Monday, January 19, 2009

The Greatest Healthcare IT Generation

In Washington, Healthcare Information Technology policy planning is accelerating at a pace that is faster than at any time in history (at least my 30 years in healthcare IT).

Over the past few days, the House Ways and Means Committee completed the Health Information Technology for Economic and Clinical Health Act (HITECH), as part of the American Economic Recovery and Reinvestment Plan.

At the same time, the House Appropriations Committee has completed a bill that is not meant to stand alone. It outlines $2 billion in funding for the programs authorized by section 4301 of the Ways and Means Committee bill.

Here are the high points of the Ways and Means Committee bill.

* It codifies the Office of the National Coordinator (ONC), ensuring its continued funding and authority. To date it has existed only because of executive order.

*It creates a Chief Privacy Officer within ONC.

*It establishes and funds an HIT Policy Committee (Federal Advisory Committee)

*It establishes and funds an HIT Standards Committee (Federal Advisory Committee)

*It specifically mentions that the AHIC Successor, now known as the National eHealth Collaborative (NeHC), can be modified to become either the HIT Policy or HIT Standards Committee.

*Interestingly, it notes that the National Coordinator shall support the development and implementation of a qualified EHR platform (imagine an open source software as a service system for the country), unless the Secretary of HHS determines that the needs concerning EHRs are met in the private market.

*NIST is to coordinate with the HIT Standards Committee to test standards and establish a conformance testing infrastructure (NIST can contract with independent non-federal labs to conduct performance testing).

* NIST and NSF are to establish a program of assistance to Institutes of Higher Education to establish multidisciplinary centers for Healthcare Information Enterprise Integration (centers to conduct research on applications for HIT)

*It authorizes and appropriates $300 million in Grants and Loans for state based demonstration programs. Grants can focus on such areas as health IT and the underserved, HIEs, technical assistance, and medical informatics education.

*It establishes HIT Regional Extension Centers, non-profit, public/private partner organizations that can have up to 50% of operations funded for up to 4 years.

*It specifies $20 billion in incentives to support health IT through Medicare and Medicaid, beginning in 2011. It outlines Medicare reimbursement incentives to eligible professionals, eligible Medicare Advantage Organizations, and eligible hospitals that exhibit a meaningful use of certified EHR. It outlines Medicaid reimbursement incentives to eligible Medicaid providers that exhibit a meaningful use of certified EHR

*It addresses the Privacy and Security of protected healthcare information to include breach notifications, relationship of business associates, and accounting for disclosures.

The bill is very well written and includes significant input from all the stakeholders - payers, providers, patients, CCHIT, HITSP, vendors, and government.

I support the notion of planning, expansion of our standards work, acceleration of the Nationwide Health Information Network and a focus on enhanced privacy policy in 2009-2010 followed by rapid implementation beginning in 2011. Some states are ready for rapid implementation now, so my only suggestion would be early additional funding for those states with a plan, staff, and experience doing large EHR rollouts.

Here are the next steps:

* The Ways and Means and Energy and Commerce Committees will mark-up their respective economic recovery packages (which include identical health IT language) on Thursday. A mark-up means the two Committees will go through their respective bills title by title and members will be allowed to offer amendments to the introduced language.

* The bills that come out of Ways and Means, Energy and Commerce and Appropriations will then be merged together, along with parts of the economic recovery package being considered by other House Committees.

* The entire economic recovery bill will go to the House floor the week of January 26.

* Assuming it passes the House, committees will reconcile the bill with whatever economic recovery package gets approved by the Senate. By all indications, both the House and Senate bills will contain similarly strong health IT provisions.

* Once the House and Senate bills get reconciled, they will go back to the full House and Senate.

* Assuming they are approved, they will go to the President for his signature. The plan is that will happen by President’s Day weekend.

I will do all I can to support this effort. With appropriate policies and requirements to implement interoperable, certified EHRs, the dream of a fully electronic healthcare system in the US will move forward more in the next few years than in my entire career to date.

One caveat. The entire healthcare IT industry had an estimated budget of $26 billion in 2008. Thus, these acceleration funds will nearly match the entire budget of the current industry. As Healthcare IT professionals we will be given the challenge of our lives to implement this much change this fast. It will be like running continuous IT marathons at the peak of our abilities.

My grandparent's generation was known as the "Greatest Generation". We will be the "Greatest Healthcare IT Generation."

Are you ready to change the world? I'm looking forward to it!


karlub said...

Super-helpful. Thanks.

One of my clients is a smaller healthcare IT vendor, and we don't have the resources to research and lobby on all this stuff.

In fact, I fear part of the challenge in delivery will be on the vendor collaboration end. The only vendors that seem to be consulted are those that *do* have the resources to lobby, and their goals, especially when it comes to standards, do not include interoperability and ease of implementation.

Ahier said...

I am very excited about this. I think this portion of the economic "stimulus" is probably the most meaningful, besides actual tax cuts...

Johnnysmooth said...

Nice post John, best one I've seen yet that succinctly summarizes all the activity now occurring on the Hill.

While I differ on many of your views regarding NHIN, straight grants to states (more failed RHIOs on the horizon?) and directly subsidizing EMRs, do agree that there is a ton of work that needs to be done in the HIT arena and hopefully, not just those with their fingers already in the cookie jar (eg, CCHIT and the entrenched vendors that are all over it) will benefit.

drwalker_rph said...

I appreciate your comments and your willingness to pass on this important information. I sometimes label myself as "just another pharmacist trying to change the world" but now I also hope to become part of the "Greatest Healthcare IT Generation" as well. Keep up the incredible work that you do.

Dave Walker, R.Ph.
Health Record Resources

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