By John Moore

New York State has awarded about $60 million in grants for localized health information technology projects, one of three rounds of grants recently issued under the state’s Health Care Efficiency and Affordability Law for New Yorkers (HEAL NY) initiative.

Gov. David Paterson announced grants totaling $436 million on Sept. 25. In addition to health IT, the grants will fund collaborative projects among hospitals and improvements to long-term care.

The state will allocate the funds through its Department of Health and the Dormitory Authority of the State of New York.

The health IT portion of the grants, HEAL NY Phase 10, targets community-based projects focused on information sharing. Examples include a $6.7 million grant to the Fort Drum Regional Health Planning Organization to help launch electronic health records and health information exchange to “improve coordination of care for adult patients with chronic pulmonary disease,” according to the health department.

HEAL NY Phase 11, meanwhile, provides more than $174 million in grants that aim to promote collaborative arrangements among hospitals in an effort to boost the quality and efficiency of care delivery. In HEAL NY Phase 12, more than $172 million in grants will be issued to 19 applicants for long-term care related projects.

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Bernie Monegain, Editor

CHICAGO – The Obama adminstration’s chief for healthcare IT technology David Blumenthal, MD, was on the healthcare IT message from dawn to dusk Thursday - a part of the White House campaign to save its troubled healthcare reform plans.

The day started with an open letter from Blumenthal about the benefits of electronic health records and ended with another open letter from him on the $1.2 billion HITECH grants that had been announced earlier in the day.

Blumenthal joined Vice President Joseph Biden and Health and Human Services Secretary Kathleen Sebelius at Mt. Sinai Hospital on Chicago’s West Side for a roundtable discussion with nurses, doctors and administrators.

At the forum, the trio announced $1.2 billion in HITECH grants would be released - $598 million to create 70 health information technology extension centers across the country to help physicians and hospitals implement electronic health records and $564 million to help states support the development of health information exchanges.

“This is just the first wave of resources invested in health technology aimed at really transforming our paper-driven system to an electronic system over the next several years, providing help and support for hospitals and doctors as they make this conversion,” Sebelius said.

“It’s no coincidence that these two grant programs are leading the way,” Blumenthal said in this open letter at the end of the day. “Key to the successful adoption and meaningful use of EHRs is the assurance that providers have the help and guidance they need to select, implement and maintain a certified EHR system. In addition, we need the various and often disparate local, statewide and regional systems to work together, regardless of location and differing state and federal standards or policies, to enhance patient care.”

After the roundtable at Mt. Sinai, Sebelius introduced Blumenthal on a teleconference with the media. Blumenthal spoke briefly and responded to questions about concerns over data security and the definition of meaningful use of healthcare IT, a measure that will determine which providers are eligible to receive extra payments from Medicare and Medicaid.

He said the definition would be completed by the end of the year. On the security issue, he said the Health Information Technology Policy Committee would be asked to take up the topic of security soon.

“We understand that is critical,” he said. “The information that is passed within the healthcare system has to be secure or the public won’t have confidence in those electronic health records.”

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By the Associated Press

President Barack Obama began a week that will dwell heavily on overhauling the healthcare system, declaring himself confident Congress will pass “a good healthcare bill” even though some Republican opponents were trying to kill the measure for political gain.

At the same time, the president and some members of both parties were shifting from hard positions about a government insurance option toward some agreement on reducing medical care costs and restricting insurance company practices

Consensus appeared to be growing on the need to prevent the insurance industry from denying coverage to those with existing medical conditions or canceling policies when a person becomes seriously ill.

A Washington Post-ABC News poll published Monday found the public in a virtual deadlock on the Democrats’ health plan, with 46 percent favoring the proposed changes and 48 percent against them. Americans are also closed divided on whether they should be required to have health coverage, with 51 percent in favor and 47 percent opposed.

The survey was conducted Thursday through Saturday, after the president’s address to Congress, and had a sampling error of plus or minus 3 percentage points.

