By Neil Versel

Dr. David Blumenthal, the national coordinator for health information technology, gave a strong indication of how HHS ultimately will define “meaningful use,” the standard that providers must meet to be eligible for Medicare and Medicaid EMR bonuses, by warning that hospitals unwilling to share data with others risk being shut out of the stimulus funding. “There’s a fair amount of money in the law for hospitals that adopt interoperability,” the Dallas Morning News quotes Blumenthal as saying. “If they don’t, they’re not likely to be eligible for payment.”

Although the three largest hospital operators in the Dallas-Fort Worth are implementing EMRs, there is no means for health information exchange between the systems or with smaller providers. The Dallas-Fort Worth Hospital Council is only now working on an HIE feasibility study, and is seeking grant funding to lay the groundwork for data sharing, the newspaper reports.

In McAllen, TX, recently named the second-most-expensive healthcare market in the country, one physician executive believes that interoperability could help rein in some of the spending.

Let me know for further assistance.

http://www.fierceemr.com/story/blumenthal-must-share-data-get-stimulus-money/2009-06-25

$1.2 Billion Slated for HITECH Priority Grant Programs

By News Staff

Nearly $1.2 billion soon will be available to help the nation’s hospitals, physicians and other health care professionals purchase and use electronic health records, or EHRs, according to an Aug. 20 announcement from Vice President Joe Biden. Money from the Health Information Technology for Economic and Clinical Health, or HITECH, Act priority grant programs, which are funded by the American Recovery and Reinvestment Act of 2009, will start flowing in 2010.

“With electronic health records, we are making health care safer, we’re making it more efficient, we’re making you healthier, and we’re saving money along the way,” said Biden in the announcement. “These are four necessities we need for health care in the 21st century.”

The money will be divided between two programs.

• $598 million has been set aside to establish the Health Information Technology Extension Program, which will allow about 70 health IT regional extension centers to offer technical assistance and guidance to support health care professionals using EHRs.
• $564 million will fund the State Health Information Exchange Cooperative Agreement Program, an initiative designed to help states and other entities establish health information exchange capacity among hospitals and health care professionals.

According to David Blumenthal, M.D., M.P.P., the national coordinator for health IT, the rollout of the programs “represents a critical step forward in laying the groundwork for meaningful use of EHRs.”

“Together, the grants will offer much-needed local and regional assistance and technical support to providers while enabling coordination and alignment within and among states, ultimately allowing information to follow patients anywhere within the health care system,” Blumenthal said in an Aug. 20 update e-mailed to health IT stakeholders and posted on the HHS Web site.

Information about the HITECH priority grants program and application requirements is available online from HHS

Above article published on

http://www.aafp.org/online/en/home/publications/news/news-now/practice-management/20090826hitech-grants.html

By Anne Zieger

The Agency for Healthcare Research and Quality has announced that it will provide a series of grants totaling $48 million that can be used to develop national patient registries for comparative effectiveness research. Clinical registries are one of a number of approaches to helping providers identify the long-term effects of treatments, along with clinical data networks and other forms of health IT networking.

This is part of a larger $300 million grant and contract package designed to fund comparative effectiveness projects funded by the federal stimulus package. The AHRQ will offer grants to study treatment benefits focused on 14 common conditions, including diabetes, obesity and heart and blood vessel problems.

AHRQ will also seek $74 million in contracts for analyzing and generating evidence, along with $19.5 million to establish an infrastructure for identifying the right treatment issues to focus on as part of comparative effectiveness reviews.

Above article published on

http://www.fiercehealthit.com/story/ahrq-handing-out-48m-grants-comparative-effectiveness-research/2009-08-16

The AP reports President Obama “returned to campaign-style rhetoric on Thursday,” saying at two New Jersey events that “inaction is not an option” as he urged supporters “to push for his overhaul of the nation’s health care system.” ABC World News, which opened with the story, called the President “a man on a mission. Everywhere he goes these days, he’s pushing healthcare reform.” The AP reports Vice President Biden was also touting reform, joining Health and Human Services Secretary Kathleen Sebelius at a forum in Virginia.

