Last week, US Vice President Joe Bidenannounced the availability beginning October 1 of government grants totaling $1.162 billion which are to begin creating the infrastructure needed to help hospitals and other health care providers implement and use electronic health records. The grants, the White House press announcement says, will be funded by (and are defined within) the American Recovery and Reinvestment Act of 2009 (ARRA) and will be used to help health care providers qualify for new incentives that will be made available in 2010 to doctors and hospitals that "meaningfully use" electronic health records.
The Recovery Act provides Medicare and Medicaidincentive payments to eligible providers, such as physicians and hospitals, in order to increase the adoption of EHRs. To receive the incentive payments, however, these providers must demonstrate that they are using meaningfully a certified EHR system.
Trouble is, meaningfully use, although defined as a requirement in law, isn't currently defined in any meaningful way (the ARRA says, "using certified EHR technology in a meaningful manner, which shall include the use of electronic prescribing") and won't be initially defined until late this year.
The term "meaningfully use" itself is ambiguous ("meaningful" to whom - the government, doctors and or patients, and is does it primarily concern functionality within a certified EHR or how that functionality is used?) but ultimately seems to be, according to the Health IT Policy Committee, that EHRs are "linked to achieving measurable outcomes in patient engagement, care coordination, and population health."
Vice President Biden said at the announcement, that
"With electronic health records, we are making health care safer; we’re making it more efficient; we’re making you healthier; and we’re saving money along the way. These are four necessities we need for healthcare in the 21st-century."
The grants that were made available include:
- * $598 million in grants to establish approximately 70 Health Information Technology Regional Extension Centers, which will provide hospitals and clinicians with hands-on technical assistance in the selection, acquisition, implementation, and meaningful use of certified electronic health record systems.
- * $564 million in grants to States and Qualified State Designated Entities (SDEs) to support the development of mechanisms for information sharing within an emerging nationwide system of networks.
According to the White House, the 70 Health Information Technology Regional Extension Centers will be set up through a competitive process and serve a defined geographic area with at least 100,000 primary care providers. The law requires that Regional Centers be affiliated with a U.S.-based, nonprofit institution or organization, or "an entity thereof." The Regional Centers will support health care providers with direct, individualized and on-site technical assistance in:
- Selecting a certified EHR product that offers best value for the providers’ needs;
- Achieving effective implementation of a certified EHR product;
- Enhancing clinical and administrative workflows to optimally leverage an EHR system’s potential to improve quality and value of care, including patient experience as well as outcome of care; and,
- Observing and complying with applicable legal, regulatory, professional and ethical requirements to protect the integrity, privacy and security of patients’ health information.
Yet, as noted here earlier this year by Dr. David Blumenthal, the National Coordinator for Health Information Technology, many of the currently available EHR systems
"are neither user-friendly nor designed to meet HITECH’s ambitious goal of improving quality and efficiency in the health care system."
Furthermore, the number of certified EHR systems available for purchase has been falling steadily since the certification process was started in 2006.
Looks like the Health Information Technology Regional Extension Centers have quite a bit of work cut out for them, assuming they can find knowledgeable and experience people to support them.
I also am going to be interested to see exactly what these so-called "mechanisms" are going to be which allow "information sharing within an emerging nationwide system of networks."
The idea seems to be to have the states (or groups of states) create health information exchanges (HIEs) that are secure, private and interoperable. How different HIEs using different info-exchange "mechanisms" and different security/privacy requirements are supposed to interoperate seamlessly is anyone's guess, however.
There is no data that I know of that discuss success/failure rates for HIEs. I guess this is a $564 million opportunity to determine one.
Robert N. Charette is a Contributing Editor to IEEE Spectrum and an acknowledged international authority on information technology and systems risk management. A self-described “risk ecologist,” he is interested in the intersections of business, political, technological, and societal risks. Charette is an award-winning author of multiple books and numerous articles on the subjects of risk management, project and program management, innovation, and entrepreneurship. A Life Senior Member of the IEEE, Charette was a recipient of the IEEE Computer Society’s Golden Core Award in 2008.