Solve for X

[Scott Serich]

This has been nagging me aside from the upcoming vote, so I figured it merited its own separate discussion topic. Again, I offer this from my own personal perspective as the former PMIX project manager. They don't necessarily represent the views of the IJIS Institute or BJA.

 

Apparently over 500 people were dying every day in 2008 from preventable errors in hospitals. This had actually been a longstanding problem, brought to the attention of many in the IOM "To Err is Human" report in the late 90's. Forward 10 years... the 2009 HITECH Act resulted in a $20 billion appropriation to "electronify" the nation's medical recordkeeping. Billions of dollars of incentive payments continue to flow to hospitals and other healthcare providers under the Meaningful Use program. Kudos to everybody involved... it looks promising.

 

Today there are over 50 people dying every day from prescription drug abuse. Here's a simple algebra problem that the vast majority of taxpayers would readily understand (no reverse logarithm functions required): if 500 deaths per day merits a $20 billion Federal appropriation, then 50 deaths per day merits X. Solve for X.

 

By my calculation, it's in the neighborhood of $2 billion. If the Federal Government is taking the prescription drug epidemic seriously, then it doesn't seem unreasonable for it to back up its words by making some significant portion of the HITECH amount available to the State PDMPs to develop and (more importantly) sustain the capability to interoperate with EHRs. A mere 0.1% of the HITECH appropriation ($20 million, no?) would probably do the trick for year 1, and there might even be funds left over to cover several years of maintenance to boot. Otherwise, the State PDMPs are going to have the same challenge they've faced for several years now, struggling to find ways to meet payroll every month and accepting funds from just about anybody willing to help out. Can we blame them?

 

No disrespect intended toward BJA or the Rogers PDMP grant program. I think the program has been a smashing success and the nation should be thankful. But its magnitude pales in comparison to HITECH. The Rogers program simply doesn't go far enough.

 

As I alluded to in an earlier post, this S&I Framework PDMP Initiative is also valuable in its own right. But it might end up being an academic exercise if the State PDMPs continue not participating because they don't see it addressing the more pressing problem of how to pay for these new exchange capabilities. By my count, there were three State PDMPs on the last teleconference, which was arguably the most important meeting of the entire initiative. Perhaps there is some plan to try to ram the results down the throats of the other 47 States whether they partipate or not? No, I can't imagine that was the intent of the initiative sponsors.

 

I don't know all the intimate budget details of every State PDMP that's out there. If they are all flush with cash and don't know how to spend it all, then I am willing to stand corrected and will promise to shut the heck up. Otherwise, the State PDMPs may not need $billions, but a couple tens of million would probably magnify the value of this S&I Initiative many times over. And I suspect that the State PDMP participation rate would skyrocket.

 

[George Shemas]

You raise some excellent points in your post Scott.  The recent S&I Committee calls have not really discussed the funding issues related to support new standards adoption by State PDMPs.  The cost discussions have been limited to citing the larger numbers (count) of EHR vendors and users versus the smaller numbers of State PDMP operations.  Knowing that state agencies often rely on Federal grants to enhance their operations, the recent discourse in Congress is worrisome for funding initiatives such as this and it make take many years for PDMPs to acquire the funds to enhance their systems.  

Funding of system enhancements such as the ones proposed have frequently been easier and more timely if done via participating private sector organizations.

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