As a result of provisions in the HITECH section of the American Reinvestment and Recovery Act, hospitals and health care providers are eager to reap the financial benefits of implementing Electronic Health Record (EHR) technology. However, to qualify for the stimulus incentives, providers must use EHRs certified by an Office of the National Coordinator of Health IT (ONC) Authorized Testing and Certification Body (ATCB). This makes sense; the benefits of widespread EHR usage only work if there is a fairly standardized and uniform process across the board.

For nearly four years, the Certification Commission for Health Information Technology (CCHIT) has been the sole organization recognized by the federal government to certify EHRs. Since being named a recognized certifying body by Health and Human Services (HHS) in 2006, CCHIT has awarded certifications to nearly 200 EHR software products based on CCHIT’s standards of functionality, interoperability, usability, and security.

However, the proprietary nature of CCHIT’s role has now changed. The ONC and the Center for Medicare & Medicaid Services (CMS) announced in early March 2010 that they would name more than one organization to certify EHR software. As of July 1, a temporary certification program has been put into place that allows other organizations to apply to become ATCBs. This program is expected to remain in place until a permanent certification program is established in late 2012. There is no restriction on the number of organizations that can become ATCBs.

Organizations that previously certified through CCHIT may be disappointed to learn that there is no grandfather clause; everyone must re-certify everything. The CCHIT itself must re-apply to become an ATCB. It is expected that EHRs certified by the ATCB program will remain certified when the permanent certification program replaces this temporary certification program.

Both private and government entities are interested in acting as ATCBs. Over 40 formal application requests were received the day the program was posted in the Federal Register.

How might this affect CCHIT? Certainly, they will now have to compete with other certifying organizations, whereas previously they had a sort of monopoly on the process. There will be more competition and oversight.

Nonetheless, CCHIT still retains a great deal of institutional knowledge about the EHR process and provides a meaningful bridge to HITECH incentives. Ultimately, CCHIT may become the permanent certifying body for EHR software. Many would argue that CCHIT is by far the most prepared organization to begin certifying EHR software for the government.

Their recommendations may be the safest bet for investment. Providers and hospitals still waiting on final clarification of the HITECH certification requirements are trying to balance selecting the right EHR system for investment while still achieving the “meaningful use” calendar goals for 2011 to capture the incentive payments. Adhering to CCHIT products may be the smartest choice. Stakeholders hoping to receive the incentive payments are increasingly in a time crunch to commit to an EHR process, yet still unsure which selection will meet as yet undefined requirements.  

Opening up the playing field to allow more organizations to act as ATCBs may ultimately create a richer, more dynamic arena for the health care community. In the short term, however, health care stakeholders may find the stimulus timelines too short to try out new entities in the certification process.

The potential promise of the HITECH act remains hindered by logistical details. Will widening the pool of organizations able to provide certification relieve some of these issues, or will it further cloud the most direct route to EHR certification and stimulus payments? The debate is open.

In 2009, there was an unprecedented focus on Health IT Policy. With large amounts of money in the American Reinvestment and Recovery Act specifically budgeted to kick Health IT into high gear, it became a real and significant area for great scrutiny and discussion. Now, in 2010 and over the next decade, all participants in this arena need to shift from discussing policy to the real and difficult work of implementation. Going from the theoretical potential of Health IT to the actual hands-on, concrete applications will no doubt prove to be our biggest challenge to date.

When the Federal Government starts priming the pump with lots of money, it is no surprise that businesses line up to earn their fair share. But for Health IT to achieve its promised potential, profit cannot be the primary goal. We must maintain a focus on the real beneficiaries of this federal investment: the Consumers/Patients/Stakeholders that stand to realize true improvements in the delivery of health care through the integration of Health IT. The Department of Health and Human Services (HHS) is currently conducting two surveys to find out more about patient perceptions and preferences for the use of health IT in the course of their healthcare. Currently, understanding about patient perceptions of practices that use electronic health records (EHRs) or about patient preferences about what functions they want from a personal health record (PHR) are not clearly established. Policymakers hope to understand how use of EHRs will affect consumer satisfaction with care, communication between patient and doctor, and coordination of medical care.