“I believe that we will have enough votes to pass not just any healthcare bill, but a good healthcare bill that helps the American people, reduces costs, actually over the long-term controls our deficit. I’m confident that we’ve got that,” Obama said in an interview broadcast Sunday on CBS’ “60 Minutes.”

Obama’s spokesman, Robert Gibbs, reiterated that the president prefers the public option, but has said “what’s most important is choice and competition.”

Sen. Olympia Snowe, the Maine Republican who could be the party’s only senator who votes with Democrats, believes choice and competition can be ensured without the public option.

“It’s not on the table. And it won’t be,” she said Sunday. “We’ll be using the co-op as an option at this point, as the means for injecting competition in the process.”

Snowe sits on a six-member panel—three from each party—of the Senate Finance Committee that is writing a version of the healthcare overhaul bill.

Instead of the government running a program that provides low-cost health insurance, Snowe and fellow negotiators are considering a not-for-profit cooperative system. Those backing the measure contend it would substantially lower health insurance premiums by cutting out private-industry profits and guarantee coverage to all who want it.

Such systems exist in some areas of the country but their success has been spotty.

Obama is trying to sweeten the deal for Republicans by indicating he is open to their ideas.

In his Wednesday speech and again in the CBS interview, the president signaled he was open to so-called tort reform. Under current practice, doctors and hospitals must pay huge amounts to insure themselves against malpractice lawsuits by patients seeking large court-ordered settlements for poor treatment.

Democrats, thanks to heavy backing from lawyers, have not supported Republican efforts to limit such payments. Doctors—and Republican politicians—say the current system drives up costs through unneeded medical procedures ordered by physicians who fear being sued.

“I would be willing to … consider any ideas out there that would actually work in terms of reducing costs, improving the quality of patient care,” Obama said in the Sunday interview, which was taped Friday.

While he said he did not back limits on court-ordered rewards for malpractice, he said “there are a range of ideas that are out there, offered by doctors’ organizations like the AMA (American Medical Association), that I think we can explore.”

Gibbs spoke on CNN’s “State of the Union.” Snowe appeared on CBS’ “Face the Nation.”

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By Sue Hildreth

Consistent Processes, Performance Metrics and Quantifiable Patient Benefits are Long-Term Goals

Many in healthcare and government want to see the wide gap in IT capabilities closed and more providers moved to adopt electronic health records (EHR) systems in order to improve the healthcare industry’s ability to transmit, share and access critical patient data when and where it is needed.

EHR applications range from simple electronic patient charts with demographic data, problem lists and medication lists, to integrated intra-hospital networks with access to diagnostic images, e-prescribing, physician notes, and decision support tools to alert physicians and nurses to potential errors or omissions, and to advise them on the best practices.

Proponents claim EHR not only improves patient safety but can save hospitals – and potentially the U.S. healthcare system – millions of dollars.

Skeptics claim EHR benefits are overrated, and point to the high cost of EHRs, which typically run in the millions of dollars, and to past implementation failures – such as LA’s Cedars-Sinai Medical Center and its failed attempt to get its physicians to adopt a computerized physician order entry system in 2003 – as proof that EHRs may not be right for all healthcare providers.

To be sure, EHR isn’t a cure-all for the healthcare industry’s ills, and the up-front costs of adoption are significant. Neither is the risk of failure miniscule. But that can be said of all major enterprise software projects. The adoption of electronic healthcare records does have the potential to significantly reduce paperwork and administrative overhead, reduce the cost of housing massive paper archives, and improve the speed and accuracy of medical care.

Table 1: Examples of EHR’s ROI by Annual Cost Reduction

Why Healthcare Needs the American Recovery and Reinvestment Act and EHR

The American Hospital Association reported in November that hospitals responding to a DATABANK survey were, on average, $831.5 million in the red in the third quarter of 2008. Cost cutting measures they were making included reducing administrative costs, laying off staff, and reducing services.

EHRs can help improve efficiency of operations and capture more of the patient services that doctors and nurses provide, thus enabling more complete billing (or overcharging, depending on who is arguing the issue).

