Doctors say data fees are blocking health reform
As they move to exchange patient information with hospitals and other health care partners, doctors are suffering sticker shock: The vendors of the health care software want thousands of dollars to unlock the data so they can be shared. It may take an act of Congress to provide relief. Story Continued Below The fees are thwarting the goals of the $30 billion federal push to get doctors and hospitals to digitize health records. The exorbitant prices to transmit and receive data, providers and IT specialists say, can amount to billions a year. And the electronic health record industry is increasingly reliant on this revenue. The goal of the 2009 program wasnât just to move doctors from paper chart to computer. It was also to share the information, improve the quality of patient care and ultimately bring down U.S. health care costs. Most doctors and hospitals have now switched to electronic health records, or EHRs. But the information is often stuck in computers run by hundreds of competing health care software companies â with incompatible products and scant incentive to make them compatible, or âinteroperable,â as the industry calls it. The additional costs were not foreseen during the bipartisan congressional push to create the federal incentive program. The expense is now imperiling the broad efforts to reform health care and adding to the host of technical obstacles that already hamper the flow of information. âI believe this to be the biggest threat to the investment the nation has made in health IT,â said David Kendrick, head of Oklahomaâs health information exchange, which links doctors, hospitals and labs in his state. âAll the money spent on electronic health records has yielded only a fraction of the value of getting interoperability.â âItâs like giving everyone cellphones and not putting up a cell tower,â he added. GOP congressional leaders are usually reluctant to intrude on business practices. But in this case, some GOP lawmakers are considering sanctions on the software vendors. âInteroperability is what makes an EHR useful,â said Rep. Michael Burgess (R-Texas), a physician who leads the House Energy and Commerce trade subcommittee and is drawing up a bill to enforce data sharing. âItâs unfair that practitioners have to spend money on connections they thought were part of the EHR when they bought it.â And itâs frustrating to physicians trying to tap into the promise of real-time electronic patient information. âMy vendor holds my data hostage, and I have to pay a ransom to access it,â said an Oregon primary care doctor. The potential of shared data to improve the quality of care while containing costs was one big reason the federal government paid doctors to get electronic health records. Getting that information in real time lets doctors keep tabs on their sickest patients. That Oregon doctor, for example, could learn immediately when a diabetic patient entered an ER with a foot infection, rather than finding out a week later â when it was too late to make sure he got out of the hospital fast with the right medications to take home. When data sharing works, it has good results. âThe minute any one of my patients is seen at a hospital or gets an X-ray, the result goes immediately to my electronic health record,â said Ed Bujold, a western North Carolina family doctor. An affiliated hospital system waived a $10,000 fee to set up Bujoldâs electronic pipeline. But in general, doctors pay $5,000 to $50,000 each for the privilege of setting up connections allowing them to transmit information regularly to blood and pathology laboratories, health information exchanges or governments, according to more than a dozen sources interviewed for this story. Sometimes additional fees are charged each time a doctor sends or receives data. âThe No. 1 factor hindering the exchange of information between health care stakeholders is the exorbitant fees that most EHRs are charging for integration, connectivity and reporting,â said Lance Donkerbrook, chief operating officer of Commonwealth Primary Care ACO, an affiliation of 250 independent physicians. They canât share information because they have 30 different EHRs among them, and each vendor wants $7,500 to $40,000 to connect them, he said. âThe government needs to step in immediately and require these vendors to open access,â he said. The Electronic Health Records Association, which represents most vendors, would not comment on companiesâ pricing policies. But it said the connections were expensive because of the lack of common computer-code standards across the hundreds of EHR manufacturers. âAs with other areas of health care, variability increases costs, and all stakeholders in health care need to work together to reduce this variability and the factors that drive it,â said Sarah Corley, the associationâs vice chairwoman and chief medical officer of NextGen Healthcare. Some question EHR makersâ commitment to easier access. New York and 18 other states spent five years creating simple standards for EHRs to link to health information exchanges in order to eliminate the need to connect with individual EHRs through individual interfaces â âeach one a handcrafted engineering problem that costs thousands of dollars and takes weeks if not months of engineering to connect,â said David Whitlinger, executive director of the New York eHealth Collaborative.