Money flows into health IT adoption efforts

The American Recovery and Reinvestment Act (ARRA) of 2009 contained billions of dollars aimed at moving U.S. healthcare onto an electronic platform. Much of it, described in the HITECH section of ARRA, is earmarked for incentive payments to physicians for demonstrating “meaningful use of certified EHRs,” paid out through Medicare and Medicaid.

In addition to these direct incentives, additional money is set aside for building the infrastructure needed to support the migration to Electronic Health Records (EHRs). Last week, the Health and Human Services (HHS) Secretary and the Department of Labor (DOL) Secretary announced the release of $1 billion in ARRA awards to help build (1) health information exchanges (HIEs), (2) regional extension centers (RECs), and (3) training programs for jobs in health IT.

With all of this money flowing into health IT, what will its impact be on day-to-day life in healthcare? Will we see any change?

For physicians and other providers of healthcare, the main attention has been around reimbursement methods for direct healthcare delivery – threats of Medicare reimbursement cutbacks for fee-for-service care, private insurance premium hikes and the impact on the percentage of patients who are no longer insured, federal health insurance reform and the impact on reimbursement rates, experiments in more coordinated delivery strategies such as the Patient Centered Medical Home, and the like. These areas of healthcare are not affected by the HITECH funds that have been released.

The money released will be felt rather indirectly by physicians and other healthcare providers. But those involved in health IT infrastructure will notice a change. Of the money disbursed, $386 million goes as grants to 40 states and qualified state-designated entities for building HIEs. These are data repositories that “sit in the background” and support EHRs in their ability to exchange clinical data about a given patient, and report on findings amassed from such collected data. Comparative effectiveness research will be aided by such improved real-time clinical data collection.

One of the categories of Meaningful Use of EHRs is the ability to exchange clinical data with others, and to upload quality metrics to public health and other centralized sources. As EHR developers ourselves, we have been surprised at the poor state of readiness of centralized registries (e.g. HIEs, Immunization Registries, etc.) – we have commented that as a web-based EHR developer, we would likely be ready to exchange data sooner than “the other end of the pipeline” will be ready to receive it. Infusing money into local HIEs may help this overall state of readiness (at least, that is the hope).

Another $375 million is being granted to 32 non-profit organization to support the development of RECs. This may actually be something that healthcare providers will see in day-to-day life. The RECs represent “feet on the street” that are intended to assist health professionals as they move to adopt EHRs in their clinical practice. The RECs will function as consultants for practices independent of EHR vendor representatives, though one can certainly expect that EHR vendors will be pressuring RECs to make sure to include their products in the list of options they recommend to physicians. This is a new program, not previously in existence, set up under HITECH/ARRA – our hope is that this service will rapidly mature, not make too many “rookie mistakes” and result in offering accurate advice to physicians about the true values available in the EHR realm.

An additional $225 million in DOL grants will be used to train 15,000 people in job skills needed to access careers in healthcare. It does not offer the actual jobs; but it goes to training programs that will teach the skills needed for anticipated jobs in the sector – e.g., jobs in HIE agencies, and local RECs. Through existing partnerships with local employers, the recipients of these grants have already identified roughly 10,000 jobs that will become available in the next two years in nursing, pharmacy technology and health IT.

These kinds of stimulus grants will certainly help U.S. job growth creation, and will add to the ranks of those involved in the health IT sector. That is a good thing. It does not guarantee that the build-out of an EHR platform across the country will go smoothly, however. Standards for HIE data exchange need to be technologically forward-looking and progressive, embracing new technologies (e.g. web-based interfaces) rather than protecting legacy vendors. This discussion is unaffected by the current funds disbursement. RECs need to make sure that they understand all the value propositions in the space, as they are changing rapidly, and not simply settle on recommending large, expensive, burdensome legacy systems. Time will tell. At the very least, however, we are heartened by the attention and support going toward this sector, as the build-out of an interconnected EHR platform is crucial to any meaningful healthcare delivery reform in the future.


Robert Rowley, MD
Chief Medical Officer, Practice Fusion, Inc.