The Politico reports, “On the defensive over the economy and health care, the White House is shooting back with a double-barreled message for its critics and skeptics. To Republicans who say the stimulus isn’t working: Back off. To moderate Democrats wary of health care reform: We’re watching you.” Bloomberg News, however, reports Senate Finance Chairman Max Baucus “complained…Obama is ‘making it difficult’” to create a bipartisan compromise in the Senate. Baucus said Obama’s “opposition to the idea of taxing health-care benefits is ‘not helping us.’” The Hill reports Baucus and other senators emerged from “another intense day of closed-door negotiations” to “admit they had not reached the finish line.” Baucus said, “We’re very close to reaching agreement. By close, I mean it’s a matter of couple, three or four days, maybe.”

Sen. John McCain said on Fox News’ Your World, “The President has reiterated time and again his commitment to getting through before the recess. This thing is like a fish in the sun. If you leave it out there very long, it’s going to begin to smell very, very badly to the American people. That is why they are in such a rush to fundamentally affect one-sixth of our gross national product.”

USA Today reports that three tax increases “proposed by President Obama and House Democrats on the richest Americans could produce the highest tax rates in a quarter-century.” About 500,000 taxpayers earning $1 million or more would pay a full 5.4 surtax under one plan; surtaxes at lower rates would impact anyone earning more than $350,000 per year. Obama’s February budget “calls for letting tax cuts for top earners enacted at the beginning of the decade expire in 2011,” and during the presidential campaign, Obama “favored bolstering Social Security by subjecting family income above $250,000 to the 12.4% payroll tax.”

The New York Times reports Congressional Budget Office Director Douglas Elmendorf told the Senate that healthcare legislation proposed so far “would not curb the federal government’s runaway spending on medical care, and that lawmakers would need to take more forceful action to meet President Obama’s goal of controlling costs.” His testimony “drew criticism from Democratic leaders” and “provided ammunition to Republican critics.” The Wall Street Journal reports Senate Majority Leader Harry Reid “quipped that Mr. Elmendorf should consider running for Congress,” while Senate Majority Whip Richard Durbin “admitted that Senate Democrats were frustrated with the CBO’s various pronouncements over their efforts to push through health-care overhaul.”

Above article published on

http://www.usnews.com/usnews/politics/bulletin/bulletin_090717.htm

Pulmonary Care of Central Florida is installing a new electronic medical records system — a move that may help it land some of the $19 billion in federal stimulus funds earmarked for health information technology.

The Winter Park medical group, which has one doctor and two nurse practitioners, decided to do so to reduce the amount of space needed for records storage and to save time, said MaryAnn Simmons, the practice’s administrator.

She estimated such systems cost $50,000-$70,000, take about a month to install and up to eight months to master.

It’s unknown how many local doctors use electronic medical records, but Melanie Boscan, executive director of the Orange County Medical Society, estimated at least 20 percent have them — and the rest may be waiting to see how the federal stimulus incentives shake out. “Doctors are a little leery. Until they are all mandated to have a system, you’re not going to see a rush.”

Above article published on

http://orlando.bizjournals.com/orlando/stories/2009/06/29/story8.html

Ever since the government announced it would offer financial rewards of $44,000 to $64,000 to each physician who could show “meaningful use” of a qualified electronic health record, doctors have been wondering what meaningful use means. Today the Health IT Policy Committee, which advises the U.S. Department of Health and Human Services, took a major step toward providing a definition of this term.

The recommendations released by the HIT Policy Committee are not the final word. In fact, they are simply the product of a workgroup, and the committee’s discussion today made it clear that the provisions are subject to change and will be tweaked over the next couple of months. After the committee adopts a definition, it will be submitted to CMS, which will put the definition through its formal rule making process. Even when that’s completed, probably by the end of the year, it will apply only to 2011 and 2012 requests for government subsidies. In 2013 and 2015, the requirements will be significantly expanded.

