On February 17, 2009, American Recovery and Reinvestment Act of 2009 (ARRA) is an economic stimulus package enacted by the 111th United States Congress in February 2009 to provide a stimulus to the U.S. economy in the wake of the economic downturn. The Act includes federa... (America Recovery and Reinvestment Act of 2009) was signed into law, which included the passage of the As a part of the America Recovery and Reinvestment Act (ARRA) of 2009, Health Information Technology for Economic and Clinical Health (HITECH) refers to the portion of the ARRA that is used to increase the use of Electronic Health Records (EHR) by ph... provisions. Significant time has passed since then. Although some directional work has been done by the various Office of the National Coordinator for Health Information Technology (ONC) – Located within the Office of the Secretary for the U.S. Department of Health and Human Services (HHS), the Office of the National Coordinator (ONC) coordinates nationwide ... committees, the regulations governing the incentives are planned for initial publication prior to the end of December. CMS (Centers for Medicare & Medicaid Services) is responsible for publishing the regulations.
When it comes to governmental processes, time passes slowly. Unfortunately, the anxiousness of health IT executives rises rapidly as many key elements remain undefined.
Two key quotes from a recent iHealthBeat article (Meaningful Silence Deafening for Health IT Industry , November 19, 2009):
Quote 1: “‘I think there is a fair amount of anxiety about the work to be done and the challenges ahead at the provider level, and yet there’s also an excitement about the opportunity to enable improved healthcare,’ said Mike Smith, CIO at Lee Memorial Health System in Florida. He added, ‘My sense is that the readiness level varies by area, provider organization and vendor.'”
Quote 2: “‘I have been at the CIO level in the industry for 14 years, and we are being asked to do much more in the next six than I have seen happen in the past 14,’ McCleese said, noting that Blumenthal agreed with his assessment. ‘He understands the question, but [said] the law has been passed by Congress with good reason and we need to adhere to it.'”
The reason behind the anxiety may be summarized around three areas:
HITECH Anxiety Reason #1: When to start which health IT projects? It is clear that a certified Electronic Health Record (EHR), as defined in Defining Key Health Information Technology Terms (The National Alliance for Health Information Technology, April 28, 2008): An electronic record of health-related information on an individual that conform... must be used in order to gain access to the incentives. There is also clear directions outline on what Meaningful Use
. To enable the health information exchanges
, provide clinical summaries, and provide reasonable electronic access to a person’s health record are all challenging projects. What will be required when is still unknown, including what the ramp in requirements will actually look like from 2011 to 2015.
Balancing competing and unknown health IT projects is disconcerting and may stall some initiatives until clear direction is delivered.
HITECH Anxiety Reason #2: Will there be a health IT resource shortage? There are funds available for Regional Extension Centers to provide information and best practices on implementing health IT solutions, including EHRs. Additionally, HHS recently announced $80 million in grants “to help address an estimated shortage of 50,000 health IT workers.” (iHealthBeat , November 24, 2009) Through community colleges and other non-degree programs, the goal is to train and develop 10,000 new health IT workers on an annual basis.
Nevertheless, with quick timelines, multiple projects, and all providers on the same implementation path, the resource concern is justified. An article in Hospitals & Health Networks highlights this concern in an article entitled Triple Whammy Hits IT Departments. Sense the anxiety in the following quote from the article:
“Compounding the issue further is a triple whammy of major IT projects facing every health care organization. Not only is there the HITECH-fueled push for electronic health records, the stimulus law also tightens The Health Insurance Portability and Accountability Act (HIPAA) was enacted by the U.S. Congress in 1996. Title II of HIPAA, known as the Administrative Simplification (AS) provisions, requires the establishment of national standards for electronic h... privacy and security requirements, something American Health Information Management Association CEO Linda Kloss calls a ‘very big challenge.’ And already in the works is the transition to ICD-10 coding and the related ANSI X12 provides for electronic exchange of business transactions-electronic data interchange (EDI). The American National Standards Institute (ANSI) chartered the Accredited Standards Committee (ASC) X12 to develop uniform standards. 5010 electronic transactions.”
Many projects, little time and, potentially, too few resources. Have a defined strategy and approach will be critical to meeting the new health IT demands ahead.
HITECH Anxiety Reason #3: How will the race for incentive funds impact the quality of patient care? Dr. Blumenthal has stated: “The meaningful use framework will be about the goals of care, not the technology.” However, getting the dollars is dependent upon implementing certain technology enablers. In the initial incentive years, it seems that proving enhanced quality of patient care is nominal, but the continued receipt of incentive funds is likely headed toward showing meaningful performance improvements.
With the amount of money about to be spent, there will be scrutiny in the press on the results being achieved. The focus on results, even from the start, will put pressure (i.e., anxiety) on health IT professionals and healthcare operations executives to prove the value of the investments being made, especially since it is coming directly from taxpayers.
A balanced approach is needed when approaching the various health IT projects. There is time to realize the full value of the incentive funds; having everything ready in 2011 is not required. Full value still can be realized if a provider begins to meet the requirements in 2012. It is important to be methodical in the implementation approach and to be positioned to show enhanced patient quality of care or improvement in key performance metrics in the later years.
A well thought out plan is a necessity. More details will come soon. Have adaptable planning processes to adjust to the changes. Remember the old adage – Plan ahead, or Plan early and often.