Obama and Biden Blast EHR Vendors for Data Blocking

Roger A. MaduroAs they are winding their terms in office, President Barack Obama and Vice President Joe Biden dropped a stink bomb on the health IT industry. Speaking at different events on Friday, January 6th, the President and Vice President both criticized proprietary electronic health record (EHR) vendors as the primary obstacle to the success of their administration’s health care strategy. This is the highest level acknowledgment so far of the serious impact that “lock-in” EHR software vendors are having on America’s medical infrastructure and the ability of physicians to provide quality medical care to their patients.

This article will tie in the comments of the outgoing President and Vice President with the history behind the adoption of EHRs in the United States and the forces within both industry and government that distorted that adoption toward systems that don’t share data well (interoperate) and that degrade the working experience for clinicians. We’ll also look at the history that could have been--an open source initiative squelched by EHR vendors--and at prospects for Congress and the new Administration to put EHR adoption onto the right track.

President Obama made his statements during an interview with Vox’s Ezra Klein and Sarah Kliff. Politico reporter Arthur Allen writes in the January 9 issue of Politico’s Morning eHealth newsletter.

Allen states:

For the first time since the gods called this newsletter into existence, President Barack Obama and Vice President Joe Biden both talked on the same day about health IT. Both of them complained about the failures of the meaningful use program, ruing what they see as the insufficient progress toward more efficiency and better care that EHRs seemed to promise when the administration signed the HITECH Act into law at the other end of their double term. "We put a big slug of money into encouraging people to digitalize, catch up with the rest of the world here," Obama said in an interview with Vox [the health IT part starts around 49:40] Friday. "It's proven to be harder than we expected. Partly because everyone has different systems, they don't all talk to each other,” he said. “It’s decentralized and everyone has different systems.” (Maybe everyone should have used VistA)? But the departing No. 44 was optimistic. “Over time it’s going to get better because every other part of our lives has become paperless,” he said.

Vox’s Ezra Klein and Sarah Kliff interview President Barak Obama

Allen also reported on the comments made by Vice President Biden to the press before the start of a no-holds-barred, several-hour meeting with the heads of all the major proprietary EHR companies. Biden was very passionate in his discussion with the press about his own personal experience with health IT. He said, “the Act also codified some of the goals we have been working toward during the year with health IT...to give patients the ability to access, to easily share, and to own their own health records.” Biden then said, “I was stunned when my son, for a year, was battling glioblastoma. We could not get his medical records. I am the Vice President of the United States...I couldn’t get his health records...it was an absolute nightmare. Ridiculous, absolutely ridiculous we are in those circumstances…”

As Allen reports:

Biden, being Biden, was much blunter than his boss. “You guys in the health care industry are the least sharing people in the world,” he said before a two-hour meeting that was part of his cancer moonshot initiative. Then Biden threatened — we think he was joking — to lock Epic CEO Judy Faulkner and the 20 or so other EHR billionaires and millionaires into the room until they got his message. “I have Secret Service on the other side, and we’re not going to get out till we have some answers,” he said. “You think I’m joking. I’m deadly earnest and deadly frustrated as a lot of you are.” Information access means a lot to Biden, who like millions of caregivers before him struggled with that while seeking to cure his son, Beau, who died of brain cancer in 2015. A few weeks ago Obama signed the 21st Century Cures Act, which gives HHS the ability to fine information blockers up to $1 million for each violation. It also defines interoperability as the ability of patients to have complete access to their records.

The statements by President Obama, and later in the day by Vice President Biden, were so shocking that, Sarah Kliff, one of the Vox reporters that interviewed Obama, wrote an article in Vox titled “Obama’s surprising answer on which part of Obamacare has disappointed him the most.” Kliff writes “There was this moment, about 50 minutes into our interview with President Barack Obama last week, that genuinely surprised me (and surprised other health care journalists, like David Nather, too).”

