VoiceIt: USA: "On track for meaningful eHealth"

HealthTech Wire / VoiceIt) - For many healthcare IT professionals around the world, the US is currently the most exciting place on earth. A vast amount of money is being invested in order to get hospitals and doctors to adopt electronic health records (EHR). What most consider particularly interesting is what is referred to as “meaningful use” of EHRs. HealthTech Wire had intended to discuss “meaningful use” and the associated incentive program at the German Health-IT conference conhIT 2010 in Berlin with Harry B. Rhodes, Director of Practice Leadership at the American Health Information Management Association (AHIMA). The discussion fell victim to the volcano Eyjafjalla. Here is a telephone interview with Mr. Rhodes instead.

Published: 05/05/2010

Why did the US administration decide to place health IT so high on the agenda?

Many people and organizations in the US have been working on digitizing the US healthcare system for quite a while already. But we had to come to terms with the fact that, overall, we were falling short of our established goals. An analysis of a recent survey of hospitals published in the March 25, 2009, New England Journal of Medicine revealed that only 1.5% of all hospitals currently have a comprehensive electronic health record system on all clinical units. Another study by the Rand Corporation revealed that common barriers to the implementation of health information technology in general included an inadequate capital base for the purchase of healthcare IT and concerns about the return on investment. We all know that healthcare costs are skyrocketing. For the US, the current estimate is that costs will reach 3 trillion US$ annually by 2012. Given this situation, increasing investments in healthcare IT was a straightforward decision. According to some estimates, implementing EHRs nationally will bring an immediate saving in the region of 80 billion US$, plus 40 billion US$ annually.

How much overall funding is being provided in the US government’s healthcare IT program?

The entire economic stimulus package (ARRA) of 2009 was worth 787 billion US$. Some 5% of this goes into healthcare IT. The amount budgeted through the Medicare and Medicaid reimbursement systems is 20.819 billion US$ in incentives to assist providers and organizations in the adoption of electronic health records. Another 12 billion US$ of funding is available for related issues such as broadband, telemedicine and IT-related construction and research.

The concept of “meaningful use” is at the heart of the US healthcare IT program. What is it about?

The idea is that funding which benefits doctors and institutions is not meant simply for buying an EHR, but rather for getting an EHR on track in a medically meaningful way. So it is not enough to show the authorities the bill for the new software. The certified technology must be connected to allow for the exchange of health information and improve the quality of care, and the certified EHR must be able to submit information for public health reporting and clinical quality measures. The “meaningful use” program is an incentive program, not an entitlement program. No healthcare organization – provider or hospital – is required to apply for or participate in the program for the first five years. Beginning in 2016, however, the program becomes mandatory. For every hospital that wants to take part in the “meaningful use” program, an initial base amount of 2,000,000 US$ will be provided, plus a “discharge-related amount”, depending on the number of discharges. Every participating physician can potentially receive up to 44,000 US$. Once the physician’s eligibility has been verified and meaningful use demonstrated, and the threshold for maximum payment has been reached, a full incentive payment will be made. If at the end of the incentive program lifecycle “meaningful use” cannot be demonstrated, Medicaid/Medicare reimbursement will be reduced over time.

Rewarding “meaningful use” implies that someone has to define what meaningful use is…

That’s right. Broadly speaking, health information exchange (HIE) has emerged as one of the key aspects of what “meaningful use” is about. When it comes to the actual definitions of “meaningful use”, the Office of the National Coordinator chartered two committees to develop the definition: the HIT Standards Committee and the HIT Policy Committee. The latter included physicians who considered “meaningful use” from a medical point of view. This is indeed one of the hallmarks of the whole program: “meaningful use” is defined not only technically, but also medically. For example, among the “meaningful use” criteria, you will find that 80% of all orders will have to be administered electronically. This is undoubtedly a technical criterion. The medical aspect is the expected implementation of drug-drug, drug-allergy, drug-formulary checks. Other “meaningful use” requirements that will improve quality, safety and efficiency while reducing health disparities include the maintenance of up-to-date problem lists and medication lists, the incorporation of  clinical lab test results into the EHR as structured data, and the ability to exchange key clinical information electronically.

What is the timeframe for the meaningful use program?

The timeframe is pretty ambitious. The criteria for demonstrating meaningful use will be delivered in three stages. Work on stage 1 deliverables begins in October 2010, the start of the Medicare fiscal year. In 2011, eligible providers and hospitals must demonstrate compliance with stage 1 requirements. Institutions will have to demonstrate and attest that they were able to electronically capture  and report measurements over a period of 90 days. Stage 2 requirements will need to be fulfilled by 2013, and stage 3 requirements by 2015. Institutions that are not able to meet requirements by the end of 2015 will experience reductions in Medicaid/Medicare reimbursements.

How important are privacy issues?

The EHR solutions implemented are expected to meet the definition of “certified EHR technology” as defined in the certification rule. AHIMA is a long-time proponent of EHR systems testing and certification and was one of the three founders of the Certification Commission for Health Information Technology (CCHIT) in 2004. Privacy and security standards are expected to be applied to the certified EHR. These standards cover encryption and decryption, authentication, verification, and “record actions related to electronic health information”, plus “record treatment, payment, and health care operations disclosures.” The latter two are directly related to the upcoming requirement to provide the patient with an accounting of disclosures upon request.

And what about technical standards?

The expectation is that the Office of the National Coordinator of Health Information Technology will leverage the standards, certification and information exchange progress of recent years. A lot of work has gone into harmonizing the existing standards. Standards development organizations such as HL7, ASTM and IHE have all contributed to standards harmonization. The idea is that by defining “meaningful use” criteria, existing standards will be implemented by more and more vendors. Health information exchange is not possible without standards. For vendors the key to success will be reaching a consensus on harmonized standards.

Mr. Rhodes, thank you for your time and answers. (HTW)

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