Participants in the business of Health IT will thrive when they keep in mind a goal of successful adoption instead of focusing only on financial rewards.  Hospitals, providers, insurers, vendors, services, and consultants all must commit to the hard work of transitioning Health IT from the blueprint to a practical reality. This means a concentrated focus on continuous innovation and usability from all participants. While the Federal Government can provide the framework and structure, the actual implementation must come from the local and regional communities who know best how to serve their populations. There cannot be just a few big players that take the risks and receive the most of the rewards—without meaningful participation at all levels, Health IT implementation will not connect with the consumers and patients it is meant to serve. Collaboration and partnership must be present to capture the input and innovation at all levels along the food chain. Keeping the focus on adoptability and usability will ensure that in the long term, the business of Health IT will remain a vital and integral part of Health Care overall. 

President Barack Obama’s State of the Union speech Wednesday night focused largely on job creation and the economy and not, as many had expected, on the passage of healthcare reform. While he made a short push for reform, he didn’t provide much direction; rather he threw open the floor, calling for anyone with ideas to jump in.  The day after, much of the buzz has focused on the lack of discussion about an issue that has occupied so much of his recent activity.It is a disappointment that he didn’t choose to discuss some of the ways healthcare reform and job creation might mesh. After the unprecedented budgets included in the HITECH section of the American Reinvestment and Recovery Act were enacted, much was made about how growing a Health IT sector would pay for itself through reductions in mishandling, medical errors, inefficient filing procedures, etc.  Studies projected cost savings in the billions once health IT was firmly in place.Interestingly, Huffington Post posted a different version of the President’s speech; in this one, he did make passing reference to the economic promise of Health IT, sayingOur recovery plan will invest in electronic health records and new technology that will reduce errors, bring down costs, ensure privacy, and save lives. . .  And it makes the largest investment ever in preventive care, because that is one of the best ways to keep our people healthy and our costs under control.The televised speech, however, did not include this section. He did end his words on healthcare reform by adding “Now, even as healthcare reform would reduce our deficit, it’s not enough to dig us out of a massive fiscal hole in which we find ourselves.” There is definitely a nod here to the ideas first put out that if Health IT is effectively implemented, it will pay for its own investment and go on to accrue significant reductions in healthcare costs. It is an idea that should enjoy a popular reception with the public; technology has been applied in so many areas of modern life, it is hard not to believe it can’t improve, streamline, and reduce costs on almost any system. This address may have been an opportune time to wield that link between Health IT and genuine economic reductions.

Although health care is one of the largest industries in the country, many communities experience health care workforce shortage problems. This is not a new issue, but the introduction of health care reform and the stimulus package for health IT have added a new category for consideration.

Most health care technology leaders agree that there is a shortage of skilled workers for the current healthcare IT projects, such as the Electronic Health Record. Over a year ago, “Characterizing the Health Information Technology Workforce: Analysis from the HIMSS Analytics Database” stated that if the healthcare system was to move toward advanced IT systems, at least 40,000 additional health IT professionals would be required. Since that report was released, the prognosis for health IT has grown considerably.

The workforce for this initiative cannot simply be pulled from existing IT venues. Hospitals have specific needs and specific workflows that require IT specialists to have a meaningful understanding of working in a busy emergency room or hospital setting with busy health care providers. IT infrastructure will need to be maintained in these health care setting, requiring specialists who understand and can accommodate the presence of patients and ongoing medical activity. All of these specific types of job requirements cannot easily be found in existing IT jobs.

Health care providers—doctors, nurses, etc. – have a standing requirement to maintain continuing education hours; this arrangement provides a convenient venue to train them on the adoption and employment of new technologies. However, a similar large-scale program to train IT specialists to function within a health care setting seems to be lacking.