Government has been looking at ways to encourage the adoption of e-prescribing and other electronic systems by healthcare providers for several years already. The Obama administration’s signing of the American Recovery and Reinvestment Act (ARRA), with its $19 billion in stimulus funds for healthcare IT, is the most expansive effort to date. It includes a menu of grants to states, Medicare and Medicaid incentives for hospitals and physician practices, and a timetable for imposing penalties for non-adopters of EHR after 2015.

Barriers and Obstacles to Adoption

The cost of software and implementation services is by far the biggest obstacle to adoption for both hospitals and physicians’ clinics. A small hospital might pay $3 million for an EHR system, while physicians’ electronic records software costs, on average, $35,000 to $50,000 per physician. So a ten-physician clinic is looking at a half million dollar investment. That is a significant investment at a time when providers are feeling squeezed financially at both ends – by the insurance payers, both private and Medicare/Medicaid, and by rising operating costs such as malpractice insurance and billing and administrative costs.

Physician reluctance to adopt IT – both in their own practices and in hospitals – is another major factor. Doctors who do take the plunge may wind up frustrated by poorly designed user interfaces or applications that lack the features they most need. Both hospitals and physicians are often handicapped by a lack of knowledge of EHR and may not know how to evaluate products or adequately map out all of the factors in the implementation.

Access to financing, as well as an investment in outside consulting help in selecting an EHR and mapping out the migration, increase the odds of a successful outcome.

Moving From EHR to HIE

Because healthcare providers rarely have the same EHR system, integration between providers in a state or region is being addressed by healthcare information exchanges (HIEs). At the end of 2008, there were 42 operational healthcare information exchanges and another 36 in the process of implementation. If most of those 36 became operational this year, there are now over 75 exchanges in the U.S., with dozens more in the planning. A few have also closed up shop, typically due to lack of financial support and interest on the part of participating hospitals.

Patient safety is one motivation for regional hospitals to collaborate on an exchange, and gaining efficiencies in their operations is another. Given that the typical patient today may see a dozen different providers of healthcare services – laboratories, diagnostic centers, nursing centers, mental health clinics, specialists, and physical therapy clinics, to name a few – integration across such a diverse group would be prohibitively costly and time consuming if done with point-to-point integration. An exchange that provides one or more standard methods for integrating with it means that a provider needs to integrate just once, to the exchange, rather than dozens of times.

Physician clinics and hospitals which obtain test results via an exchange save themselves the time and administrative costs of waiting for a fax or courier, and routing the documents to the appropriate department or physician. With electronic delivery of results and patient data from outside providers, caregivers can more quickly, effectively and efficiently care for patients.

For hospitals, exchanges also help ease integration between them and their affiliated physicians. Some hospitals have offered free EHRs to their doctors, in an attempt to improve information flow. Not all doctors opt to use the hospital’s system, however, and an HIE alleviates the need to construct point-to-point integrations between hospital EHRs, physicians’ electronic records applications.

Our Assessment

A basic EHR application that meets federal certification requirements will be a necessary investment for all hospitals. However, hospitals should resist the rush to purchase and implement EHR in order to meet federal deadlines and take the time needed to carefully evaluate, test and implement the best application for the needs of the medical staff. Even with the clock ticking on the Medicare incentives, a precipitous purchase of the wrong EHR would wind up being a much more costly move then missing a year of incentives.

At the same time, the government has made it clear that all but the most cash-strapped rural hospitals and clinics will be expected to be using EHR within the next few years or face real financial penalties – up to a 3% reduction in Medicare payments. While these penalties may wind up being delayed, there is no good reason for most healthcare providers not to be evaluating EHR products with an eye to adoption in 2010 or 2011 at the latest.

While the Medicare and Medicaid incentive payments won’t provide for the initial cost of an EHR implementation, AARA does include monies for state loan programs, and other federal and state grants and loans are available for healthcare IT adoption. Also, more EHR vendors are likely to be willing to provide low-interest loans or payment plans for healthcare providers, so that their customers can use the ARRA incentives to pay them back in the future. Healthcare providers which already have an EHR system will qualify for incentives, but only if those systems meet the government’s requirements. So this is the time to begin evaluating upgrade possibilities to ensure the system is compliant.

