Electronic health records probe expands to hospitals

Introduction

A congressional inquiry into plans for spending billions of dollars in stimulus money on digital medical records is now questioning some of the nation’s most prestigious health care providers about possible safety flaws and other problems with the electronic systems.

Sen. Charles E. Grassley (R-Iowa), ranking member of the Senate Finance Committee, has asked 31 hospitals and health systems across the country in a Jan. 19 letter to advise him of any problems with their computer systems and any “issues or concerns that have been raised by your health care providers” over the past two years.

“Hospitals are on the front lines and their perspective will be very valuable in this effort, so I look forward to hearing what they have to say about expanded use of health care information technology,” Grassley said Wednesday in a statement.

The hospitals include [see full list here] the prestigious Mayo Clinic and others among the country’s leading users and pioneers of digital records, such as Kaiser Permanente, a California-based health system with more than 8 million members.

Several top government policy advisors on electronic health records currently work or have been affiliated with some of the institutions now included in the inquiry. David Blumenthal, the Department of Health and Human Services’ top digital records official and a physician, previously was with Massachusetts General Hospital, which received the query from Grassley.

Federal officials expect to spend up to $27 billion in stimulus money over the decade to help doctors and hospitals purchase the systems. On Dec. 30, Medicare officials issued draft guidelines detailing standards that doctors and hospitals must meet to qualify for the stimulus payments. Starting next year, doctors can receive as much as $44,000 each from Medicare for buying the systems and making “meaningful use” of them. Hospitals are eligible for millions of dollars in Medicare bonus money.

But Grassley, whose committee oversees Medicare, has expressed doubts about the quality of some systems as well as the business practices of some vendors. In October 2009, Grassley wrote to 10 manufacturers, asking them to report problems with what he termed “faulty software.” Grassley said some health care providers told him that, in some cases, software was producing “incorrect medication dosages because it miscalculated body weights by interchanging kilograms and pounds.”

Grassley also expressed concern about allegations that some companies impose “gag orders” that prevent users from publicly discussing problems that crop up. The senator also is looking into any financial incentives vendors pay to hospitals that purchase their systems.

In his statement, Grassley said he had expanded the investigation after receiving responses from the vendors, although his staff declined to explain what specific information they had received. But Grassley stated in the Jan. 19 letter: “Over the past several months, however, I have been made increasingly aware of difficulties and challenges associated with” adopting digital records systems.

An official at the University of California, San Francisco Medical Center, which late last year scrapped part of a $50-million digital records installation amid persistent technical problems, confirmed the hospital had received the letter and would “provide the information requested.” In a statement, the hospital said it has begun working with a new company and expected to have a comprehensive electronic system “operational within the next two to three years.”

Grassley’s spokesperson Jill Gerber said they had chosen the hospitals based on both “positive and negative” press reports, complaints, whistleblowers, and their own research.

Grassley’s letter also signaled that he was reviewing “reported problems” that “appear to be associated with administrative complications” and “actual computer errors stemming from the programs themselves.”

The senator also expressed concerns that many systems essentially cannot talk to each other and that administrators in some institutions have been slow to take action when confronted with software glitches and other concerns.

“In addition, I have heard from health care providers around the country that when they report such problems to their facilities and/or the product vendors, their concerns are sometimes ignored or dismissed,” Grassley wrote. He also said that because the systems are not regulated by the Food and Drug Administration, there is no national system for reporting “product errors or failure and adverse events associated with the use of such products.”

Spokespersons for two of the facilities, Kaiser Permanente and Massachusetts General Hospital, confirmed they had received the letter, but had no further comment.