Local, State, Federal

HIMSS, Health Care Experts Respond to Stimulus
“Capital Crunch” at Hospitals Impacts Imaging
CCHIT Expands Certification Road Map

HIMSS, Health Care Experts Respond to Stimulus

After President Barack Obama signed the American Recovery and Reinvestment Act of 2009 into law in February, many in the medical IT industry applauded the $787 billion stimulus package and its incentives to create a widespread and interoperable health care system.

“The creation and support of legislation, as well as regulation that advances health care IT adoption and interoperability, is something we wholeheartedly support,” said Tee Green, president of Greenway Medical Technologies. “The creation of an interoperable health care system will benefit America by improving care quality, increasing patient safety, eliminating waste, and reducing fraud.”

Agreeing that $19.2 billion included for health IT will offer important economic benefits, the Healthcare Information and Management Systems Society (HIMSS) said health IT funding is essential to meet Obama’s goal of computerized health records for all Americans by 2014.

On February 13, McClatchy/Kansas City Star reported, “Many economists and health care experts say the plan is worthy of stimulus money because it will create tens of thousands of jobs in information technology, informatics (the managing and processing of data and information) and other computer-related industries, and will also lower health-care costs and improve efficiency by reducing medical paperwork.”

HIMSS added that economic benefits include the expected creation of hundreds of thousands of jobs and annual health care cost savings of as much as $77 billion. The society also anticipates a number of advantages for patients and doctors, including fewer medical errors and reduced administrative delays.

In a July 2008 issue of The New England Journal of Medicine, a report published results of a survey, which found that 66% of doctors who had not adopted an EHR system cited cost as the biggest barrier to adoption. The Washington Post on February 18 reported that this cost is an estimated $150 billion, representing a significant barrier to the 2014 target deadline.

Naming other roadblocks, the Washington Post also pointed to “concerns over lack of universal protocols for collecting data as well as rules that establish how, with whom and under what circumstances the data can be shared. Many health-care providers—physician practices, testing facilities, hospitals and clinics—fear liability if private information gets into the wrong hands.”

Under the legislation, doctors and hospitals are now eligible for incentive payments through Medicare and Medicaid reimbursement systems after demonstrating “meaningful use” of certified EHR technology.

“To computerize their medical records, physicians and their practices stand to get $44,000 to $64,000 in incentives, and hospitals up to $11 million,” the Washington Post reported. “But there are also penalties. Providers who treat Medicare and Medicaid patients and have not gone to paperless systems within five years could lose funding. With the federal government spending more than $600 billion annually on 80 million Americans through Medicare, Medicaid and other programs, that could prove a powerful incentive for providers to get on board.”

Nevertheless, HIMSS maintains, “in drafting this legislation, policy-makers demonstrated that they are listening to Americans’ views on health IT. The legislation allows the Secretary of Health and Human Services to utilize processes American taxpayers already financially supported under the second Bush Administration.”

The American Recovery and Reinvestment Act of 2009 includes many recommendations made by more than 100 HIMSS members in a December 2008 report titled “A Call for Action: Enabling Healthcare Reform Using Information Technology.”


—Elaine Sanchez

“Capital Crunch” at Hospitals Impacts Imaging

In today’s tumultuous economic environment, hospitals looking to make facility upgrades and investments are facing severely reduced funds, according to a newly released report from the American Hospital Association (AHA). As a result, improvements in patient care are postponed, physicians and staff are being squeezed, and radiologists are facing dangerously diminished patient access to imaging.

The AHA report, which describes the results of a survey of 639 hospitals collected from late December 2008 to January 6, 2009, details a “capital crunch” that is forcing delays for new buildings, technologies, and other improvements. Many “shovel-ready projects” have been stopped or postponed as philanthropy, reserves, and loans dry up.