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By Mary Mosquera

The Centers for Medicare and Medicaid Services will reimburse states for 100 percent of their payments to healthcare providers participating in the federal health IT stimulus program, according to a Sept. 1 letter from CMS to state Medicaid directors.

Moreover, state Medicaid agencies can immediately apply for 90 percent in federal matching funds to cover the initial planning that will be required to launch health IT incentive payment systems in their states, according to the letter from Cindy Mann, director of CMS’s Center for Medicaid and State Operations.

The letter and a package of supporting policy documents are the first formal direction CMS has provided state Medicaid agencies on how to manage the millions of dollars in incentive payments that will flow to healthcare practices under the federal stimulus law.

But federal financial support for state planning will not come without a hefty burden on state Medicaid agencies. According to the documents, CMS plans to keep a close eye on how states develop their incentive payment systems as well as how they mesh with other state health IT projects.

In order to receive the 90 percent administrative match, state Medicaid agencies must obtain from CMS an “HIT Advance Planning Document prior to initiating planning activities and expending funds.” States must receive prior approval of any initial planning eligible for the match, according to the letter.

CMS outlined a litany of state activities that could be eligible for 90 percent matching funds, including planning “for incentive payment delivery systems and audit tracking of payments to providers,” CMS said.

Work by states to set up “metrics and measures for providers to demonstrate meaningful use of electronic health records” would also be eligible for a match. So far, CMS has issued no guidance on how it plans to measure, account for, and verify payments that will be made to providers under the health IT stimulus plan.

States will also be on the hook for making payments to providers whose certified EHR software is incompatible with state and federal administrative management systems. “States risk making unallowable incentive payments prior to receiving guidance on how to make these systems compatible,” Mann said.

Although the letter focuses on Medicaid, it notes that Medicare provider health IT incentives are also called for under the stimulus plan. CMS said it will be a “priority for these incentives to be coordinated in order to reduce confusion, improve administration, and maximize the ability to advance HIT across the health system.”

CMS will provide states with more guidance about planning and administrative expenses and will work with the states to determine when each is ready to start making payments, the letter said. CMS will detail the information in a proposed rule by the end of the year.

CMS is especially keen that state Medicaid agencies’ incentive payment management systems be linked to the states’ overarching vision for health information exchange.

According to the letter, Medicaid offices will be required to submit a “State Medicaid HIT Plan,” or SMHP, describing “how it will integrate current and planned Medicaid HIT assets and fit within the larger State HIT/HIE roadmap,” the letter said.

“We expect the State to include in the SMHP their vision for Medicaid to become part of existing or planned Federal, regional, statewide, and/or local health information exchanges (HIE),” CMS said, “with projected dates for achieving objectives of the vision where appropriate.

“State plans should build off of existing efforts to advance regional and State level HIE, facilitate and expand the secure, electronic movement and use of health information according to nationally recognized standards, and move towards nationwide interoperability.”

The 90 percent matching funds are in addition to matching funds rates that states now receive under current law for using state Medicaid claims processing and automated retrieval systems, referred to as the Medicaid Management Information System (MMIS).

CMS expects that states to closely link their SMHP with these systems, as well as their work adhering to the Medicaid IT Architecture (MITA), an ongoing technology and business plan for Medicaid IT systems.

The MMIS contains a great deal of claims data and other information. “When combined with other systems and databases, [MMIS] can be of significant value in achieving the vision of using certified electronic health record technology to promote health information exchange, enhance quality and improve outcomes,” Mann said.

But CMS cautioned that states “should not begin implementation activities” related to their SHMP’s “until CMS issues future guidance on the Recovery Act HIT requirements or states risk not receiving (federal funding) for incentive payments due to non-compliance.”

CMS and the National Coordinator for Health IT will evaluate the states Medicaid health IT plans to make sure that planning activities are coordinated. CMS will publish more guidance in the near future on the review process, Mann said.

