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The greatest health care 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!

John D. Halamka, MD, MS, is CIO of the
CareGroup Health System, CIO and Dean for
Technology at Harvard Medical School, Chairman of the New England
Health Electronic Data Interchange Network (NEHEN), CEO of MA-SHARE, Chair of the US
Healthcare Information Technology Standards Panel (HITSP), and a
practicing emergency physician. He blogs regularly at Life as a Healthcare CEO, where this post first appeared.

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2 replies »

  1. It’s very nice info John.I like it.Thanks for info.I sometimes label myself as just another pharmacist trying to change the world” but now I also hope to become part of the Greatest Health care IT Generation as well. Keep up the incredible work that.
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  2. Dr. Halamka,
    I applaud the enthusiasm and the good intentions of the committee. These are indeed exciting times. I read the Ways and Means report and sadly it seems that good intentions may result in very unfortunate outcomes.
    Somehow, somewhere, someone, must realize that the term “certified” in the EMR market has come to represent large, unwieldy, very expensive products that are no more interoperable than their smaller, more affordable, easier to implement and use, un-certified cousins. The only interoperability that CCHIT certifies today (for an exorbitant price) is vanilla communications that are anyway enforced by reference Labs and pharmacy gateways. There is no trace of the “massive” data exchange that the report is alluding to, unless you count the measly patient summary that can be easily printed on a piece of paper with more reliable results.
    The vast majority of CCHIT certification today deals with a multitude of minute and irrelevant function points that have nothing to do with interoperability and the lofty goals ahead of us. Do we really have to maintain audit logs in a specific format that is almost impossible to read? Do we really have to be able to mark any routine x-ray as posing danger to the patient? Is this what the government is proposing to spend tax payer’s money on? I submit that today’s CCHIT is nothing more than a protectionist vehicle for those large vendors that founded it and still exercise undue influence on the entire process.
    I thought this administration is supposed to bring us change.
    So let CCHIT certify standards of true interoperability. Let it certify basic requirements for privacy and security not workflows and minutia. Let there be wide arrays of products so physicians can have choices of price, workflow, functionality, shape, color, flavor and texture. Let small companies innovate and let the large vendors compete, if they can, without special favors from government agencies and without having the tax payer finance the unreasonable prices they impose.
    The time for special interests and old boys clubs was supposed to be over on January 20. Am I mistaken?

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