Blumenthal: Health IT adoption will need more than incentives

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Although the American Recovery and Reinvestment Act of 2009 (ARRA) provides an unprecedented $19 billion program to promote the adoption and use of health IT and electronic health records (EHRs), spurring adoption will probably require more than financial carrots and sticks, according to David Blumenthal, MD, recently named as national coordinator for health IT.

In a perspective published in this week's issue of the New England Journal of Medicine, Blumenthal discusses the health IT provisions of the new law, which fall under the HITECH act. He also outlined the challenges that still remain to implementing and maintaining health IT systems.

"Many physicians and hospitals will need technical help to keep their systems working and to update them as technology improves," he wrote.

HITECH provides $2 billion for the Office of the National Coordinator for Health IT (ONC) to put support systems in place, authorizes a variety of tools for building the requisite infrastructure, and also sets aside $300 million to support the development of health information exchange capabilities at the regional and state levels. It also authorizes grants to create regional technology extension centers to help providers install EHRs and train a work force to assist with health IT implementation.

Additionally, it extends HIPAA privacy and security regulations to health information vendors not previously covered by the law, including businesses such as Google and Microsoft, when they partner with healthcare providers to create personal health records for patients.

It requires healthcare organizations to promptly notify patients when personal health data have been compromised, and it limits the commercial use of such information.

"All this constitutes a substantial down payment on the financial and human resources needed to wire the U.S. healthcare system," said Blumenthal, who added that major hurdles still remain.

One of these hurdles is the tight operating schedule of the Department of Health and Human Services and ONC, he wrote, referring to the 2011 deadline for incentives. To meet that, organizations must have an infrastructure in place to support health IT adoption well before 2011, which "will be challenging."

"It takes time to develop and implement innovative federal programs, and it will take even more time to create the local institutions needed to support [health IT] implementation," he wrote.

A second hurdle is the need to more adequately define two critical terms: certified EHR and meaningful use. ONC currently contracts with the Certification Commission for Health Information Technology (CCHIT) to certify EHRs as having the basic capabilities the federal government believes they need.

However, Blumenthal suggests that many certified EHRs are neither user-friendly nor designed to meet HITECH's goal of improving quality and efficiency in the healthcare system.

"Tightening the certification process is a critical early challenge for ONC. Similarly, if EHRs are to catalyze quality improvement and cost control, physicians and hospitals will have to use them effectively. That means taking advantage of embedded clinical decision supports that help physicians take better care of their patients," he wrote.

One problem with tying Medicare and Medicaid financial incentives to "meaningful use," Blumenthal wrote, is that while "Congress has given the administration an important tool for motivating providers to take full advantage of EHRs, if the requirements are set too high, many physicians and hospitals may rebel," petitioning for changes to the law or by simply not adopting the technology and accepting the penalties.

"Realizing the full potential [of health IT] depends in no small measure on changing the healthcare system's overall payment incentives so that providers benefit from improving the quality and efficiency of the services they provide. Only then will they be motivated to take full advantage of the power of EHRs," he concluded.