Grassley Takes Aim at Hospitals' Problems with Health IT Implementation

Republican Sen. Chuck Grassley of Iowa has asked 31 of the nation's largest hospitals and health systems to detail their problems implementing the $19 billion federal HIT program that was launched last year.

Grassley said that his 11-question survey is a response to complaints he's heard from providers about administrative complications, formatting and usability issues, errors, and interoperability roadblocks.

"Given the taxpayer investment and the investment of the healthcare system overall in the information technology industry, the more Congress and others overseeing implementation of this program dig into the problems and work to get them sorted out now, the better," Grassley said in a media release.

The ranking member of the Senate Finance Committee said providers have cited instances where software produced incorrect medication dosages because it miscalculated body weights by interchanging kilograms and pounds. Grassley said providers have also complained that their concerns and questions about software snafus are being "ignored or dismissed" by vendors and hospital administrators.

"Some sources recount difficulties in approaching the HIT vendor with problems and the lack of venue to discuss these issues either with the vendor or peer organizations," Grassley said. "Often this is attributed to alleged ‘gag orders' or non-disclosure clauses in the HIT contract that prohibit healthcare providers and their facilities from sharing information outside of their facilities regarding product defects and other HIT product-related concerns."

Grassley said some HIT products do not have to meet reporting requirements for adverse events under the FDA's Manufacturer and User Facility Experience database. "Thus, problems with these products may go without remedy thereby inhibiting the ability of the healthcare professional to provide quality care and potentially impacting patient safety," he said. "Furthermore, contractual restrictions on the sharing of experiences and information related to specific vendor products limit a healthcare facility's ability to make informed decisions about HIT adoption and implementation."

Hospitals that were sent the query include: Banner Health, Brigham & Women's Hospital Case Western Reserve University Hospital Health System, Catholic Healthcare West, Geisinger Medical Center, Kaiser Permanente System, Mayo Clinics, and the University of Pittsburgh Medical Center. Grassley has asked the hospitals to complete and return his survey by Feb. 16.

Last fall, Grassley wrote a similar letter to 10 major HIT vendors relaying those issues and concerns. His office is still examining those responses.

Louis Wenzlow, director of HIT at the Rural Wisconsin Health Cooperative, says Grassley's new letter underscores the myriad challenges involved in implementing HIT on such a massive scale.

"What makes the incentive program a potential disaster isn't the fact that providers will face these challenges, but the fact that they are not being given the time or the flexibility to implement [electronic health records] systems in a way that will mitigate these challenges and meet the quality and efficiency goals of the incentive program," Wenzlow says.

"Rural providers, who are much farther behind non-rural providers in their EHR adoption efforts, will be particularly hard pressed to meet the implementation deadlines," Wenzlow says. "The result will be that hospitals that already have EHRs will be getting the vast majority of the incentives; and hospitals without EHRs—those most in need of funding—will be largely excluded from the incentive program."

Charles E. Christian, CIO at Good Samaritan Hospital in Vincennes, IN, says some problems should be expected considering the size of the undertaking.

"Software is software. Even Microsoft has problems getting the code written, and these are not simplistic systems," says Christian, who sits on the steering committee of the College of Healthcare Information Management Executives.

Christian says hospitals must be careful not to rush to meet the meaningful use deadline. They need to get the technology in place properly and take the necessary time to make sure the systems are working correctly.

Christian says it's imperative that providers understand the abilities and limitations of the systems they're buying. "A lot of the systems being purchased these days are flexible enough to let you bend and twist them in ways that meet your work flows and work practices. But if you aren't careful and don't test them appropriately you could create self-inflicted wounds that could have unintentional outcomes," he says.

Whatever new systems are installed must be tested vigorously.

"Sometimes, the protective measures we take drive people crazy," Christian says. "But I'd rather make sure it fails in the testing environment than when I put that in live productive use and have the potential to harm the patient."