The surprise? Kliff writes:

My colleague Ezra Klein had asked the president a question about which part of the law had overperformed his expectations, and which part of the law had underperformed. The president gave a surprisingly frank assessment of something his administration has tried, and failed, to do: Get doctors off paper and on to digital medical records. “We put a big slug of money to encouraging everyone to digitalize and catch up with the rest of the world here,” President Obama told us. “And it’s proven to be harder than we expected.” Obama then went on to analyze why this had been so hard — why in a world where, in the president’s words, “you can basically do everything off your phone,” the medical system remains buried under “mountains of paperwork.”

Vice President Joe Biden on lack of EHR interoperabilityThe statements by President Obama and VP Biden were clearly coordinated. There may be a more significant message that is being communicated here. Biden made an additional, and very interesting statement when he said that health data interoperability is the last remaining area of policy-making where there is a clear opportunity for bipartisanship in Washington. Biden mentioned the 21st Century Medicines Act as an example of bipartisanship.

One of the key authors of that act is Rep. Tom Price (R-GA), who has been nominated by President-elect Donald Trump to be the Secretary of the Department of Health and Human Services (HHS). While the media has been focusing on Price’s role in the repeal of Obamacare, they have overlooked his role as one of the most outspoken critics of proprietary EHR vendors in Congress for the past decade. Price, together with his colleague Rep. Michael Burgess (R-TX) has taken the side of physicians and their patients and have been vocal proponents of open solutions that lead to interoperable EHRs. Open Health News has posted multiple articles on their efforts over the past several years.

Updated 3/4/2019: This post was part of a longer post that included a discussion of the impact of the HITECH ACT one the healthcare industry. That section is now a separate post and can be found here


40K people at HIMSS - GDP explains it

Roger, I thought of you when I wrote the 2nd to last sentence:

At first glance, the number of people who annually attend HIMSS struck me as huge.

One might think that with 40,000 people from the healthcare industry attending the annual HIMSS conference, healthcare delivery might need to slow down for a week. If 40,000 postal workers went to conference the mail wouldn't get delivered. But it is all a matter of scale.

Healthcare as an industry is 17.8% of GDP, over 1/6th of all business activities in the U.S. The magnitude of that may not be immediately obvious. It is greater than the combination of: the financial industry (8.3%), the auto industry (3.2%), and the oil industry (3.1%) that only totals 14.6%. There is room to throw Walmart (2%) in there as well and still not reach the scale of healthcare.

Many things happen in any realm where that much money is swirling around. It attracts what the Bible called money changers, and it has enough wealth to develop bureaucracy and layers of administration without restricting excessive profitability. That is why the pure profit of just the handling of healthcare money, performed by insurance companies and major corporate healthcare entities like HMOs, is 1/3rd of that 1/6th of GDP. That is right......1/3rd of healthcare GDP, or 1/18th of all GDP, is in just the 'profits' absorbed by those who move the money around. That is 5.93% of GDP and comes in a very close 2nd behind the entire financial industry. It does not include the profit made by those who invent the next better MRI device, or pharmaceuticals, or those that built the hospital. Just the profit of those that move the money around.

This occurs in an industry where demand is inelastic, the provider of the goods or services determines the demand, and it is all conducted under the free market model. When your healthcare providers say you need surgery/antibiotics/chemotherapy/set a bone/etc. the patient doesn't opt out based on price. Possible death, pain, disablement, pretty much makes that demand inelastic. Yet healthcare services needed is determined by the providers. That conjoining of the supply and demand being set by the same entity totally erodes the check and balance in a free market model of supply and demand as a function of elasticity that controls price. Econ 101 stuff. But we have allowed our healthcare delivery to be constructed on a for profit, free market, laissez fair, Adam Smith model. OK for sneakers, cars, TVs, and such, but runs into the aforementioned problems in healthcare. Not to mention the moral issue of profitizing healthcare, but just on the pure economic analysis of it, this is a formula for high prices and excessive profits.

So it is no wonder that 40,000 people will attend HIMSS and the industry won't even notice relative to service delivery.

So it is no wonder that the proprietary and closed approach that EHR providers have with regard to patient data, as outgoing President Obama and VP Biden spoke about in the closing days of their administration, pervades healthcare today.

So it is no wonder that America pays way more per person for healthcare than anywhere else in the world.