Arguments about and disapproval of President Barack Obama's health care reform law are intensifying, and the future of mandatory insurance remains uncertain. There's little doubt, however, about the future of the other significant reform handed down to the industry -- the regulations spelled out in the Health Information Technology for Economic and Clinical Health Act, or
The Patient Protection and Affordable Care Act, known colloquially as ObamaCare, passed in March 2010. The law faces challenges from states arguing that the individual insurance mandate (which requires U.S. citizens to purchase insurance) is unconstitutional. A federal judge in Virginia ruled in agreement with that assessment. Two other federal judges previously ruled in favor of ObamaCare, however, and the Supreme Court is expected to take up the case at some point. In addition, newly elected Congressmen have stressed that repeal of the law is the centerpiece of their platform.
The reform law does contain some health IT provisions, most of them related to the development of Accountable Care Organizations. Nevertheless, the expanding effort among providers to adopt electronic health record (EHR) systems and implement IT comes from a different law: the American Recovery and Reinvestment Act of February 2009.
The stimulus law's requirements are bundled with the HITECH Act's regulations, which mandate a variety of programs for federal agencies, states, health professionals and vendors if they want to participate in federal EHR incentive programs. The centerpiece program includes the meaningful use of health IT, which requires providers to follow specific criteria if they want to be eligible for funding. That program is overseen by the Centers for Medicare & Medicaid Services (CMS), and its funding comes from the stimulus law, not the health care reform law.
The distinction is important, because there is no talk of any changes being made to the stimulus law. And that means health IT is here to stay, officials say.
Indeed, health IT serves as the backbone of health care reform, regardless of any other legislation, said Jonathan Perlin, chief medical officer and president of clinical services for the Nashville, Tenn.-based HCA Inc. health system. He co-chairs the Health IT Standards Committee for the Office of the National Coordinator for Health Information Technology (ONC), which is overseeing the meaningful use program jointly with CMS. The committee develops recommendations for which technical standards should be incorporated into health IT applications.
Technology is a tool for ensuring more effective care, and both providers and patients are placing higher value on that performance, Perlin said. IT investments were already happening; the HITECH Act regulations "expedited what was likely to occur."
HITECH Act regulations enable IT investment in tough times
It was the timing of the HITECH Act that allowed Mount Sinai Medical Center in New York City to move forward with its inpatient EHR implementation. The health system was focusing on rolling out IT applications in its ambulatory settings during a 2006 plan, according to Dr. Bruce Darrow, assistant professor of medicine and cardiology. He's also physician champion for the hospital EHR implementation using software from Epic Systems Inc. When the recession hit in 2008, the project was put on the back burner, but HITECH Act regulations helped the hospital get back on track.
"It's ferociously hard to put this in place," Darrow said. Without the hope of stimulus funding, the implementation would have been more piecemeal, he added.
Mount Sinai expects to complete its inpatient system by June 2011, and says it's ready to meet meaningful use criteria. The ambulatory settings' system is 90% complete and will be finished next year as well.
In 10 years, could you imagine going to a hospital working without a computer system in place?
Dr. Bruce Darrow, Mount Sinai Medical Center
The criteria are not flawless, said Darrow, who has been using Mount Sinai's EHR system since 2006. The broad requirements are scaled to benefit larger systems and multipractice locations, not individual doctors. Specialty physicians, for example, aren't always looking at a patient's height and weight. "If I'm an ophthalmologist, I don't care how tall or short the patient is," he said. "I just want to take care of the eyeball." (The same is true for radiologists addressing meaningful use.)
That said, the HITECH Act is spurring necessary development, Darrow added. "In 10 years, could you imagine going to a hospital working without a computer system in place?"
The HITECH Act regulations help align incentives and objectives for the use of health IT, said Dr. Paul Tang, an internist who is vice president and chief medical information officer for the California-based physician organization Palo Alto Medical Foundation. He also co-chairs the ONC's Health IT Policy Committee, which is charged with devising recommendations for Stage 2 meaningful use criteria. "It's still in everybody's best interest to widely adopt IT in clinical practice."
The policy committee is learning from how it developed Stage 1 meaningful use criteria to come up with a roadmap for the next two stages, Tang said. In addition to monitoring how well providers implement meaningful use criteria in 2011, the policy committee is going to ask for feedback from stakeholders regarding the final two stages before releasing its draft policies.
Policymakers hope to have a draft for both Stage 2 and Stage 3 by the summer of 2011. That timing will give providers and vendors more than a year to consider upcoming criteria and how those will fold into the work already being done for Stage 1. "It's not a matter of just turning on software; it never was," Tang said. "We need to use these tools to help our practice. That's always been true."
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