Will the HITECH Act be Effective or a Bust?

When it comes to implementing electronic health record systems and exchanging health information electronically, healthcare providers are being incentivized, nudged, or hit with a stick. As everyone reading this probably already knows, healthcare providers have until 2015 to be deemed "meaningful users" of certified EHRs before they are penalized under the regulations outlined in the HITECH Act.

The big question is will we spend this stimulus money in a way that truly makes healthcare more cost effective and improves the quality of care for patients. Almost every one that I talk to makes a point to say that the HIT Policy committee is approaching this the right way—although they may grumble about recommended guidelines being too aggressive or not aggressive enough.

A lot of questions still remain and the final definition of meaningful use and the certification criteria for vendors likely won't be finalized until the first quarter of 2010. So will the HITECH Act—based on where we are headed and the work that has already been done—achieve its goals? I know. It's a tough question to answer and no one has that crystal ball to glimpse into the future. But if we are getting off track, the time to correct the situation is now or we could end up wasting a lot of tax payer money for naught.

"We have a fragmented healthcare system where patient data is not available, so we want informational integration at least," J. Marc Overhage, MD, PhD, director of medical informatics and research scientist at Regenstrief Institute, Inc. and president and CEO of the Indiana Health Information Exchange, told me during an interview for HealthLeaders magazine's August cover story, "Hang On."

We were discussing whether smaller community and rural providers would be left behind and the impact that would have on the healthcare system as a whole.

"It is important that we move the whole market and not just fragments of the market," said Overhage, adding that "if I can send and receive healthcare data, but no one else is out there to do it—the patients won't get any benefit."

The challenges for rural providers are well documented. Certain regions still have limited or no Internet connectivity, many rural providers are barely scraping by financially and have extremely limited access to capital to purchase EHRs or build the infrastructure required to support the EHR, and most do not have the IT support staff to implement and maintain EHR systems or negotiate with vendors to ensure all of the certification requirements for meaningful use will be covered.

There are hardship exceptions available for critical access hospitals in the regulations, vendors are offering flexible payment solutions where providers can pay for systems on the backend, and there are grants for regional extension centers and states to help providers implement EHR systems and achieve "meaningful use" and establish health information exchanges. But time keeps ticking, deadlines are looming, and there is still an enormous amount of work to be done. It seems to me that many of the providers who need the incentive payments the most are probably facing penalties instead.

There will be thousands of hospitals and physicians trying to do the right thing very quickly, says Overhage. "The risk is significant that we won't do it right."

With the likelihood that many rural and small community providers will lag behind, will that threaten to drag the whole effort under or can the early adopters and larger systems achieve enough success to keep the momentum towards a national electronic health system moving forward?

I don't have the answers. And the early adopters of EHRs have concerns of their own. Many do not know whether their existing systems will be certified or if they will have to make major upgrades to their existing systems or even start from scratch.

The demand on vendors from existing clients could be enormous not to mention all the new clients that will want to implement systems—and fast. I know vendors are promising they will have the resources to meet the demand and their systems will be certified. I guess time will tell whether they were right.