Much of the attention in the mainstream press surrounds the ongoing health care reform debate. The emotions have run hot at times as the debate and legislative process continues. With all the focus on health care reform, a simple fact may be overlooked – healthcare IT reform is already well underway.

The American Recovery & Reinvestment Act (ARRA) was passed in February 2009, and included in the Act is a provision called Health Information Technology for Economic and Clinical Health Act or HITECH. It is law, although many of the details are still being defined.

HITECH is driving significant changes in healthcare by providing incentives for implementation and Meaningful Use of certified Electronic Health Records (EHRs).

Given this, is HITECH really reforming health IT or just muddling it?

View Point One: HITECH is reforming health IT.

Healthcare data standards are no longer just a framework for data exchanges; they now are a necessity. HITECH is driving healthcare standards to a new level of intense focus and use. Although there are still many healthcare standards, they are being narrowed into action. Through implementation guides, healthcare standards are being shaped into usable templates to achieve Meaningful Use. Healthcare organizations can no longer afford to ignore healthcare standards and rely solely on paper exchanges. HITECH has changed the economics of healthcare standards adoption and use.

  • Meaningful Use is the new buzzword in healthcare, but it is also well thought out. It balances three key items: implementing certified EHR technology, ensuring meaningful use (shelfware is unacceptable here), and protecting privacy of patient information with stricter guidelines and fines. If HITECH included only one or two of these elements, the opportunity for success would be significantly lessened. For example, consumers and patients may be more open to having their data exchanged with other appropriate providers given the strict breach and disclosure reporting requirements along with the costly fines imposed. The stakes and the requirements have risen significantly for healthcare providers, and patients should feel their privacy is safe with these new protections.


    The balance in which Meaningful Use has been legislatively crafted increases the likelihood of eventual, significant patient data exchanges within a circle of care.

  • HITECH is driving a mind shift in healthcare; it is changing a culture of “good enough” with regards to the adoption and use of healthcare information technology. Change is no longer just an option. True, some organizations can select not to participate and accept the eventual reduction in payments from payer organizations. However, in a majority of the scenarios, adopting and using EHR technology will be the only way to match the revenues with the expenses in a positive way and continue to service the patient community in a high quality, service-oriented way.


    In the world of instant access through ATM machines, websites, smart phones, etc., healthcare providers can no longer be on the sidelines. In each and every healthcare IT conference or vendor-based user group meeting, the talk is centered on what needs to happen in order to change their operations and meet the new, new requirements in healthcare. In any reform movement, the attitudes and culture need to change in order to adapt. There are clear signs that these mind shifts are beginning to occur.

View Point Two: HITECH is muddling real changes in health IT.

  • HITECH is creating too much change too soon. HITECH is not creating a “perfect storm” of change by balancing EHR adoption, Meaningful Use, and privacy to drive real change. Instead, HITECH is driving a perfect bottleneck and will ultimately create intense frustration. Think about it. The incentives begin in 2011, and less than a third of healthcare providers currently use a certified EHR. Over the next 18 to 24 months, how many implementations can realistically take place? How much change can the US healthcare system take?


    In most implementations, it takes people, process, and technology for success. With the current timelines and requirements, downloading and installing the software can happen easily, but having the right people available to define the workflows and implement the technology in a meaningful way will put successful EHR implementation at significant risk.

  • Consensus is still the approach in defining and using healthcare standards – it is too slow. Instead of accelerating the definition of healthcare standards to be used in meeting the new requirements, there is another layer being added. As part of the Office of the National Coordinator for Healthcare IT, there are two new committees: Health IT Policy Committee and Health IT Standards Committee. Added to the mix are the Federal regulatory processes. Although a direction has been defined, the details really will not be ready until Spring 2010.


    All the standards development organizations need to align to the requirements and funnel their comments and guidance up to the two committees and then wait for Federal regulation processes to be completed. Consensus is taken to a new level, combining hours of work by dedicated healthcare IT volunteers and the hours of Federal bureaucratic processes. Change may happen, but the timelines set are unrealistic and, most likely, will not be achieved.

  • The market will be the ultimate driver for the adoption and use of EHR applications, not the government. In the end, the market wins. What is meant by that statement is the market has greater influence than having a program totally driven by the government. Yes, government incentives work, but the influence can be short-term. For example, Cash-for-Clunkers incented people to purchase new cars, but at what consequence? There was a spike in new cars being purchased, but will the people buying the cars be able to afford the new loans? What happens if another round of loan defaults occur? What will be the government’s response then? Sometimes, when the government is driving a change, the market or consumers can get dizzy chasing the incentives and then suffer the consequences later.


    Market and consumer natural behavior ensures longer term sustainability of significant changes. If consumers see the value in having electronic access to their health records, then they will see physicians who have such applications. When physicians see a drop in patient volume because they have not met a consumer or patient need, then change will happen.

    To facilitate this change, consumers need to gain value from the electronic information collected. This value can come from the knowledge of what the care delivered means for them, both now and in the future, as well as what their costs are to receive that care. If clear descriptions of care being delivered along with the associated costs by providers were more readily available, imagine the change that would take place! Consumers would have greater insights and choices in the care being selected and delivered, with the associated costs. Imagine an Amazon-type marketplace of healthcare providers with consumer ratings, service descriptions, and prices!

The new Federal incentives under HITECH are not focused on real change. Change the model by placing more information in the hands of the consumers and then watch sustainable changes occur in healthcare.


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