Currently, there is not a consensus about the exact skills and expertise that this new health IT workforce should have. The American Recovery and Reinvestment Act does include provisions to support educational institutions in expanding their programs to include health IT, but a clear idea about what the precise skill sets this workforce should have remains uncertain.

There has been a call for a national approach to this situation; some feel the Office of the National Coordinator for Health Information Technology (ONC) needs to spearhead the effort to find the best way to train a workforce to develop and manage this new technology within the health care system. The ONC can conduct a national survey to ascertain exactly the best mix of skills and knowledge, and how to best prepare a workforce to achieve this mix. Certainly, it remains clear that technological investment can only be truly successful if it also invests in the correct development of human capital.

The 4^th annual National Health IT Week 2009 is taking place this week, September 21st – 25^th, in Washington, DC. It is hard to imagine that when this event began, any of the participants could have envisioned a President passing a bill containing $20 billion worth of support for IT initiatives, but with that event a firm reality, this assembly of healthcare constituents—vendors, provider organizations, payers, pharmaceutical/biotech companies, government agencies, industry/professional associations, research foundations, and consumer protection groups—have a platform to demand serious national attention to the necessity of advancing health IT. Boasts event publicity, “Health IT brings the 18th century medical paper file system into 21st century medical care by providing crucial information in a secure and confidential manner in a matter of seconds.”  

The theme for this year’s event is “One Voice, One Vision,” and organizers hope to provide a forum for assembling key healthcare constituents with the goal of achieving President Obama’s healthcare transformation. President Obama has designated 2009 as the “Year of Healthcare Transformation.” Thanks to the HITECH section of the American Recovery and Reinvestment Act (ARRA), the government is advocating increased use of health information technology (HIT) through an unprecedented investment of federal money that will impact healthcare delivery using HIT for decades to come.

Key players are quick to note that it is healthcare reform, not IT reform, that is the main focus. David Blumenthal, the National Coordinator for HIT, is careful to insist that the primary goal of the HITECH Act is to “improve health care quality, not simply to promote health IT adoption.” Getting healthcare IT up and running in doctors’ offices is not the main objective; improving the healthcare system overall is.

There is plenty of research to back up the claims that investment in HIT will pay for itself. A recent survey, released by the Massachusetts Medical Device Industry Council (MassMEDIC), outlines areas of wasteful spending that hemorrhage billions of dollars annually. One of the top two greatest areas of excess, according to the report, $210 billion caused by inefficient healthcare administration, an area that certainly lends itself to improvement via the application of HIT. It can be argued that the third largest category, $100 billion for the care necessitated by preventable conditions, could be remedied with the judicious use of health IT to better monitor and stabilize patient health care by promoting a seamless, user-friendly and universally transferable medical information through the Electronic Health Record, (EHR).

But despite all the promise, there is plenty of evidence to show that consumers do not support HIT. A study, published Sept. 11 by the Agency for Healthcare Research and Quality (AHRQ), indicated that most people do not understand the emphasis on HIT in the healthcare reform debate. While healthcare in general is an important issue to most, HIT is not. Health IT is perceived by the majority as having a slight impact in areas of efficiency or convenience, rather than as a catalyst for meaningful healthcare reform.

They will need more education about how HIT will influence their care as EHRs become more prevalent. Public education is needed to help explain to consumers how HIT will affect their healthcare experiences and how they can have an influence on how IT is used.

As events unfold during this National Health IT week, it will be important for the policy makers and other stakeholders in the process to fully live up to the “One Voice, One Vision” approach and ensure this vision and the promise it carries it being adequately translated to all health consumers.

Net New Growth is a Proud Partner in National Health IT Week 2009 

This September, Net New Growth, as a partner in the advancement of health information technology to help reform healthcare, will join approximately 75 public and private sector organizations in Washington, D.C., to participate in the Fourth Annual National Health IT Week (September 21-25, 2009). With 2009 designated by the current Administration as the Year of Healthcare Transformation, the timing has never been better to invest in bringing tangible improvements to our nation’s healthcare system via healthcare information technology – a topic front and center at this year’s partner-initiated National Health IT Week events and publications. 

