HIT: The $20 billion needle in the haystack

Dear Mr. President,

In my first letter to you (see Drug Store News, Dec. 9, 2008, “Dear Mr. President-Elect,” page 12), I implored you to make fixing the U.S. healthcare system the enduring legacy of your presidency.

That’s why I applaud the $87 billion Congress has built into the most recent version of the economic stimulus package to beef up Medicaid and extend COBRA health benefits for the millions of unemployed Americans who have lost their jobs in recent months, as just about every sector of our economy continues to wrestle with the worst slowdown since The Great Depression.

Even if none of that spending creates one single job or puts one more dollar back into the economy in any kind of way that would please John Keynes, I get it. We can either pay now to make sure these people don’t lose their health insurance or pay more later to cover the upstream costs of the lapse in their coverage today. Making sure that patients see doctors and stay on their meds today is a lot cheaper than paying for otherwise unnecessary surgeries and long-term hospitalizations tomorrow. This isn’t about charity. This is insurance against the higher cost of not having insurance. I get it.

Today, I write about the $20 billion healthcare information technology “needle” buried deep inside that $800 to $900 billion “haystack” of legislation you demanded Congress return to you for your signature in time to make economic stimulus your Valentine’s gift to the nation. As I mentioned in my first letter to you, I truly believe that the widespread adoption of an HIT infrastructure that connects providers throughout the continuum of care is a fundamental and absolutely necessary component of a modern healthcare system.

While others may choose to debate whether ‘tis nobler to cut taxes or spend our way out of our current economic crisis, I am not looking to politicize any of this. I think that the central issue here revolves around concerns of patient privacy, which I believe in this context is less a matter of partisanship than it is a matter of unfounded paranoia. If for some reason the original version of HIPPA isn’t enough to guarantee patient privacy in a world where health information would suddenly be digitized, where are the gaps?

And if there are gaps or areas in which HIPPA might be improved, why are these decisions that are being legislated by a group in Congress that, quite frankly, doesn’t fully understand the issues that surround patient privacy? As community pharmacy leaders have urged, this is clearly a matter best resolved by a process of negotiated rule-making conducted between HHS and the various stakeholders involved.

Because if you really get under the hood and take a closer look at these proposals, you will see that, not only do they stand in contrast to the very concept of economic stimulus, they do even less to promote improved health outcomes for patients.

Take this “Accounting of Disclosures” proposal that was part of the House version of the stimulus bill and, at the end of January, was expected to be part of the Senate’s bill, too. Basically, this would require pharmacies to keep records of each time a patient’s health information was “disclosed” to another “covered entity.” Every day, pharmacies make thousands of these “disclosures” just to process third-party claims and receive payment for the services they provide. Forget the fact that this is a logistical nightmare with the potential to significantly slow healthcare delivery, the cost to house all of that data—literally, billions and billions of transactional records—would be staggering.

Or, how about the “Marketing Issues” provision, which basically would require a patient to opt in to every patient communication that a pharmacy might ever choose to send them. So, let’s say a pharmacy were to receive a first-time prescription for a newly diagnosed diabetic; if the pharmacy wanted to send that patient some information on how to better manage the condition, it would need that patient’s authorization. If you wanted to invite them to take part in a disease state management program that could reduce their long-term healthcare costs by tens, perhaps hundreds of thousands of dollars, you would need them to fill out another authorization form. How about a simple refill reminder? Another authorization.

Each year we spend about $177 billion in direct and indirect costs related to patients not taking their medications as they have been directed to. How does this $20 billion in HIT spending address that, especially considering how much more pharmacy providers are going to have to invest to navigate their way through these new privacy proposals just to get back to the status quo?

What is currently being proposed will force community pharmacy—which clearly, has led the charge on HIT in this country, with more than 95% of all retail pharmacies electronic prescribing-enabled—to either scrap entirely their existing pharmacy systems, which have been programmed to operate according to existing HIPPA requirements, or invest inordinate sums to have those systems completely redesigned to meet the new proposed requirements. This is simply unfair, as a large portion of that $20 billion is going to fund special physician incentives to adopt e-prescribing technology. Why reward one group for being late to the dance and penalize another for arriving early?

HIT is too big and too important to the future of this country and, ultimately, is too expensive an undertaking to get wrong. Right now, it is a $20 billion needle in an $800 billion haystack of economic stimulus measures, and the real point of it all—to improve health outcomes and reduce long-term healthcare costs—is getting lost in all of this.