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$19B stimulus to boost health IT advancement

Posted: 24 Feb 2009 ?? ?Print Version ?Bookmark and Share

Keywords:health IT stimulus? information technology? system interoperability? software?

Heath care specialists commended the U.S. government's plan to spend $19 billion on information technology in the sector as part of the economic stimulus package. Government support has long been needed to help shift health care out of a Stone Age of paper records, they said.

But observers were quick to note real progress depends on how the many details in the legislation are implemented. Some have deep concerns about the focus and effectiveness of the plan and the current lack of interoperable systems.

The Health Information Technology for Economic and Clinical Health Act includes $17 billion in incentives for doctors to adopt electronic health records. Another $2 billion will go to the Department of Health and Human Services for a broad range of state and local grants as well as an effort accelerate the move to interoperability standards.

"I had a stimulus party the other day," said David Ahern, an assistant professor of psychology at Harvard Medical School, who heads two national efforts promoting electronic health care. "This is an unprecedented investment in health care, and it's long overdue."

Only a small fraction of doctors today use digital records and networked systems, he said. But there is wide belief IT can both improve health care and lower costs.

"All in all we think this is a great effort and will really help advance health care in this country," said Alice Borrelli, who manages a group in Washington that tracks global policies in health care technology for Intel Corp. "The technology is here, it's been the incentives we've needed to create a system of electronic health records," she said.

"Having the government stimulate this area is right on target," said Vince Kuraitis, principal of Better Health Technologies Inc., a consulting firm specializing in health care IT. "Whether or not this bill offers the best approach is still unclear because there is so much we don't knowthis is just the beginning," he added.

One big unknown under the new legislation is exactly who will buy what and when. The $17 billion in incentives require doctors show "meaningful use" of electronic health records to get reimbursement through Medicare and Medicaid starting in 2011. Borrelli of Intel said she expects that means doctors will begin buying software and hardware in 2010, once a new round of standards efforts settle down.

Ahern and Kuraitis said they think doctors will tend to adopt Web-based services. "Web and cloud computing software requires less training and installation costs," said Kuraitis. "Client/server systems are more expensive and harder to network."

"Physicians will not want to buy standalone applications, but will prefer to use some kind of licensed software services," agreed Ahern.

Both Ahern and Borrelli agreed an emerging class of home monitoring gear made by Intel and others could also see greater uptake, although nothing in the legislation specifically supports it. "In my book [remote diagnostic systems] should be paid for under this stimulus package because they would have a meaningful impact on health care," said Ahern.

"Several buckets of money [in the stimulus package] could be used for home health systems" including parts of the $10 billion going to the National Institutes of Health for research in health care, said Borrelli. "No one knows exactly how all the money will be spent, but the objectives seem to be consistent with what we are working on in home health," she added.

Interoperable software programs
Kuraitis criticized the bill's focus on driving the shift to electronic health records (EHRs). He also raised doubts about the Certification Commission for Healthcare Information Technology (CCHIT), a group with its roots in industry trade associations that currently tests health care software.

"EHRs are part of the equation, but the assumption here is they are foundational and I think that's questionable," he said. "There are a number of other technologies like personal health records, remote health monitoring and clinical groupware that don't meet the strict definition of certified EHRs" but they have great value, he added.

The CCHIT standards are expensive and unnecessarily complex, Kuraitis said. The non-profit group specifies more than 200 different software functions and charges $30,000 to certify compliance, a relatively high fee for many small medical software companies, he said.

What's worse, the current certification system to date has spawned a variety of software programs using proprietary formats. Thus the small fraction of today's doctors who have gone digital can't easily share data with clinics, pharmacies or insurers who use other programs.

"To date the vendors have had no reason to build in interoperability, and in fact their business models have gone toward being proprietary and tying data to their application," Kuraitis said. "This stimulus money is totally wasted if interoperability does not occur."

More work on standards is in the wings. The legislation calls for the department of health to set up within 45 days a new high level committee to recommend policies for health IT.

It also calls for the national coordinator of health IT, a branch of the department of health, to set up a new high level standards committee made up of all relevant stakeholders. The groups are expected to hammer out a set of recommended standards within a year.

Just how these new groups will interact with existing standards efforts is unclear. The Healthcare Information Technology Standards Panel already is developing a suite of interoperability standards that feed into the certification process at the CCHIT, said David Merritt, a project director at the Center for Health Transformation, part of a health care advocacy group headed by former Speaker Newt Gingrich.

"In my mind starting over from scratch would be a terrible idea," said Merritt. "This group has been up and running two years and has industry wide participation, so I'm all for accelerating its work," he said.

"There may be some tension and friction initially on who will do what and how people collaborate, but everyone involved in the field is singing the same tune that we have to get to agreed standards," said Ahern.

Incentive program
The standards efforts are a small part of a broad allocation of $2 billion in discretionary funds the stimulus package grants to the department of health to promote IT.

The department has to come up with a plan within 90 days for how it will allocate the money. Most of the $2 billion is expected to be allocated to a broad range of state and local programs.

"They are probably working around the clock to come up with a process" for allocating the money, said Merritt. "My guess is much of it will go to projects that are underway" such as local health data exchange projects in places such as Indianapolis and Spokane that link several local hospitals, he added.

The biggest slice of the package in health IT$17 billionis for incentives to doctors and hospitals to start using electronic health records. Starting in 2011, physicians can earn up to $64,000 over five years from Medicare and Medicaid if they can show they are using digital records in a "meaningful" way. Hospitals can earn more than $10 million.

The Congressional Budget Office estimates that 90 percent of doctors and 70 percent of hospitals could be using EHRs by 2020, Merritt said.

Kuraitis criticized as vague the bill's language about showing "meaningful use" of digital records to get the funds.

"What's screwed up with health care today is there are no incentives to improve quality, there are just incentives to do more procedures," he said. "What we want to see in national health care reform is improvements in quality.

"This is not as simple as building interstate highways where you just send out steamrollers and workers, you need to have the right incentives," he added. "IT can be a means to improve quality, but the current system does not provide the right incentives for interoperable data exchange."

- Rick Merritt
EE Times

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