BOSTON and CAMBRIDGE, Mass. -- Financial reimbursements might not be enough to get health care providers in compliance
with electronic health record (EHR) adoption meaningful use criteria.
Providing additional EHR adoption incentives -- and harsh penalties -- through the HITECH Act will get providers into the game, said Dr. JudyAnn Bigby, secretary of Health and Human Services for the commonwealth of Massachusetts. She was speaking at Massachusetts Gov. Deval Patrick’s two-day health IT seminar last week.
She said that -- in addition to the federal HITECH funds and resources it offers -- Massachusetts will use an additional carrot and stick: Enforcing a 2008 law requiring physicians to demonstrate EHR competency by 2015 or lose their eligibility for license renewal. Under the same law, hospitals can also miss out on state public health department recertification come renewal time if they are not using computerized physician order-entry systems and EHR systems certified by the Certification Commission for Health Information Technology.
“It’s not a payment mechanism, but that’s the stick here in Massachusetts,” said Bigby, who was among other state and federal officials and 16 health IT vendor CEOs to discuss EHR adoption last week.
Hamid Tabatabaie, Life Image Inc. CEO, said states have another stick: their Medicare and Medicaid budgets. Requiring certain behaviors, such as procuring medical images in a sharable format, in order to receive reimbursement could effectively hasten health IT system interoperability and EHR adoption. Private payers would probably follow suit, too, he added.
Streamline health privacy laws, get payers involved
Also at the conference, Dr. David Blumenthal, national coordinator for health information technology, moderated a session including Bigby, Vermont Gov. Jim Douglas and Arkansas Gov. Mike Beebe. Blumenthal said payers, not just providers, need to get more involved in the nationwide health IT build out. They do not necessarily need to fund EHR adoption among physicians and hospitals, Blumenthal said, but to reward improved performance coming as a result of electronic health data systems.
It’s not a payment mechanism, but that’s the stick here in Massachusetts.
Dr. JudyAnn Bigby, secretary, Massachusetts Health and Human Services
Getting payers involved would help grease the skids, agreed Dr. John Halamka, CIO of Beth Israel Deaconess Medical Center, chair of the U.S. Healthcare Information Technology Standards Panel and co-chair of the Office of the National Coordinator’s HIT Standards Committee.
“The answer is alignment of incentives,” Halamka told SearchHealthIT.com. “There are cases where payers would asymmetrically benefit from care coordination and wellness; there should likely be a gain share. I’m not certain this is a situation where payers just say, ‘Here’s millions of dollars, go build it,’ but to say, 'As we coordinate care, as wellness results, as revisits to hospitals go down, then let’s figure out how to share that savings.’”
Douglas and Paul Grabscheid, vice-president of strategic planning at InterSystems Corp., noted that a major snare to interstate health data exchange is the state-to-state variation in health privacy laws that makes exchange difficult to achieve and compliance near impossible. The differences make it especially tough when getting to the nearest big hospital for care requires crossing a state line.
“The variations in privacy law from state to state are really an impediment to doing business in a consistent way,” Grabscheid said.
Develop broadband infrastructure, provide funding
EClinicalWorks CEO Girish Kumar Navani suggested that government should concentrate on building a standards-based network and broadband infrastructure, with input from vendors, to create a sustainable network. He cited the example of cell phones. The Federal Communications Commission set a broadcast standard and, as the network built itself around those standards, cell phones from different carriers eventually talked to one another.
“Playing that kind of catalyst role in facilitating that type of information transfer could lead, I think, to a faster adoption of technology, and a faster adoption of health care information sharing, which then would hopefully get [us] to the bigger questions at hand -- can it reduce health care costs and improve health care quality?” Navani said.
Many vendors, naturally, suggested that more funds would stimulate health IT development and EHR adoption. Some of them -- such as Humedica Inc. chief medical officer Dr. Paul Bleicher -- called not for grants, but for tax breaks. His theory? With such incentives, technology companies might develop tools for the corners of the health IT network that needed it, even if they weren’t profitable undertakings.
The seminar began the morning of April 29 at Microsoft’s New England Research & Development (NERD) facility in Cambridge, and continued that afternoon and the next day at the Westin Boston Waterfront.