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HDM Breaking News

The Centers for Medicaid and Medicaid Services has sent a letter to all state Medicaid directors to provide initial guidance on upcoming Medicaid EHR incentive payments. Under the American Recovery and Reinvestment Act, hospitals and physicians that treat a qualifying number of Medicaid patients can apply for incentive payments based on their meaningful use of electronic health records.

The letter points out that states may immediately apply for federal funds to pay for 90% of administrative planning activities. It spells out criteria to receive the funding.

“This letter, including the enclosures, will provide preliminary guidance on state expenses related to activities in support of the administration of incentive payments to providers,” CMS states. “More information will be forthcoming through guidance and rulemaking regarding state administrative expenses and provider incentive payments. We intend to published proposed regulations to address the steps outlined in this letter by the end of the year.”

Other points of interest in the letter include:

• States should coordinate activities with their CMS regional office to reduce confusion of the Medicare and Medicaid incentive programs and maximize the ability to advance health I.T.;
• States should view Medicaid planning activities as part of larger evolving state health I.T. efforts; and
• States must settle a range of issues before they can begin making incentive payments. For instance, providers using certified EHRs are not eligible for Medicaid incentive payments unless the EHR is compatible with state or federal administrative management systems. “Therefore, states risk making unallowable incentive payments prior to receiving guidance on how to make these systems compatible.”

The letter and accompanying documents are available at cms.hhs.gov/Recovery/11_HealthIT.asp.

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Two weeks ago, the Obama administration offered nearly $1.2 billion in stimulus-funded grants to set up state-run health information exchanges, and create 70 “health IT regional extension centers” to help physicians adapt to the digital era, a term officials defined in greater detail during a conference call late last week, Modern Healthcare reports. “As many as 1,250 participants logged- or dialed-in to hear and ask questions about the ground rules to apply” for the grant money “to be awarded over a four-year period to about 70 not-for-profit organizations that will run the regional extension centers.”

The centers will spend more than $500,000 a year, mostly on services for physicians; serve approximately 1,000 doctors each, mainly at smaller primary care offices; help doctors select an effective electronic record system; help them implement it and achieve “meaningful use,” the administration’s requirement for doctors hoping to get other stimulus payments; provide “in-depth” technical support on “a narrow list of vendor systems.” A caller pointed out that the government’s role in recommending and supporting individual, private vendors raised a potential conflict of interest for state officials choosing the potential grantees that will set up the centers.

Half of the grant money will go directly to states to help establish “a widespread and sustainable health information exchange,” American Medical News reports. “Legal, financial and technical support is necessary to enable secure exchange of sensitive patient data across health care systems, according to HHS. The program will help fund efforts at the state level to implement directories and technical services to enable interoperability within and across states. Some health IT experts say such assistance is vital in helping physician practices become meaningful users”.

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By Joseph Conn

Another month, another matrix in the development of definitions of “meaningful use,” the key criteria providers must meet to unlock tens of billions of dollars of federal healthcare information technology subsidies under the American Recovery and Reinvestment Act of 2009.

The Health Information Technology Policy Committee, a creature of the stimulus law, received a third set of recommendations from its meaningful-use work group. The recommendations were again detailed, as were their predecessors handed over by the group in June and July, in a spreadsheet or “matrix” format.

The HIT Policy Committee accepted the recommendations, which under the order of events set out in the stimulus law the committee will forward to the Office of the National Coordinator for Health Information Technology at HHS, which will hand them over to the CMS for official rulemaking. All of these hand-offs will occur fairly seamlessly since David Blumenthal, the physician head of the ONC, is chairman of the HIT Policy Committee and Tony Trenkle, director of the Office of eHealth Standards and Services at the CMS, is a policy committee member. Both men attended Friday’s meeting.

This latest batch also stuck to the original staging schedule first proposed by the work group in June of creating three sets of increasingly more complex meaningful-use criteria, which hospitals and office-based physicians must meet to qualify for the subsidy payments. The matrix includes a dozen broad goals, more specific objectives and proposed metrics by which compliance with the goals and objectives can be measured. The lowest bar is set for 2011, the first year electronic health-record subsidy payments can be made under the Medicare portion of the technology funding program.