To what end? The HIT Policy Committee has very grand ambitions. As it states in the preamble to its report, “We recommend that the ultimate goal of meaningful use of an Electronic Health Record is to enable significant and measurable improvements in population health through a transformed health care delivery system.” In other words, the committee members are not just trying to make sure that physicians are using the EHRs for which they’re seeking subsidies; they want to make sure they’re using them to “transform healthcare.”

The pertinent questions are whether what the committee is considering bears any resemblance to 1) the EMRs currently on the market; and 2) the environment in which physicians and hospitals (which will also be subject to the definition) operate. The answer to the first question is Maybe: most of the requirements for 2011 can be satisfied by the leading certified EMRs, but it’s unclear whether more than a handful of them will be able to keep up with future requirements. As for the second question, the ability of physicians to exchange information with providers that use different systems is very limited right now, and some of the other requirements in the future may discourage physicians from acquiring EMRs.

During the discussion period at the committee meeting today, committee member Neil Calman, of the Institute for Family Health, noted that it takes a while for physicians to get up to speed on EHRs and begin to use various components of them. “You can’t open up a patient portal on the day your EMR goes live,” he pointed out. So if the meaningful use criteria for 2013 are too advanced, he said, “A non-adopter will look at those criteria and say, ‘This is not achievable.’”

Calman suggested that as the bar is raised for meaningful use, first-year applicants for government subsidies be allowed to meet the original criteria in that year, and then go through the process of using their EMRs to reach higher goals. David Blumenthal, the national coordinator of health IT, said, “That’s more realistic in some ways.” But a CMS official stepped in and said the law doesn’t allow it. “The meaningful use criteria in 2013 have to be the same whether you’re a first-year or third-year user,” he stated.

That strikes me as a way to guarantee the program will fail. If the law doesn’t make sense, Congress should amend it.

Other committee members expressed reservations about the report. Gayle Harrell, a committee member and former Florida state legislator, pointed out that “this is a very aggressive model.” Some hospitals are taking a long time to roll out health IT to their physicians, she pointed out, and the degree of interoperability varies dramatically from one region to another. “Are we setting goals that are not achievable?” she asked. “I’m afraid we will set ourselves up for failure if we’re not specific and take smaller bites of the apple.”

After the meeting, Blumenthal announced he was asking the workgroup to revise their recommendations over the next month. I just hope that the HIT Policy Committee–perhaps with some input from practicing physicians–considers the issues raised by its members today before it issues its final definition of meaningful use.

Above article published on

http://industry.bnet.com/healthcare/1000806/is-
government-health-it-program-overreaching/

Stimulus funds would help replace paper medical files.

By Kristi E. Swartz

The Atlanta Journal-Constitution

Hurricane Katrina illustrated what can happen when medical records are on paper instead of stored on a computer.

They washed away, rendering thousands of people unable to get prescriptions, notify doctors about allergies or receive medical help.

“We have to bring our best technology to bear in the health care system,” said Dr. David Satcher, former U.S. surgeon general and director of the Satcher Health Leadership Institute at Morehouse School of Medicine.

Federal stimulus money is available for health care providers in Georgia to convert paper medical records to electronic ones, Satcher and others said Thursday at Georgia State University. Though such technology has been available for years, fewer than 4 percent of doctors have made their medical records completely electronic, said Janet Marchibroda, chief health care officer for IBM, who said the stimulus dollars will help with some of the conversion challenges.

Stimulus money will be funneled through Medicare and Medicaid programs as well as through the National Coordinator for Health Information Technology. Marchibroda cautioned that it be spent wisely.

“We could really mess this up by just pushing a lot of money out there but not focusing on improving health information technology,” she said.

