For the health care industry, 2009 was a year of sudden change. One provision of the American Recovery and Reinvestment Act, the economic stimulus bill signed into law by the Obama administration on Feb. 17, allocated more than $19 billion to stimulate the adoption of health IT and the meaningful use of electronic health record systems, which only a small percentage of health care providers are using. Cash and Medicare or Medicaid reimbursements were included in ARRA as incentives for providers and hospitals to adopt EHR systems between 2011 and 2015. After 2015, penalties will be levied on organizations that have failed to adopt these systems and practice their meaningful use.
The Health Information Technology for Economic and Clinical Health Act (HITECH Act) within ARRA has attracted its share of controversy in the past year, starting with the sheer number and breadth of its criteria. Among the Act's most-talked-about requirements: Using computerized physician order entry, or CPOE, systems; maintaining medical information in structured electronic records; reporting quality data to the Centers for Medicare & Medicaid Services (CMS); and providing patients who request it an electronic copy of their information. The last criterion, especially, is a reflection of the American population's general fears about the privacy and security of personal data, and has led to state-level efforts to legislate data encryption.
These HITECH Act criteria, among a great number of others, represent the scope of meaningful use according to CMS; but the term itself was still not clearly defined as late as the middle of last December -- adding to providers' difficulty in meeting what they see as a steep 2011 deadline.
There was also the unforeseen problem of harmonizing certification with meaningful use. The definition of certification -- the health care software-rating criteria of the National Institute of Standards and Technology -- was slated to be codified by December, along with the definition of meaningful use; until then, physicians and health care organizations continued to deal with the confusion of the two terms. As Dr. John Halamka noted, however, meaningful use is about how the software is used, not the software itself. The unwarranted label of "meaningful use" on vendors' software, then, was another issue clinicians dealt with in the rush to implement EHR systems.
Apart from its requirements, EHR's potential implementation cost is also of great concern to health care organizations. ARRA provides for a $44,000 rebate for each health care provider that adopts an EHR system by 2011, but data center managers remained uncertain about whether this rebate would be sufficient to cover the extensive expense of adopting such systems, especially with fewer than 20% of doctors and about 10% of hospitals employing them as of last September. Many health care organizations do not know whether doctors will have to pay as much as $100,000 out of pocket.
Another facet of the issue of EHR's cost feasibility is the consequences of missing the HITECH Act's 2015 deadline, which, according to a PricewaterhouseCoopers report, could, for example, result in a 500-bed hospital missing $3 million a year in reimbursements -- even though 70% of hospitals (and 90% of physicians) do intend to implement EHR systems by 2019. In addition to this potential out-of-pocket spending, health care IT managers confronted such medical record digitization obstacles as drafting data retention policies, purchasing storage hardware and scanning countless paper records into the new EHR systems.
Under the radar, however, were the probable benefits of EHR technology. Health care IT analysts repeatedly stressed that these ends would justify the means. Aside from the immediate effect EHRs will have -- eliminating the hassle of dealing with paper records that make it difficult for organizations to share information -- the technology's potential to save health care organizations money in the long run has drawn plaudits from many. EHR systems offered unanticipated benefits, such as its ability to document health care disparities and to improve the quality of care for the underprivileged.
The HITECH Act has had its share of controversy in the past year, starting with the sheer number and breadth of its requirements.
EHR vendors were also thought to be positively affected, according to recent assessments of the EHR software market. Even with the abundance of objectives for EHR systems, vendors, too, face incentives, because less than up-to-par applications are not as likely to interest physicians and hospitals looking to buy quality EHR systems. Another result of the HITECH Act was continuous innovations, including offerings of small, specialized modules; the adoption of open-source application development standards; and the targeting of various specific niches within the health care community.
Although in the past year many doctors, health care organizations and IT developers alike expressed qualms over the HITECH Act's very specific criteria and deadlines, many also commended its overall goal of more and easier information collaboration and sharing through EHR applications -- as well as its being a financial boon to health care. A greater number also praise EHR technology's potential to improve health care safety and quality.
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