For example, one care goal is to provide a patient healthcare team access to “comprehensive patient health data.” In 2011, one objective proposed for meeting that goal is a requirement that all hospitals use computerized physician order entry, or CPOE, systems for at least 10% of orders by doctors, nurses and physician assistants. By 2013, the work group proposed raising the bar, requiring that 100% of hospital orders be initiated using CPOE. In 2015, the objective switches from using a specific system, CPOE, to achieving “minimal levels of performance” that can be measured using clinical outcomes standards to be agreed upon sometime between now and then.

The other highlight of the meeting was the report and recommendations by the policy committee work group on EHR system certification and adoption. Under the stimulus law, only certified EHR systems qualify for federal subsidies, and only if they are used in a “meaningful manner.” In the past, the federal government deemed the certification of an EHR by the not-for-profit Certification Commission for Health Information Technology as good enough to meet its certification requirements for Stark and anti-kickback exceptions for EHR subsidies made by hospitals to office-based physicians. CCHIT took its cues on certification criteria from the American Health Information Community, the Bush administration’s counterpart to the HIT Policy Committee, and developed a program that tested vendors’ products on their ability to perform more than 300 functions.

But the stimulus act, which became law in February, did not specify that CCHIT would be even an acceptable certification body for EHRs for stimulus law subsidies, much less the only certification body with deeming authority as in the past.

To guide the new way forward, the certification and adoption work group made five recommendations, which were accepted by the policy committee.

First, the group recommended that certification under the stimulus law should focus solely on the functions needed to meet the meaningful-use standards. The statute provides eight specific areas that the HIT Policy Committee must consider in making its recommendations on meaningful use, plus 10 other areas that the policy committee might also consider.

Still, at least initially, the number of criteria against which systems will be tested under the stimulus law is likely to be far fewer than the 300 or so in the most recent CCHIT testing regime. In June, CCHIT announced its intention to continue to offer its comprehensive testing program, but also would add new testing and certification schemes tailored to the meaningful-use criteria as they are developed.

Second, according to the recommendations, progress needs to be made on testing and certifying systems that have the functionality to meet privacy, security and interoperability requirements called for in the stimulus act. Those include some amendments to the federal privacy law under the Health Insurance Portability and Accountability Act of 1996, such as the requirement that the systems be able to produce and report audit trails of where and when disclosures of patient information has been made, and to manage patient consents to release information, including a new authority that patients can block the release of their treatment information to their insurance company if they pay for treatment out-of-pocket.

Third, the work group recommended generally that the certification process be made more objective and transparent, with a specific recommendation that the federal National Institute of Standards and Technology, an agency of the Commerce Department, be tasked with helping the ONC develop a process to establish a separate and independent accreditation procedure for certification organizations such as CCHIT and any additional organizations that might join CCHIT in certifying EHRs to stimulus law criteria.

Fourth, the work group suggested that the certification process needs to be standardized so there is a level playing field for all seekers of EHR certification, whether they are commercial vendors of proprietary software systems, provider organizations that have developed home-grown systems, or communities or service providers of open-source EHR systems.

Finally, the work group recommended that the ONC and the CMS leverage as much as possible the work that has been done to date developing a certification program. Since an initial, official definition of meaningful use isn’t expected from the CMS until early next year, the work group recommended establishing a “preliminary certification process” so vendors can begin preparing their systems to what will be a likely set of criteria. CCHIT, for example, has prepared an analysis of its current testing and certification criteria and how they stack up against what might be expected to meet meaningful use under a new certification regime.

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President Obama held a town hall meeting in New Hampshire today, Tuesday, August 11, in an effort to calm fears over the Democrats’ legislative initiatives to reform healthcare in this country. The meeting was structured, and no visible emotional outbursts were seen as in other meetings with lawmakers across the country.

