The Big Black Hole of HIT in American Politics

Posted by aaronberdofe on March 3, 2016 · Leave a Comment

Healthcare is always a prominent topic in the American political election cycle and this current one is proving to be no different. Yet, throughout all of the blustering about saving lives and curing diseases, what most politicians usually hone in on is health insurance and understandably so. Health insurance is the medium through which most of the money, at least the money immediately relevant to a patient [voter]’s care, passes through. But this isn’t a blog about healthcare, so I won’t pretend to be an expert on the topic. I will humbly offer that between the two dueling political parties at the moment, one has a fundamental misunderstanding of what the current laws are, or knows them and are flat out lying, and the other party seems to be getting it mostly right. No candidate appears to have dealt directly or indirectly with the process of care and the flow of payment for that care for a patient with a chronic disease. But this is a blog about HIT. A topic which has gotten zero mentions in the debates, stump speeches, or even presented healthcare platforms thus far.

So why is no candidate talking about HIT in their healthcare platforms? My primary assumption is that they don’t exactly know how computers, databases, or the internet actually work. I think Hillary could probably give a good high level overview of how e-mail servers work now, but keep in mind, this is the same group of people who have nearly universally agreed that the solution to figuring out how to break encryption used by terrorists while still maintaining the privacy of everyone else can be solved by throwing “smart people,” presumably from Silicon Valley in a room together to figure it out. My Pollyanna optimistic hope is that they just correctly understand that HIT is really just a tool and the underlying infrastructure to assist with well-developed processes and systems, but they think the topic is too much detail to get into for the general public. I know, I’m probably wrong on that last one, but a man can hope, right?

Let’s take a look at why HIT deserves at least a passing mention in the political sphere:

Via the CMS, tens of billions of dollars have been given out to incentivize the adoption of EHRs over the past 5 years. This stems from the over-arching American Reinvestment and Recovery Act (ARRA) which had a primary focus on building infrastructure (which is what HIT is).
- More than $21.1 billion in Medicare EHR Incentive Program payments have been made between May 2011 and January 2016.
- More than $10.3 billion in Medicaid EHR Incentive Program payments have been made between January 2011 (when the first set of states launched their programs) and January 2016.
The major benefit of EHRs and related technology is that we can standardize and deliver relevant information to public health agencies at the local, state, and federal level which can then be analyzed to further our knowledge of how effective current treatments are and identify patterns that beget further research. Admittedly, I think I’m the one pushing this as the “major” benefit, but I know public health agencies and those who aren’t trying to sell you something generally agree. Being able to assess a population is a basic necessity of public health.
If you are going to bring up a topic such as privacy, you should probably include HIT. In terms of the privacy discussion it seems most people are primarily concerned about two things: digital identity theft and the potential financial losses associate with it, and exposure of medical information. I think some people are also concerned with the possibility of someone being able to view their browsing history online, but I think that is more of a decorum issue. Embarrassment seems to lessen when you find out everyone’s doing it. If privacy of medical information is a concern, perhaps we should revisit HIPAA which despite popular opinion only contains one P and that does not stand for Privacy. It’s the Health Information Portability and Accountability Act. Either way, if you are porting health information in this digital age or protecting it, you really need to talk about HIT, because that’s the tool being used.
Speaking of HIPAA, it ironically seems to be the most used reason as to why better communication options haven’t developed between doctors and patients. Conversations with patients about what they need out of the healthcare system, which are happening, should probably be compared against current laws to discover any incompatibilities. There’s a reason why companies that we feel are really good at software and hardware development have barely dipped their toes into the healthcare arena. Both patients and doctors are trying to navigate and game a system in which one of those groups is supposed to be servicing the other and who wants to develop solutions for groups of people who have universally decided that the situation is FUBAR and they’ll take what they can get? Technology can be a disrupter, but only in a system that allows it to be.
Remember that whole VA scheduling scandal? The Department of Defense will be spending upwards of $9.6 billion (remember this is an IT project, so the number will most likely double) to apply HIT and magically fix the problem. Well… $9 billion to replace the VA’s EHR system, and $624 million to tackle that whole scheduling issue. The first project uses one EHR vendor, Cerner, and the second uses Epic. Yet, we are still deep in the fight to make EHR vendors communicate information between one another.

I will literally faint if I hear a presidential candidate in this election cycle mention HIT in a way that reflects reality and a basic understanding of how technology works. You know what, I’ll do a half faint if someone even just mentions HIT while associating the amount of resources being poured into it. So far though, it seems a safe bet that I don’t need to purchase a fainting couch because not one candidate has mentioned HIT thus far and I don’t anticipate they will reading through their healthcare platforms regardless of how many points they may or may not contain. I’ve taken the liberty of finding the best layout of each candidate’s healthcare proposals (Sorry, I didn’t include “I don’t see a political path forward” Ben Carson). The links are below, but be warned, they are light on details.

Pro-tip for political candidates: The best source of your views and platforms should probably be your own website. At the least, some vague bullet points might be nice.