“From cancer centers to expanded emergency departments to electronic health records systems, hospitals are postponing or delaying projects that could greatly benefit health care in communities across the country,” said Rich Umbdenstock, president and CEO of AHA. “Stopping these projects also means new jobs are not created within the health care field or for construction workers, contractors, IT specialists, and others. The ripple effects of the capital crunch on employment are cause for great concern.”

Radiologists and radiology organizations are especially concerned. The Medical Imaging and Technology Alliance (MITA) say the effects are already being felt in the imaging arena.

“We are seeing this ‘capital crunch’ translate to patient care,” said Ilyse Schuman, managing director of MITA. “Hospitals aren’t purchasing the new and innovative imaging equipment that can result in life-saving diagnoses. That compromises their ability to make sure patients have access to the right care at the right time.”

Nearly half of hospitals surveyed by the AHA have postponed projects that were to begin within the next 6 months. Many have stopped projects that were already in progress. Most of the hospitals that have postponed projects have delayed updating their facilities, while more than six out of 10 hospitals have put clinical and information technology projects on hold. The hospitals surveyed said these postponed upgrades and investments would have resulted in very real benefits for their hospitals and communities:

  • More than eight out of 10 hospitals said they have delayed projects to update or replace aging clinical equipment, or to use new technologies to automate clinical processes.
  • More than six out of 10 hospitals reported that facility upgrades, along with clinical and information technology projects, would have increased patient care efficiency and improved quality of care.
  • Nearly 60% of hospitals said the IT projects that are put on hold would have improved care coordination.
  • About half of hospitals are trying to meet growing demand for existing services through either facilities projects or purchases of clinical equipment.

Figures like these demonstrate that the capital crunch is not an esoteric concept, but something very real and devastating, Schuman said. They also point the way toward potential restorative action.

“We need to make sure that, going forward, policy-makers understand that additional cuts in reimbursement or capital will only exacerbate the situation,” she said. “Lack of funds means a lack of access to the best patient care. When it comes to imaging, upgrades and new technology are much more than new tools, but are the key to the best treatment possible.”

—Amy Lillard

CCHIT Expands Certification Road Map

The Certification Commission for Healthcare Information Technology recently announced an update to its road map for expansion of health information technology (HIT) certification activities.

Furthermore, the body emphasized the importance of flexibility and responsiveness to emerging impacts of the American Recovery and Reinvestment Act.

A total of nine new programs are slated to launch in 2010 and beyond. According to CCHIT, they aim to “extend certification to new specialties, settings, and populations, while also opening the door to labeling that recognizes advanced capabilities in electronic health records as users become ready to adopt them.”

Mark Leavitt, MD, PhD, chair of the commission, commented that this year will bring an across-the-board acceleration in health IT activities.

“I believe this is the most important turning point in the history of health IT, and of our organization as well,” Leavitt said. “With about $20B in funding and incentives for EHRs, health information exchange, and associated technologies—based on certification as a key qualification—we must be very flexible and responsive as federal health IT initiatives emerge and grow.”

Receiving approval from the Board of Commissioners, development of four programs—Clinical Research, Dermatology, Advanced Interoperability, and Advanced Quality—looks to result in a 2010 launch date. These programs will join two that have been previously scheduled for a 2010 launch, Behavioral Health and Long Term Care.

Scheduled for launch in 2011 are Eye Care, Oncology, Advanced Security, and Advanced Clinical Decision Support. Development of Obstetrics/Gynecology certification was placed on schedule for possible launch in 2012.

The final expansion road map and public comments are available at www.cchit.org/expansion. Volunteer work group recruitment for new and existing certification programs began on March 23 and will end April 20.

CCHIT said the road map was drafted in response to requests from stakeholders representing a variety of health care domains. Leavitt said the organization received more than 700 pages of materials during the previous public comment period.

“While previous road maps defined expansion in terms of professional specialties, care settings, and patient populations, this year the commission is adding more flexibility, opening up the option of certifying advanced levels of technology for products that go ‘beyond the basics’ in any domain,” Leavitt said.

—E. Sanchez