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 ofMedical Records Briefing, a monthly publication from HCPro, Inc.
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Last week's robotic partial nephrectomy was actually the second surgery that was blogged live by the Detroit-based system. In January, Henry Ford surgeons performed robotic surgery to a remove a cancerous bladder while simulcasting live to a symposium the hospital had organized in Las Vegas and blogging the surgery on Twitter, an increasingly popular micro-blogging site that limits users to writing posts of 140 character or less.
General curiosity aside, one reason the Henry Ford Twitter surgeries have garnered so much attention is the educational possibilities they bring to light for medical students, providers, and the public. Bill Ferris, Web services manager at Henry Ford, who helped set up the live Twittering, says the hope is that Twitter will eventually be used as an educational tool for medical students and residents learning about specialized medical procedures.
"We saw this as a great opportunity for medical students and doctors to be able to interact live, even if at 140 characters at a time, with the surgeon in the operating room. With this second surgery we saw an increase in followers from physicians and patients and a greater mix of questions. Some about robotic surgery in general, some specific questions about the case. Overall we see it as an effective way to interact with the surgeons as they perform the procedure," says Ferris, who says the hospital also plans to delve into another form of social networking by launching a Facebook page at some point in the near future.
"Right now we are just trying to figure out how it would fit into our strategy. We're looking at a lot of options: Hospital communications, a patient support group, another way for hospital staff to connect, a recruiting tool. There's a lot to consider," he says.
So how does a Twittered surgery work? In this case, the primary surgeon, Craig Rogers, MD, sits at a terminal guiding a robot from a remote console about eight feet from the patient. The entire surgical procedure is being displayed in 3-D on large monitors in the OR, so the person doing the Twittering, Rajesh Laungani, MD, chief resident of urology at Henry Ford Hospital, can give Twitter followers a play-by-play of the surgical action.
He can also ask specific questions of the surgeon as they come across his laptop screen, says Ferris. "The fact that this allows for interactivity as well as an archive for future review, are both important components. We recognize that we don't have it all figured out, I think we learned from this that we would like to incorporate video and more multimedia, but overall it's generated some really positive buzz."
Buzz aside, just how useful Twitter and the like will be in terms of formal medical education remains to be seen. Right now a physician isn't going to get CME credit, for example, simply by asking a question during a Twittered surgery. But Lawrence Sherman, president and chief executive officer of the Physicians Academy for Clinical and Management Excellence, an accredited provider of CME/CPD, says even slow adopters are beginning to see the value of social networking sites when it comes to education.
"Currently, the main value we're seeing is with peer-to-peer communication. As a CME provider I've been looking at different ways to use social media and incorporate it into CME. There are strict guidelines about what qualifies and simply tweeting without a needs assessment isn't going to cut it," he says. "However, I do think there are other ways to use social media and CME. For example, public and proprietary social media sites are good for making CME announcements or for tweeting from activities for people who can't get there."
And therein lies the real strength of sites like Twitter and Facebook. Whether they are ever recognized formally by accrediting agencies for their educational value, the peer-to-peer educational and networking opportunities offered by them should not be underestimated.
Take my own experience writing this column, for example. Friday morning at 10:00 a.m., I wrote on Twitter that I was "Writing my column for this week. Topic: social media in healthcare." Within 30 minutes I had a message from Joel Selzer, co-Founder and CEO of Ozmosis Inc., (which has a great blog on the use of social networking in healthcare) offering to answer any questions I had for the column. By noon, Joel had kindly introduced me via email to Sherman who informed me he had just landed in L.A. and I should call him at his hotel. In the space of two hours I had two new contacts and had completed an interview. For someone who is used to spending hours trying to track people down, hoping they have something relevant to say about the topic at hand, this was nothing short of miracle.
This kind of instant access to experts is exactly what Henry Ford offered with its Twittered surgery, and I can only hope that more hospitals will follow in their footsteps.
Kathryn Mackenzie is technology editor of HealthLeaders magazine. She can be reached at kmackenzie@healthleadersmedia.com.
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