Newspapers and bloggers have spilled a lot of real and digital ink in recent months over the Department of Energy’s controversial stimulus-created loan guarantee program, the now-defunct green tech firm Solyndra, and its wealthy benefactor/Obama campaign bundler George Kaiser. Too few are paying attention to the government’s push for widespread health information technology adoption, funded in large part by the stimulus bill, and key industry players exerting influence over the policy process for personal benefit. If you haven’t yet heard of Wisconsin-based Epic Systems and its CEO Judith Faulkner, pay attention.
“Meaningful use” is a health industry term that refers to a set of standards that determine whether funds from the $787 billion stimulus can be allocated to “ambulatory clinics” (read “doctor’s offices”), and “providers” (read “hospitals”) through Medicare and Medicaid reimbursements for implementing health information technology. The rollout of meaningful use criteria will occur in stages. Stage 1, which has already begun and will continue this year, establishes a baseline for the gathering of electronic data and the sharing of information. Stages 2 and 3—designed to be implemented in 2013 and 2015 respectively—are supposed to expand on these baselines.
In her capacity as the lone industry representative on the Health IT Policy Committee, created by the HITECH Act of the stimulus bill, Judith Faulkner has argued for a delay in the implementation of Stage 2 criteria. She pressed for the delay to last six months; eventually, the Department of Health and Human Services decided that it would delay implementation for one year, which means that the implementation of Stage 2 criteria now will not take effect until 2014. Commenting on Stage 2 implementation, Faulkner said that “[i]f we don’t know how long it will take vendors to do the work, we don’t know how long it will take for providers to get up and running,” and has expressed concern regarding the ability of doctors to spend time with their patients.
Like the promise of “a clean energy future,” all of this sounds laudable . . . until one recognizes that Epic stands to benefit from a delay of Stage 2 implementation.
Consider the case of Aurora Health Care, a Wisconsin organization, like Epic. Judy Murphy, formerly a vice president of information services at Aurora, now the deputy national coordinator for programs and policy at HHS’s Office of the National Coordinator for Health IT—and like Faulkner, a member of the Health IT Policy Committee—also wanted to delay the implementation of Stage 2 criteria. Aurora was working to attest to Stage 1 criteria with another vendor, but providers must use certified electronic health records (EHR) technology for a full year before applying for Stage 2 stimulus fund payments. Curiously enough, in October of 2010, Aurora announced that it was going to switch to Epic as a vendor, but that the switch would take place over a three-year period, at least.
If it takes three years from Aurora’s announcement that it will switch to Epic, then the switch won’t be completed until 2013. Once the switch takes place, Aurora will have Epic as a vendor for one year until 2014, when the delayed implementation of Stage 2 criteria is now supposed to occur . . . at Faulkner’s recommendation. This means that Aurora will qualify for stimulus fund payments, while Epic gets to have a new customer. Both companies get rich.
Perhaps Faulkner didn’t intend for this arrangement to benefit Epic directly. Indeed, since it is impossible to read her mind, let’s assume for the sake of argument that she didn’t. But when one considers that both Faulkner and Murphy served on the Health IT Policy Committee, it is more than a little unsettling to contemplate the possibility that committee members might make deals that would serve to benefit particular industry players. At the very least, the conflict of interest that might have helped fuel the drive to delay the implementation of Stage 2 criteria ought to have been recognized, and commented on in public.
But then, given that Faulkner was appointed to the committee after making significant donations to the Democratic party, and given that the process by which her appointment was confirmed was utterly opaque, I suppose that it would be too much to expect transparency and an upfront explanation regarding whether the profit motive, rather than best practices or health outcomes, drove the decision to delay the implementation of Stage 2 criteria. There are, to be sure, perfectly acceptable ways to argue for delays in criteria implementation, but absent even the most perfunctory attempt to disclose a potential conflict of interest that might affect the decision-making process, outside observers are given reason to suspect that the process may have been compromised.
Political contributions may have led to Judith Faulkner’s presence on the Health IT Policy Committee. Political contributions may have led politicians to praise Epic’s work product and services, despite its failures, and the costs those failures imposed on Epic’s customers. And now, we have a failure to acknowledge a potential conflict of interest that might have served to drive a decision on health care policy implementation. Why aren’t more people asking questions about this process?
Of his baseball team, the legendary manager Casey Stengel once asked, “Can’t anybody here play this game?” Judith Faulkner and the work of the Health IT Policy Committee lead one to ask whether anybody can implement health care policy in a way that won’t make others believe there are ulterior motives at work.
Pejman Yousefzadeh is an attorney in the Chicago area. He is a contributor to The New Ledger, co-host of the Coffee and Markets podcast, and editor of A Chequer-Board of Nights and Days.
While the Old Media has been ecstatic over recent job numbers, claiming that some 200,000 jobs have been added to the economy, we should note that while Obama giveth Obama also taketh away. The media may be trying to claim the President has “created or saved” jobs (the latest weasel word is he’s created job opportunity) but his policies have also cost jobs. In particular his policies are costing jobs in the medical field.
Last week, layoffs were announced at the University of Mississippi Medical Center due in part to the 80 million dollars that it will cost to implement a new computer system named EPIC Systems, Obama’s newly mandated electronic medical records system.
