Stimulus Package Promotes Good Health IT

With nearly $20 billion from the Recovery Act earmarked for electronic health record incentives, state and local governments lend support, enforce accountability.

by / February 1, 2010

It's no question that last year's American Reinvestment and Recovery Act (ARRA) upped the ante for hospitals adopting electronic health records (EHRs), setting aside $19 billion in incentives for systems that meet specific criteria. To that effect, Dr. Mark Leavitt, chairman of the Certification Commission for Healthcare Information Technology (CCHIT), called the U.S. economic stimulus package "the biggest thing that's ever happened in health IT."

But Sen. Chuck Grassley, R-Iowa, has some concerns about hospitals implementing health IT provisions under ARRA.

In recent months, Grassley, the ranking member of the U.S. Senate Finance Committee, learned about usability and formatting issues on some systems, administrative complications and errors. He found out about tangled communication lines among health care providers, vendors and hospital administrations. He also heard that in serious cases, some software miscalculated body weights swapping kilograms and pounds, which produced incorrect medication dosages.

In the fall, Grassley wrote letters to health IT vendors about these issues. Then, in January, he sent letters to 31 hospitals nationwide asking about their experiences.

"Given the taxpayer investment and the investment of the health care 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 statement.

As the stimulus package also provides billions of grant dollars to federal and state organizations for research and the promotion of health-IT adoption, state and local governments can play a pivotal supporting role during this health IT transition.

Take Michigan, for instance, which has been encouraging the adoption of EHR systems for the past few years. Formed in 2006, the Michigan Health Information Technology Commission has made investments to connect physicians in underserved areas to broadband services, show hospitals how to effectively use technology and support health IT exchange to make sure no regions get left out, said Greg Forzley, commission chair and medical director of informatics at St. Mary's Health Care in Grand Rapids, Mich.

"We are there, watching all this to make sure pieces fit together," Forzley said. "In addition to incentives, the federal government has given us resources to help them pick the right technology and do better jobs of connecting. We're reaching out to the primary care physicians to show them how to use dollars wisely and help them be successful."

Increasing Adoption

The goal of the federal government is for most Americans to have electronic health records by 2014. For citizens, that means getting used to the idea of having medical records online. But for hospitals, creating a nationwide network of private, secure and interoperable EHRs is a massive and expensive undertaking, which Leavitt once compared to NASA's manned spaceflight mission to the moon in the 1960s.

An interoperable nationwide network means that health records can be accessed online around the country: test results from labs and radiology, disease and symptom records, CT scans and images, etc. Essentially the standards will help EHRs speak the same language so patients won't suffer from health information getting lost in translation.

Forzley compared the process to electronic banking, even though he notes that health IT is a "much more complicated language than the monetary system."

"If I want to make a transaction, I want to know the currency I'm translating to, and that if I do the same transaction 65 times it's going to be accurate 65 times," Forzley said. "If I have no confidence that your health information is accurate and reliable, not only is it not a good idea, but it's also bad practice in terms of care for patients."

The health-care community seems to be getting the message, according to preliminary results (mail-only) from a National Center for Health Statistics survey. The National Ambulatory Medical

Care Survey (NAMCS) shows that 43.9 percent of office-based physicians used some level of EHR systems in 2009. In 2008, combined data (from mail and in-person surveys) from the NAMCS survey showed only 41.5 percent of doctors using all or partial EHR systems in their office-based practices.

Starting in 2011, the federal government plans to offer the incentive Medicare and Medicaid bonuses to physicians and hospitals that demonstrate "meaningful use" of interoperable, certified EHRs. In December, the Office of the National Coordinator for Health Information Technology issued a draft of qualification criteria. Expect a final version of the standards, implementation specifications and certification criteria later this year.

Meeting the Criteria

But how will the EHRs be evaluated? That's where the CCHIT comes in.

Before, the commission only evaluated products for providers. But now, CCHIT plans to certify EHR systems -- which range widely in price depending on how robust the system is -- to determine if the technology meets the criteria to receive incentives.

"Hospitals have been building their systems layer upon layer for years," said John Morrissey, communication manager for CCHIT. "They have a lot of the technology already in place, which might be partly or fully self-developed. But they might have a product version that may be too old and can't be upgraded."

This fall, after the final regulations have been released, CCHIT plans to perform site certifications. By that time, Morrissey added, a lot of the preliminary work should have been done so providers know how to get up to standards.

Overall, that means ARRA has not only given hospitals financial incentives to adopt EHRs, but the federal regulations have also enhanced the push for more health IT accountability whether it's through Grassley's letters to hospitals or CCHIT certifications of systems.

"We need to fill this gap in the certification landscape," Morrissey said. "The stimulus funds create the need for vendors to show the marketplace that they have all the tools in place."


Russell Nichols Staff Writer