Healthcare providers looking for assistance with the adoption of EHRs may be in for a pleasant surprise, according to the Health Information Technology (HIT) Extension Program included in the American Recovery and Reinvestment Act of 2009 that President Barack Obama signed yesterday.
Title XIII of the Act focuses on HIT and quality, with $19 billion in grants and loans set aside for infrastructure and incentive payments under Medicare and Medicaid for providers who adopt certified EHR technology. The grants and loans include $17 billion slated for incentives, with $2 billion allotted to jump-start health IT adoption.
The Act also formalizes in statute the establishment within the Department of Health and Human Services an Office of the National Coordinator for HIT that was created during former President George W. Bush's administration. In addition, the Act establishes HIT policy and standards committees to promote a nationwide infrastructure.
Effectiveness of the incentives remain unknown
Will this be the much-needed fire to spark a widespread EHR adoption? Industry experts remain skeptical.
"I think it will help the industry move forward over the long haul, but do I think that we're going to see significant transformation over the next year or even two years? No I don't," says Chris Apgar, CISSP, president of Apgar & Associates, LLC in Portland, OR. "Yes, funds must be available, but ultimately, when it gets down to it, providers have to buy into it, and that's not going to be quick."
Others say the allotted funds may not be enough considering the colossal financial burden associated with an EHR implementation.
"Compared to the percentage of the GNP [gross national product] that healthcare is and the billions and billions of dollars that it costs to provide healthcare, it's sort of a drop in the bucket," says Darice Grzybowski, MA, RHIA, FAHIMA, president of HIMentors, LLC in LaGrange, IL. "However, any incentive for hospitals to adopt better electronic document management technologies is a step in the right direction. Motivation to get started is half the battle."
Interoperability remains yet another challenge in fostering a nationwide infrastructure, Apgar says. "Just because I incentivize someone to purchase and install an electronic health record doesn't mean that the electronic health record can talk to another electronic health record," he adds.
Smaller providers, clinics, and physician practices may benefit most from the financial assistance because of their tighter budgets, Apgar says. The information that these providers—particularly primary care physicians—gather is also important from a health data exchange standpoint, he adds. These physicians hold the much-needed patient demographic information, medical history information, and anecdotal data that will help improve overall patient care across a variety of settings.
Still others have a more hopeful outlook now that Congress has stepped up to the plate. AHIMA, for example, has been a long-time proponent of widespread EHR adoption.
"Besides the overall impact of improving patient care through the adoption and use of standard electronic health records, AHIMA is pleased that Congress recognized the need for individuals educated and trained health information management and informatics to facilitate the adoption, implementation, and management of EHRs, and electronic health information exchange," says Dan Rode, MBA, CHPS, FHFMA, vice president of policy and government relations for AHIMA in Washington, DC.
Funds to assist in a variety of initiatives
The $19 billion in state and federal funds will be available through the National Coordinator, Health Resources and Services Administration, the Agency for Healthcare Research and Quality, CMS, the Centers for Disease Control and Prevention, and Indian Health Services to provide the following:
- An HIT Research Center that will render technical assistance and publish best practice guidance
- Regional centers to assist and educate providers as well as disseminate information from the Center to various regions of the country
- Planning and implementation grants for states or state-designated entities
- Grants to establish loan programs to state or Indian tribes for the purchase of certified EHR technology, provide training, or upgrade systems to meet certification requirements
- Competitive grants to fund demonstration projects to integrate EHR technology into the clinical education of health professionals
- Assistance in the creation or expansion of medical health informatics education programs at institutions of higher education or consortia of institutions
And it doesn't stop there. Aside from the planning and implementation grants and loans, the Act also creates several incentives for the adoption of EHRs. The allocation schedule (i.e., when and how monies will be distributed) has not yet been clarified.
Potential negative consequences for no implementation
Hospitals that don't jump aboard the EHR bandwagon could see larger—and negative—ramifications down the line, Apgar says. "In the future, Medicare may require providers to have an interoperable EHR that meets national standards as a prerequisite for participation. Medicare will use its buying power rather than regulation or statute."
But just because the funds are available doesn't mean that they will benefit every provider, particularly those who may not need a certified system that includes all of the bells and whistles, Apgar adds. "From a business standpoint, it may not make sense to accept a couple thousand dollars and put it in a system that doesn't do what you need it to do," he says.
Incentives could boost health IT jobs
Aside from creating an impetus to implement EHRs, the stimulus plan could also significantly spark employment in the HIT sector, according to a January 2009 report published by the Information Technology and Innovation Foundation (ITIF), a Washington think tank. ITIF estimates that a $10 billion investment in HIT would create as many as 212,000 new or retained U.S. jobs a year.
"It will definitely have favorable implications from an employment perspective for those in the HIT or HIM fields," says Daniel J. Pothen, MS, RHIA, CHPS, CHPIMS, CCS, CCS-P, CHC, director of clinical informatics and health information services at Mission Hospital/CHOC in Mission Viejo, CA.
Editor's note: To learn more about HIT initiatives, view the American Recovery and Reinvestment Act of 2009. Click on "bill text division A" in the "conference report" column for more specific information related to EHRs and Title XIII.
Lisa Eramo, CPC, is Senior Managing Editor of Medical Records Briefing, a monthly publication from HCPro, Inc.