March 25, 2009
Stimulating the Adoption of Health Information Technology
A commentary from today's New England Journal of Medicine from David Blumenthal, M.D., M.P.P. National Coordinator for Health Information Technology.
Exerpts
One of HITECH's (health information technology - collectively labeled HITECH in the law) most important features is its clarity of purpose. Congress apparently sees HIT — computers, software, Internet connection, telemedicine — not as an end in itself but as a means of improving the quality of health care, the health of populations, and the efficiency of health care systems.
To achieve this goal, the law takes several approaches. It starts by creating a leadership structure to guide federal HIT policy: the Office of the National Coordinator of Health Information Technology (ONCHIT) within the Department of Health and Human Services (DHHS). ONCHIT currently exists under executive authority, but HITECH enshrines it in statute and greatly expands its resources. One of the national coordinator's first responsibilities will be to create a strategic plan for a nationwide interoperable health information system, a plan that must be updated annually. Two statutory committees will advise the coordinator: a Health Information Policy Committee and a Health Information Standards Committee.
From the standpoint of physicians, the legislation's most important provision may be $17 billion in financial incentives intended to get doctors and hospitals to adopt and use EHRs. Starting in 2011, physicians can receive extra Medicare payments for the "meaningful use" of a "certified" EHR that can exchange data with other parts of the health care system. These payments can total as much as $18,000 in the first year in the case of physicians who adopt in 2011 or 2012, with at least $15,000 for physicians who adopt in 2013 and a slightly lower amount for those who do so in 2014; incentives are gradually reduced and then ended in 2016. Thus, physicians demonstrating meaningful use starting in 2011 could collect $44,000 over 5 years. Waiting until 2013 would result in a maximum bonus of $27,000 over 3 years. Experts estimate the cost of purchasing, installing, and implementing an electronic-records system in a medical office at about $40,000.
Mindful of concerns about privacy and the security of electronic-records systems, HITECH strengthens protections of health care information as well. It extends the privacy and security regulations of the Health Insurance Portability and Accountability Act to health information vendors not previously covered by the law, including businesses such as Google and Microsoft, when they partner with health care providers to create personal health records for patients. It requires health care organizations to promptly notify patients when personal health data have been compromised, and it limits the commercial use of such information.
The nation's economic woes have given birth to an unprecedented federal effort to modernize the information systems of a troubled health care system. It is now up to the government and the nation's health care professionals and facilities to turn this opportunity into real improvements in the health and health care of Americans.
Stimulating the Adoption of Health Information Technology
David Blumenthal, M.D., M.P.P.