$20 Billion Worth of Optimism

Kathryn Mackenzie, for HealthLeaders Media, January 20, 2009

Electronic medical record adoption has stalled. It's as if the industry hit a hump and couldn't ever quite get enough momentum to get over it. Then last week Democratic leaders in the House of Representatives unveiled an $825 billion tax cut and spending bill with a huge chunk set aside for healthcare initiatives, including $20 billion to modernize health information technology systems.

There is no doubt that $20 billion is a lot of money, but it's certainly not enough to buy every physician practice in the United States an EMR. So I was curious to see what your reaction to the stimulus plan would be. I wanted to know how you expect to see the money spent and, more importantly, if you think this could be the nudge the industry needs to get over this hump.

Luckily there has been no shortage of people willing to share their opinions with me. Shortly after the stimulus plan was announced, I began receiving calls and emails from a number of you, including a sprinkling of CIOs, some vendor-types, and one or two industry analysts, and the picture that began to emerge was, well, surprising. The overall sentiment is one of optimism. Maybe slightly colored by caution, but optimism nonetheless. The money itself is important, but it is the inclusion of health IT in the economic stimulus package that has caused a stir of excitement.

"We have heard a lot of talk about technology and adoption over the last few years, but we have seen nothing done to actually make adoption happen. What we're hearing and seeing now seems to be a sincere interest and motivation on the part of Congress in improving this situation," says Stephen Lieber, president and CEO of HIMSS. "The technology is there. The barrier of adoption has not been a question of whether the technology is ready or if we should wait until it advances to a different level. The barrier has been financial."

Lieber has a point. Your average primary care providers are not getting paid to manage data, they are getting paid for office visits, diagnostic tests, and procedures. So what does a family practice physician have to gain from digitizing his practice?

It's that question that the healthcare portion of the economic stimulus package is meant to address. The proposal includes $18 billion to be parceled out to hospitals and physicians through a combination of grants, loans, and incentive-based payments. And, for physicians who do not make the switch to digital, Obama is expected to eventually propose lowering reimbursements from government-subsidized healthcare programs. The proposal also includes provisions for establishing more standards and increasing interoperability, which are both going to be needed to boost adoption, says Sarah Corley, NextGen Healthcare's Chief Medical Officer.

"We definitely think there will be some money spent on helping interoperability. And that's where funding toward standards comes in, because I think that lowers the barrier to adoption for a lot of practices. If they feel this information can be shared, while saving them costs and improving healthcare, that will probably push adoption," she says.

The proposal also provides for $2 billion to be managed by the Office of the National Coordinator. Though ONCHIT hasn't specified what aspects of HIT it will target, it's expected it will be used to further the national health information network and possibly for grants to help providers purchase CCHIT-certified HIT products. "We do believe that money should be used for the acquisition of HIT that is based on nationally accepted standards from the Healthcare Information Technology Standards Panel and certified by the Certification Commission for Healthcare Information Technology," says Lieber. "The main point behind that is that the technology has already gone through these processes that are broadly endorsed by the private and public sector."

While I'm as skeptical of politicians as the next guy, it seems that Obama, with the help of his economic team, has already begun to follow through on at least one of his campaign promises, and it's only his first day in office. Including health information technology in the economic stimulus plan is proof to me (and it seems you, too) that President Obama meant what he said when he pledged to bring our healthcare system into the 21st century.

Kathryn Mackenzie is technology editor of HealthLeaders magazine. She can be reached at kmackenzie@healthleadersmedia.com.
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