Georgia’s Department of Community Health has received $339.6 million in the first batch of stimulus money. Rhonda Medows, the state’s health officer and commissioner of the community health department, said the agency is waiting for federal guidance on how it can use that money to reimburse health care providers who buy an electronic health record system.

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Care for uninsured, electronic records receive cash

The $4 billion in federal stimulus health care money headed to the Bay State over the next three years will help provide care for those who can’t afford it and - it is hoped - help stem hemorrhaging health care costs by funding new technologies.

The bulk of the health care stimulus funding - some $3.5 billion - will keep most safety net programs afloat with Medicaid/Federal Medical Assistance Percentage funds.

But a portion of the federal stimulus money is targeted for cost-saving innovations. Massachusetts is getting $1.3 billion in technology and research funds, with more than $500 million going toward eHealth initiatives in the commonwealth.

The initiatives will fund the creation of electronic patient records. State officials hope the federal investment will lead to a secure statewide database of patient information, or in government parlance, an interoperable Health Information Exchange.

The program could have a long-standing impact by providing doctors quick, seamless access to patient records, offering the possibility of savings in time, money and lives. Nationwide, some $19 billion will go to e-records programs with a goal of freeing a profession from an archaic paper-based system by 2014. President Barrack Obama has touted the potential costs savings from the program.

Massachusetts, which is ahead of many states in initiating electronic medical records, stands to gain from significant federal reimbursements.

Stimulus funds will be used to reward those who have already installed the record system and provide money to hospitals and physicians who implement it. The state would also penalize those who fail to upgrade to e-records.

Physicians who meet the state criteria for electronic files could receive reimbursements of up to $44,000 each over four years directly from the federal government. There are about 20,000 physicians in the state, according to the Department of Health and Human Services.

Partners Healthcare could be a big winner in the stimulus sweepstakes because it has already implemented a records system. With individual reimbursements for its 3,000 members, including teaching hospitals Brigham and Women’s and Massachusetts General Hospital, the health care consortium could receive from $10 million to $50 million.

The state’s Health Care Quality and Cost Council estimates that it takes a small medical practice an average of four months to adopt an EMR at an up-front cost of up to $40,000 per physician.

Up-front costs have been one of the biggest obstacles in creating an electronic system. But Massachusetts, which has nearly twice the national average of doctors using EMRs, could face an easier transition with quicker federal reimbursements.

“The adaptation in Framingham was smoother because there wasn’t an existing paper record, so our advisors picked it up very quickly,” said Paula Kaminow, executive director of the Framingham Community Health Center, which began using EMRs when it opened five years ago.

Community health centers are important centers of medical information because they serve a wide range of the population that doesn’t have personal physicians. Installation of electronic records in 12 centers could increase staff productivity, allow for expansion in the number of patients and ensure easier and faster sharing of patient information with hospitals.

“From a risk-management standpoint, it’s much easier for providers to find the information they need,” Kaminow said. “The handwriting is clean, you can find different chart notes very quickly and can integrate information from different sources.” The electronic system could save the nation $530 billion over 10 years, according to the Health Care Quality and Cost Council, which estimates that the stimulus’ national eHealth initiative could reduce the nation’s health care spending by up to 30 percent.

Kaminow said the most important characteristic for an electronic record is the ability to interface with other types of records.

“The challenge is to make sure that all the different pieces can speak to each other, such as a management system that can speak to an electronic health record or a lab report,” she said.

The central project for the state is the Health Information Exchange, which is not funded by federal dollars. The state’s newly established Health Information Technology Council will provide $15 million in initial funding to help install the exchange by 2014.

The exchange would combine electronic record projects for individual practices, hospitals and community health centers, sharing patient information in a secure statewide database. Anyone in the system treating a patient could quickly learn about the patient’s allergy data, medication and test results.

The IT initiative has another reward: job creation. Private sector jobs would grow among vendors installing database systems, with positions ranging from entry-level programmers to high-level project managers.

Massachusetts has a leg up in this respect with an already developed system of software and hardware vendors.