Obama answered questions posed by attendees, emphatically telling the audience that the current healthcare system solely benefits the insurance industry. With 46 million in the country without health insurance, he tried to reassure his audience that they would be able to keep their current coverage and doctor and that the government would not be “in charge”. Obama hammered on the fact that the government and insurance bureaucrats should not be meddling, that pre-existing conditions will be covered and that insurance companies would not be able to drop or deny coverage or water down coverage. Many of the questions on voter’s minds that were expected to be answered, especially with respect to employers and small businesses, were not addressed.

Numerous recent polls show support for healthcare reform is eroding, and the President’s numbers are dropping as well over fears that a government takeover of our healthcare system in the U.S. will lead to a Canadian style system with long waits for treatments and referrals.

The President’s message today was supposed to address people who already have insurance through their employers and highlight how his proposals would affect them. HAI monitored the town hall meeting and didn’t find the retool of the White House message to have answered those questions. Another town hall meeting with Obama is scheduled for Bozeman, Montana on Friday, and on Saturday, Obama will be in Grand Junction, Colorado.

Meanwhile, the White House has opened a Reality Check website with a viral tool aimed at online healthcare combat on everything from rationing to euthanasia. The website incorporates lessons learned from the Obama presidential campaign, and shows the White House is becoming more aggressive in dispelling what they call misinformation in the healthcare debates.

The August Congressional Recess is not even half over, and Democratic lawmakers are very much at risk of losing control of the public debate over healthcare reform, facing wary constituents and facing a barrage of accusations and criticism over their writing of the legislation prior to leaving Washington. Powerful groups on both sides of the debate are using the August recess to hammer home to lawmakers that there are very serious political consequences to the healthcare issue.

Senators working on a yet to be released draft bill said earlier this week that President Obama would like to get something passed for healthcare reform and then start negotiating in a House-Senate conference committee. Some Democrats support the public option, but it will be a tough sell for Republicans if they want to get a bill through the Senate. The flashpoint in the debate has become the question of whether a healthcare overhaul should include a public option. As the debate rolls on, Americans are questioning what the shape and size of the government’s role in the economy should be, especially on the heels of Congress passing three massive economic stimulus bills.

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Diana Manos, Senior Editor

The State Alliance for e-Health issued new guidance on Tuesday for state health information exchanges.

The executive-level organization, composed of governors, state legislators, attorney generals and state commissioners, included information on how states can lead the way in using health IT as they begin instituting the federal Health Information Technology for Economic and Clinical Health (HITECH) Act.

The HITECH Act, enacted as part of the 2009 American Recovery and Reinvestment Act, expands the role of states in fostering health information exchange and adoption of electronic health records over the next five years.

“Governors understand that swift and thoughtful action is needed at the state level to plan and implement a national system of health information exchange,” said Tennessee Gov. Phil Bredesen, co-chairman of the alliance. “Widespread adoption and use of electronic health records provides a critical foundation for improving health outcomes and cost-effectiveness.”

The report recommends actions states should take now to qualify for the HITECH Act, including:

• Preparing or updating the state plan for HIE adoption;
• Engaging stakeholders;
• Establishing a state leadership office to manage the different phases of HIE implementation;
• Preparing state agencies to participate;
• Implementing privacy strategies and reforms;
• Determining the HIE business model;
• Creating a communications strategy; and
• Establishing opportunities for health IT training and education.

“States already have taken the lead in modernizing the healthcare system by advancing the use of health IT, electronic health records, e-prescribing and electronic exchange of health information,” said Vermont Gov. Jim Douglas, NGA chairman and co-chairman of the alliance. “We now have an opportunity to accelerate adoption of health IT across the states and create a truly comprehensive healthcare system that is effective, affordable and accountable.”

The report and state initiatives to implement health IT and electronic HIE will provide a central focus for the alliance’s semi-annual conference, to be held Aug. 7 in Burlington, Vt.

The alliance – supported by funding from the Department of Health and Human Services – provides a nationwide forum through which governors, state policymakers and other stakeholders can work to identify effective HIT policies and best practices and explore solutions to challenges related to the exchange of health information.

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