National Health IT Week 2009 will aim to educate and raise awareness among industry and policy stakeholders about leading health IT policy issues. Activities will focus on the recent developments surrounding the American Recovery and Reinvestment Act (ARRA) and healthcare reform.  

Initiated in 2006 by the Healthcare Information and Management Systems Society (HIMSS), National Health IT Week has emerged as a landmark occasion for bringing together diverse national healthcare stakeholders, who partner in developing neutral, common ground for the advancement of health IT adoption with “One Voice, One Vision.”  

The agenda for the week consists of several partner events, including:

• Capitol Hill Steering Committee on Telehealth and Healthcare Informatics Technology Showcase (September 24, 2009)
• National Health IT Week Press Conference on Capitol Hill (September 22, 2009)
• National Health IT Week Networking Reception (September 22, 2009)
• HIMSS Policy Summit (September 22-23, 2009)

One Voice, One Vision: Transforming Health and Care!Healthcare reform has now taken a prominent role in Washington, D.C., with both the House and Senate working in concert with the Obama Administration to pass effective legislation. In February, the President signed into law the American Recovery and Reinvestment Act, a landmark bill that will impact healthcare delivery using information technology for decades to come. National Health IT Week 2009 participants will partner to send a powerful message to our nation’s policymakers about the importance of fostering widespread health IT adoption to improve patient safety and healthcare quality.  

Visit www.HealthITWeek.org for a full list of partners and a calendar of the Week’s activities. Working together with our growing coalition of stakeholders, Net New Growth will help transform healthcare for all. 

The last blog’s look at ensuring that physicians play a central role in constructing the specifications for Electronic Medical Records (EMR) and Electronic Health Records (EHRs) generated a good discussion.

As one commenter stated, there exists a “lack of standards to even TALK about the lack of standards.” Medical personnel need to be consulted to ensure a system is established that works, but insurance companies must be included as well. The EMR facilitates documentation of services performed by physicians and hospitals, and this can be used to account for billing. Medicare has already set some standards, and the reality is that their regulations could force the hand of the industry—no organization can blithely ignore the financial power of Medicare reimbursement.

A repeated concern was the dislike of physicians to be forced into a system that may not work—to be faced with a “you must adopt this or you won’t get funded” approach. Most seem to have experience with software and interface systems created by well-meaning designers who are not medical professionals and, despite enormous investments of time and money, create a product that does not give doctors what they need.

Ensuring that medical personnel, who will primarily enter important health information, have a system that is appropriate is of obvious importance. But the needs of patients can not be overlooked. The ability of consumers to manage all aspects of life—financial, educational, travel, communications, shopping—online is accompanied by an increasing expectation for digital transparency and organization in the health care arena.

The Google Health Patient Health Record (PHR) is a good case in point. Patients control their own information, and physicians can share medical information directly with the PHR. Patients can invite family members or other decision makers to view their records as well.  Google emphasizes that consumers should be able to access and maintain important medical data online, warehoused securely, in a manner that clearly seems more modern than an overflowing file cabinet: “Isn’t it crazy that you don’t have a copy of your medical records under your control? It’s your information; why shouldn’t you control it?” asks the website. But as articles such as this one show a lack of common standards can result in misinformation or alarming inaccuracies as information gets transferred to the PHRs.

Patients want access and control of their medical data, and their goals for the use of such information may be in sharp contrast to how medical professionals or insurance companies or Medicare use such data. A truly beneficial EHR must accommodate considerations of all these groups.

There is evident optimism that the stimulus money can provide the catalyst for meaningful change IF the initial steps are taken correctly and big-picture standards are set early on. And it may be that social networking will provide the best path for getting the conversation for HIT headed in the right direction. Health portals might provide the best forum for all players to add their input and create the best strategy that can then be executed and put into play.