Although federal stimulus funds end after two years, the reimbursements that follow implementation of the systems could create jobs in the long term.

“We’re looking to bring on more staff and extend our hours,” Kaminow said. “After a start-up period, our costs are covered through billing, so in that way we’d be able to sustain increased employment.”

The other big slice of the health care stimulus pie is the $764 million coming to Massachusetts for this year and next.

Funds will be used primarily to maintain services - securing jobs, meeting health care standards and safety net services, with $190 million going to offset fiscal year 2009 budget holes, according to the Department of Health and Human Services.
Above article published on

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The law offers bonuses for health IT adoption but will penalize physicians who don’t have adequate systems by 2015.

By Doug Trapp, AMNews staff.

Washington – President Obama on Feb. 17 signed a $787 billion stimulus bill that directs about $150 billion toward speeding adoption of health information technology and maintaining health care coverage, among other provisions.

The sweeping measure — the American Recovery and Reinvestment Act of 2009 — provides nearly $90 billion in temporary increased federal Medicaid funding, delays four cost-cutting Medicaid regulations and spends a net of about $19 billion to encourage physicians and others to adopt health IT.

Obama said the enactment of the stimulus package and the Feb. 4 enactment of the Children’s Health Insurance Program reauthorization are big steps in health care. “We have done more in 30 days to advance the cause of health care reform than this country has in a decade.”

The American Medical Association applauds the investments in health IT and coverage for the poor and newly unemployed, wrote AMA Executive Vice President and Chief Executive Officer Michael D. Maves, MD, MBA, in a Feb. 11 letter to Sen. Max Baucus (D, Mont.), chair of the Senate Finance Committee.

The stimulus also provides $500 million to help train physicians through the National Health Service Corps, a provision widely supported by physician organizations. “This program is integral to rebuilding the primary care physician pipeline,” said Ted Epperly, MD, president of the American Academy of Family Physicians.

$19 billion of the stimulus bill is for incentives to encourage health IT adoption.

But few Republicans backed the stimulus measure. The House adopted the bill Feb. 13 with no Republican support. The Senate approved it the same day with votes from only three moderate Republicans: Sens. Olympia Snowe and Susan Collins of Maine and Arlen Specter of Pennsylvania. The final bill is a compromise between earlier versions adopted by the House and Senate.

Many Republicans, including Senate Minority Leader Mitch McConnell (R, Ky.), lambasted spending in the measure that they said would not stimulate the economy quickly. McConnell also criticized Democrats for not accepting more GOP input on such a massive spending bill.

Some Republican lawmakers, such as Phil Gingrey, MD (R, Ga.), also worried that the stimulus is not offset by new revenues and therefore will increase the national debt. “I don’t know how our children and grandchildren are going to pay for this,” Dr. Gingrey said.

“Significant” health IT support

Under the stimulus law, physicians and other health professionals are eligible for tens of thousands in health IT incentive payments via Medicare or Medicaid through 2016. But in 2015, penalties for non-adopters begin.

Medicare-participating physicians who adopt a certified electronic health record system by 2011 or 2012 and use it in a way that the government deems “meaningful” — a term to be defined later — could receive up to $44,000 over a period of up to five years. The incentives will be limited to 75% of the physician’s Medicare charges in any one year.

Health IT grants and loans from the federal government won’t become available until 2010.

Physicians who have caseloads of at least 30% Medicaid patients and who also meet the health IT adoption standards are eligible for nearly $64,000 in support during the same time frame. Medicaid incentive payments are limited to 85% of physicians’ Medicaid charges. Pediatricians can qualify if their patient mix is 20% Medicaid, but they would be eligible for only two-thirds of the incentive payments available to physicians meeting the 30% standard.

This health IT funding is “very significant,” said Robert Doherty, the American College of Physicians’ senior vice president for governmental affairs and public policy. “Our sense is for a lot of physician practices, that may be the tipping point where it begins to make business sense to consider plunging into that pool and buying a certified EHR.”

