I've often written that technology needs to be complemented by policy in order to be successful. Local policies help protect privacy by documenting "community standards" and ensure local IT assets are used wisely. Federal and State policies define best practices, align incentives, and establish priorities.
I try to divide my time on various local, state and federal initiatives between technology and policy work to ensure I meet all stakeholder expectations for data use.
Last week I read a great summary of the policy work being done throughout the country. The National Conference of State Legislatures published "Health Information Technology: 2007 and 2008 State Legislation"
Over the past 18 months, 132 bills related to health information technology were enacted in 44 states (everywhere except Arkansas, Kentucky, Mississippi, Nebraska, South Dakota, and Wyoming). Legislation included EHR adoption, e-prescribing incentives, financing, healthcare information exchange, and privacy. This burst of legislative activity demonstrates that eHealth is on the radar screen of just about every state and the pace of change is truly enabling interoperability.
In Massachusetts, there were 3 major legislative efforts in 2007 and 2008
Massachusetts HB 4141, 2007 (Enacted 7/12/2007)
* Creates an eHealth Task Force that will develop a healthcare information exchange plan to link multiple settings of care, both public and private 2) evaluate the economic model and the anticipated benefits of electronic health record implementation and 3) provide quarterly updates to the governor and the chairs of the House and Senate committees on Ways and Means and the chairs of the Joint Committee on Health Care Financing regarding the status of national standards efforts
Massachusetts HB 4900, 2008 (Enacted 7/13/2008)
* Establishes and appropriates $25 million to the e-Health Institute Fund. Provides the Department of Public Health with $425,710 for a federally funded grant entitled Enabling Electronic Prescribing and Enhancement.
Massachusetts SB 2863, 2008 (Enacted 08/10/2008)
* Establishes the Healthcare Quality and Cost Council, which just launched its transparency site documenting procedure costs, quality and patient satisfaction measures for all hospitals in the state.
*Establishes the Massachusetts e-Health Institute and the e-Health Institute Fund to accelerate EHR implementation.
*Defines consent as Opt-In (no data is shared until patients give permission)
*Establishes rules for reporting unauthorized access or disclosure of healthcare data.
*Requires Computerized Physician Order Entry as a requirement for hospital licensure by October 1, 2012. Requires interoperable CCHIT certified EHRs by October 1, 2015 as a condition of hospital licensure.
*Requires IT competency as a condition for licensing healthcare providers.
*Calls for a medical home demonstration project based on IT interoperability.
The combination of technology, policies, and funding is all we need to accelerate health information technology. The legislative accomplishments of 2007-2008 are a great enabler.
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I like the idea of requiring hospitals to implement a CCHIT certified EHR as a condition for licensure. The fastest way to get hospitals on board nationally is for the center for medicaid and medicare services (CMS) to add an inpatient and/or an outpatient CCHIT certified EHR as a condition for hospitals to keep their rate of re-imbursement intact or face a reduction of 2%.
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