Change has not been slow in coming with the installation of the new administration. David Blumenthal has been appointed the new Director of the Office of the National Coordinator for Health IT (HIT). The government has budgeted $19 billion for HIT, with the goal of containing healthcare costs and creating new jobs. But ultimately, the best instruments for implementing this HIT  will be America’s physicians. The implementation of the electronic health record (EHR) is a case in point. A 2008 survey found only 17% percent of U.S. doctors have electronic health records. A recent study indicates that in all, only about 9% of hospitals have EHRs.

The slow adoption rate has been blamed by both groups on cost. So the big influx of federal money earmarked to encourage the EHR program should get the ball rolling, right? The current budget translates into about $6 million over several years for a midsized hospital, according to an expert cited by the Wall Street Journal — an amount that goes a long way toward covering the total cost.

But the main ingredient here may prove to be strategic marketing of this initiative to not only health care consumers, but practitioners and stakeholders at the state and local level.  There remains much uncertainty and wariness in the these communities regarding the effects of the the HIT Stimulus Package. Without their support, it will be difficult for the HIT stimulus effort to have the desired effect.

Strategic marketing seeks to ensure that all the players involved are part of the process. This includes making sure that practitioners and health care administrators are all a part of the process of defining and implementing HIT. Technology and other vendors hoping to provide services to health care organizations will need to bring to the table a commitment to maintaining an ongoing, long-term relationship rather than focusing on simply landing and executing a contract. Firms that successfully participate in the revenues the HIT Stimulus Package will generate will need to employ serious strategic account planning to ensure all parties involved are fully onboard and committed to the new enterprise.

Rather than trying to reform health care by imposing additional rules, regulations, and penalties to enforce change, the HIT Stimulus Package may offer a real opportunity for all stakeholders to find the best strategic path for meaningful change.

The new Administration has listed health care as one of the top seven priorities in the American Recovery & Reinvestment package. There is over $19 billion earmarked to advance Health Care Information Technology (HIT) alone, money which is expected to provide a return on investment as health care systems become increasingly efficient and costly medical errors are avoided.  

The Department of Health and Human Services alone offers over 300 programs and has an overall budget of over $700 billion. They are actively seeking to accelerate the adoption of HIT and the use of electronic health records. To achieve this goal, they must rely on being able to find the right contractors to meet their needs: Standards, Best Practices, Reviews, Management Consulting and IT Support, IT Security and Privacy, IT Infrastructure Consolidation and Software Standardization… the list goes on.   Naturally, there are significant existing barriers to entering the Health IT market. There are concerns regarding how digitizing patient identifiable medical information (PII) might conflict with privacy and security concerns. Navigating through federal acquisition regulations and responding to federal government procurement processes can be cumbersome and overwhelming. Finally, even with the best of ideas, change is always difficult in the Federal Government marketplace; despite ever increasing evidence of the advantages of Health IT, across-the-board adoption will happen slowly. 

So how can a credible health IT business take part in initiating and implementing this kind of monumental change? Understanding how to handle challenges and how to find the right opportunities is what the workshop The U.S. Federal Government Market For Health Information Technology (HIT): Strategies for Identifying Business Opportunities, Acquiring Partners and Positioning Your Company for Success is designed to provide. Health IT Consultants Peggy McShane of Net New Growth, LLC and Kathy Minchew of Federal Insights, LLC will break down the provisions of the HIT part of the stimulus package so participants can fully understand what requirements and opportunities are available, as well as clarifying purchasing tends, explaining the procurement process, examining how to market to the US government, and outlining references for finding specific vehicles for your business.  These workshops provided a unique opportunity for Canadian health IT vendors to gain practical insights into the U.S. federal market for health IT. Seminars, sponsored by the Canadian Embassy in Washington, DC, are taking place March 9, 2009 at the McDougall Centre in Calgary; March 11, 2009 at the Ontario Investment Trade Centre in Toronto; and March 12, 2009 at the Hampton Inn in Ottawa.