Physicians cannot apply for incentives in both Medicare and Medicaid, but hospitals can, said Erica Drazen, ScD, managing partner for emerging practices at health IT consultant CSC’s Global Healthcare Sector.

Also, while physicians must use an EHR system to qualify for the stimulus incentive payments, they need not own one. The measure provides $2 billion to the Office of the National Coordinator for Health Information Technology for health IT grants and loans, but those won’t become available until 2010, Drazen said. She expected private firms to offer new financing options for the EHR systems or to offer them through leases.

But the stimulus measure will penalize physicians, beginning in 2015, if they have not become meaningful EHR users. These doctors face a 1% reduction in Medicare fees that year. The yearly cut would phase up to 3% in 2017 and beyond.

The ACP would prefer that the penalties not apply if, for example, a shortage prevents EHRs from being available to physicians or if another factor not in physicians’ control prevents them from meeting the health IT standards, Doherty said.

Drazen said existing EHR vendors and consultants will be strained by the demand created by the health IT stimulus. “We’re going to have a real short supply of people who know how to do this well.”

Sustaining Medicaid

The $87 billion in stimulus going to state Medicaid programs should help avoid health coverage cuts to low-income people. But states still may need to trim other parts of their Medicaid programs, because many have budget shortfalls exceeding their stimulus funding, said Ann Kohler, director of the National Assn. of State Medicaid Directors.

The enactment could be significant for physicians in California. State lawmakers and Gov. Arnold Schwarzenegger have been struggling to close a roughly $42 billion budget deficit.

California’s Medicaid program would receive more than $11 billion in stimulus funding over 27 months, according to the California Medical Assn. But to qualify for the additional funds, states first must maintain or restore Medicaid eligibility and renewal procedures to their status on July 1, 2008. California lawmakers would need to reverse legislation enacted late in 2008 requiring people on Medicaid to re-enroll twice a year instead of once.

“This is another great opportunity for state lawmakers to maximize federal assistance,” said CMA President Dev A. GnanaDev, MD.

The stimulus offers another boost to states by extending moratoriums on three Medicaid rules through July 1, 2009. Those regulations, issued by the Centers for Medicare & Medicaid Services, would have reduced federal Medicaid spending by billions. The new law also delays until July a CMS rule that reduces some states’ Medicaid rates by aligning the program’s hospital outpatient services definition with that of Medicare.

This content was published online only.

Above article published on http://www.ama-assn.org/amednews/2009/02/23/gvl20223.htm

Physicians can earn tens of thousands in IT incentives, but they must act quickly to achieve the biggest benefit and avoid penalties.

By Chris Silva, AMNews staff.

Washington – The recent economic stimulus package provides a significant investment in health information technology that could benefit many physicians. But the government is expecting doctors to do their part to implement health IT and is prepared to penalize those who don’t.

Over the next decade, the federal government is projected to spend more than $35 billion on Medicare and Medicaid bonuses to physicians, hospitals and others that adopt certified electronic health records. Because of the Medicare penalties that eventually will apply to nonadopters, however, the net spending level will be only about $20 billion over 10 years.

Physicians with approved EHRs in place before 2011 or 2012 will be eligible for the maximum Medicare incentive payments allowed by the stimulus. They will receive bonuses equal to 75% of their allowed Medicare Part B charges — up to a sliding cap — in each of the five years after adoption. The maximum of $18,000 in the first year phases down to $2,000 in the fifth year for a total five-year bonus of up to $44,000 for early adopters.

Doctors who wait until 2013 or 2014 to have EHRs in place will be eligible for smaller bonuses. The 2013 adopters can capture a maximum of $39,000 over four years, while the 2014 adopters can claim up to $24,000 over three years. Medicaid will have its own five-year bonus schedule that will offer as much as $64,000 to eligible physicians who don’t claim Medicare bonus money.

