Dear New York Times: Next time, dig deeper into the EHR vendor industry


There's been quite an outpouring of sentiment about last week's New York Times article "A Digital Shift on Health Data Swells Profits in an Industry", most of it negative. Many of the 525 comments that the article received blasted electronic health record systems themselves: their lack of usability and interoperability, loss of privacy and reduced physician-patient interaction. Other commenters ragged on the article itself for mischaracterizing the Meaningful Use Program as a "giveaway" and bias against the adoption of EHRs.

But many of the comments focused on the subject of the article: the larger vendors that engaged in the "intense" lobbying campaigns to digitize medical records who now are reaping tremendous profits as providers jump on the EHR bandwagon to meaningfully use their systems before penalties kick in in 2015. The vendor-related comments have honed in on vendors' insistence on proprietary systems, squeezing out of smaller competitors, and lack of clinician input into design, among other things.

What I find interesting is that the Times thought that years-old EHR vendor lobbying and the ensuring profits were news in 2013. 

Why is it surprising that the EHR vendor industry lobbied for a program that would incentivize providers to purchase their products? Is that any different from any other industry lobbying for or against an initiative that will affect them financially? According to figures compiled by the Center for Responsive Politics--a non-profit and nonpartisan Washington, D.C.-based research group--$3.28 billion was spent on lobbying last year. In 2009, the year the HITECH Act was enacted under the American Recovery and Reinvestment Act, $3.5 billion was spent on lobbying; in 2008, that figure stood at $3.3 billion.

Those dollar amounts make Cerner's $400,000 lobbying expense and Glen Tullman's $250,000 spent on political contributions, as noted by the Times, seem rather modest.

And it's no surprise that vendors are going to take advantage of the opportunity placed before them. At least companies like Allscripts and Cerner were already in the EHR business. Think about the many new players that entered the EHR market to get a piece of the action. Sure, the larger vendors likely stifled some good competition in the EHR vendor industry, but I can't imagine that all of those upstarts were offering great products. Some of them likely had visions of dollar signs dancing in their heads.

The Times article missed the point. What I would like to have learned is if, and how, that EHR vendor lobbying affected how the HITECH Act and the Meaningful Use Incentive Program was structured. Would it have looked the same? Would it have required more of the vendor industry? Would it have passed at all?

And I also would like to have learned why the government seems to still be walking on eggshells with the EHR vendor industry. Why is the industry relatively unregulated, while providers are drowning in regulations? Why aren't vendors required to report adverse safety incidents, as recommended by the Institute of Medicine, but rejected by the U.S. Department of Health & Human Services in its draft program on health IT and patient safety? Why are vendor contracts allowed to be so one-sided? These are questions that I'd like answered.

The past is interesting, but the Times really should have tried to answer some of the questions we have in 2013. That's an article we're all waiting to read. - Marla (@MarlaHirsch)