Naturally, the system Obama is forcing on an entire nation of medical professionals and hospitals is the same system owned and operated by Judith Faulkner, one of his own big donors. Faulkner is also a big donor to the Democrat Party. Not surprisingly, besides affording her the lucrative, crony capitalist business deal, Obama also put Faulkner in a key role on the Health Information Technology Policy Committee, the committee responsible for implementing the President’s e-records policy. She has become known as Obama’s medical records czar.
As hospitals and doctors are forced to launch their own EPIC Systems portals, the costs are forcing hard choices for administrators. All to implement what many call a flawed system.
Representative Tom Price (R, GA), a medical doctor, scoffs at Obama’s EPIC Systems e-record program. Price is not amused by the government-speak bestowed on this e-records systems, those “meaningful use” standards that he calls “anything but useful or meaningful.”
Rep. Price revealed to an audience at a recent Heritage Foundation event that Obama’s new electronic medical records system is filled with “nonsense.”
One of the things about the system Price told the audience was that the system requires a pathologist to fill in a field of information on what a patient is allergic to in every case the docs deal with. If they do not fill in this field the system will “ding” the doctor on his reimbursement funds. That may not seem so absurd, but Price also noted that the pathologist has to fill out these same fields even if he is just consulting on a case by looking at a slide in a microscope and won’t actually see the patient in person.
It gets worse. Price went on to recount that this system is so dysfunctional that it requires the same fields to be filled out for a corpse at an autopsy.
“This is no lie,” Price says. “The federal government wants the pathologist to determine whether or not a corpse has any allergies. …This is nonsense.”
Price told the Heritage audience that a bureaucrat simply cannot tell a doctor what to do. He felt that there wasn’t anything wrong with government mandating a main “highway” for electronic medical records to “ride” on but felt that bureaucrats in Washington simply haven’t the knowledge to make a single system that is all things to all doctors for all patients.
“[Washington should] not dictate what the docs are doing on a day-to-day basis for a given patient because it doesn’t make any sense, it’s a waste of time.” Price insisted. “They can never, ever put in place the right standards …for a bureaucrat to determine whether or not the doctor is doing the right thing.”
The fact is, while this month’s jobs record might seem good, Obama is still destroying jobs in other areas due to his constant stream of regulations. And maybe these numbers aren’t so good at that. This rosy 8.5 percent unemployment figure that the White House is touting is “terribly misleading,” according to James Pethokoukis. The AEI columnist notes that if the White House was still using the size of the U.S. labor force from 2009, the unemployment rate would be at 10.9 percent today.
Lastly, we should note that the full implementation of Obamacare is still several years off. When that bell tolls, job loss with be monumental. But even though we have yet to get to full implementation of Obamacare, it is still costing jobs even today.
A popular, veteran doctor from central Illinois has been sidelined by employer (Springfield-based) Memorial Health System because he has not become proficient with the electronic medical records system that they purchased and implemented. Patients are so incensed that they’ve started a Facebook page as well as a blog to rally to his defense. This situation brings into focus the problem of top-down medical solutions, calling into question the efficacy of healthcare by committee, not to mention Obamacare itself. Do we really want to sacrifice good doctors in favor of good followers of top-down rules? Do we want good computer operators or excellent doctors?
The doctor, Steven Kottemann, 63, was placed on paid administrative leave in September because he was allegedly not properly utilizing the new electronic medical records system that his employer, Family Medical Center, instituted. Kotteman initially tried to upload verbal recordings of his notes made when meeting with patients, but the system failed to accept the recordings. The only other option was to type in by hand all his patient notes. Kottemann tried to input the notes while actually with his patients but eventually came to feel that typing at a computer while trying to work with his patients was not conducive to good care.
Dr. Kottemann then began staying late after office hours to type in all the notes, but due to a stroke of his own, the effort became too much for him. “It got to the point where I was going in seven days a week to keep up,” Kottemann told the State-Register newspaper. For its part, the employer says that Kottemann’s lack of proficiency with the computer system was not the only reason they fired him, but Memorial Medical Center refused to comment further on this story when I contacted them.
Kottemann’s patients, though, are not as reluctant to comment. His patients have become incensed that their favorite doctor has been fired merely because he doesn’t meet administrators’ expectations for computer savvy. They started a blog to come to his aid. On the blog, one patient praised Dr. Kottemann saying, “I don’t need a 15 min Dr, or a computer whiz… I need a doctor that cares about me and my family. I have that in Dr. Kottemann.” There are other equally laudatory entries.
Kottemann is now afraid to say much about this incident because lawyers are involved, so he demurred from offering a comment for this story. The upshot of this whole thing is that good care seems to be sacrificed to push electronic medical records systems. This is happening across the country, too. We have hospital administrators driving hard to implement Obama’s medical records solution, such as the one called EPIC Systems being pushed by his medical records czar, Judith Faulkner. In so doing, they are acing out excellent doctors whose only deficit is that they are not proficient with the new records technology. Are we really willing to stand by as Obama’s representatives bully those good doctors that criticize these electronic medical records systems? Are we willing to sacrifice good doctors for merely competent computer jockeys?
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