Once the chance for bonuses ends, Medicare starts penalizing physicians who have not responded to the incentives. Doctors who have not adopted an EHR before 2015 and who fail to obtain a hardship exemption will see a 1% cut to their Medicare pay, a reduction that phases up to 3% for 2017 and remains each year after that.

Simply setting up any paperless system is not enough to earn bonuses and avoid penalties. The stimulus package stipulates that physicians must adopt a qualifying EHR and use it in a “meaningful way.” Meaningful users are defined as physicians who demonstrate to the Health and Human Services Dept. that they are using electronic prescribing; that their technology is connected in a manner that provides for electronic exchange of health data to improve quality of care; and that they submit information to HHS on clinical quality measures.

No longer a question of “if”

Some physicians already have begun to move away from paper, and they would rather act sooner than later to avoid penalties down the road. “The question now isn’t if, but how and when, because physicians are feeling a sense of inevitability,” said Todd Rowland, MD, executive director of HealthLINC.org in Bloomington, Ind., a regional health information exchange that covers a multicounty area. “We need to figure out how to implement it in an economical, management-oriented approach that requires as few work-flow sacrifices as possible.”

Dr. Rowland added that he doesn’t expect physicians to like the implementation process — or the possibility of penalties if they don’t do it right — but that it makes sense for physicians younger than 55 in particular to get on board. He estimates that more than 50% of physicians in Bloomington’s metro area and more than 75% in the rural area have adopted EHR systems.

Early EHR adopters can get up to $44,000 in a Medicare bonus or $64,000 in a Medicaid bonus.

While the stimulus also provides Medicaid incentives, physicians can’t have it both ways — they must choose either Medicare or Medicaid bonuses, said Heidi Echols, a partner at the law firm McDermott, Will & Emery in Chicago.

In an effort to prevent additional “double-dipping,” physicians who report using an EHR system that is also capable of e-prescribing no longer will be eligible for the e-prescribing bonuses that went into effect this year under the Medicare Improvements for Patients and Providers Act. On the other hand, Medicare penalties for those not e-prescribing by 2012 will sunset after 2014, so that no physician will be subject to double penalties for failing to e-prescribe and failing to use an EHR.

Now that Congress has set up the incentive structure for adoption, President Obama and his administration also must promote interoperability of EHR data so the records don’t become information “islands,” said David J. Brailer, MD, in an article published online as part of a series on health IT in Health Affairs’ March/April issue.

Dr. Brailer was the first National Coordinator for Health Information Technology at HHS from 2004 to 2007 and is now chair of Health Evolution Partners, a health care investment firm based in San Francisco. He said physicians particularly need to be wary of vendors from which they purchase IT services, as systems that become obsolete could set back progress.

“What it boils down to is, are you buying EHRs that you can use and keep for a long time, or is it a system that in two or three years goes kaput?” he asked. “We’re trying to avoid doctors having to start over again with electronic records during their career.”

The next steps

The stimulus act requires HHS by Dec. 31 to develop an initial set of standards, implementation specifications and certification criteria for EHR system adoption. It also authorizes the department to provide competitive grants to states for implementation loans to health care entities.

The national health IT coordinator also will be authorized to make available a qualifying EHR system to physicians and others for a nominal fee. Doctors who do not purchase the government’s system can purchase a qualifying system from a vendor of their choice as long as it meets certain standards, including interoperability requirements.

The American Medical Association will seek clarification from HHS on the cost of the government system and when it will be available. The department must determine more details on how it will spend the stimulus dollars and how doctors can access them.

Once those details are available, physicians must examine the cost-benefit breakdown. According to a May 2008 report from the Congressional Budget Office, estimated total costs for implementing a typical office-based EHR are about $25,000 to $45,000 per physician. Each physician would then need to spend about $3,000 to $9,000 per year to maintain the system.

Above article published on http://www.ama-assn.org/amednews/2009/03/16/gvsa0316.htm