate. In most advanced nations it’s 8-11% and they have comparable or slightly better outcomes according to many health economists.
Q: Recent studies have shown that health reform, including meaningful use, is 50% favored and 50% unfavorable? Will this change?
A: Even though health reform opposition candidates recently gained considerable seats in Congress, I strongly doubt there will be a successful attempt to repeal major elements of the reform legislation. In addition, none of the opposition candidates have ever proposed changing the HITECH and other IT incentives. I am confident these reforms are safe no matter which party is in leadership. The more likely outcome is gridlock over the other contentious elements of reform. One recently announced strategy is to starve the IRS and HHS of funding which is a roundabout way of slowing down implementation of reform. Again, I still believe the IT piece is very safe.

About Tom Sullivan, M.D.

Thomas E. Sullivan, M.D is a board-certified specialist in cardiology and internal medicine with over 40 years of clinical practice. He currently works for DrFirst and sees patients part-time in Massachusetts. His expertise in the application of information technology to health care has helped to create an international standard (ASTM) for the exchange of medical record information called the Continuity of Care Record (CCR). With AMA, he was founding chair of their e-Medicine Advisory Committee, worked with the Physician Consortium for Performance Improvement, represented the AMA and helped create the Physician EHR Coalition and is past chair of the AMA Council on Medical Service.