As the nation stands on the threshold of one of the most important eras in health information technology (IT) history, we are witnessing a "perfect storm" of health IT advancements, innovations and drastic overhauls.
Three waves of change in health IT over the past two years bear this out:
First, on Feb. 17, 2009, President Obama signed into law the American Recovery and Reinvestment Act (ARRA), which includes billions of dollars in Medicare and Medicaid incentive payments to eligible professionals and hospitals for the "meaningful use" of certified health IT products. The legislation also included the Health Information Technology for Economic and Clinical Health (HITECH) Act, which allocates about $36 billion in funding to help healthcare providers obtain meaningful use of health IT, including electronic health records (EHRs) and care coordination through health information exchange (HIE).
Second, on Jan. 16, 2009, the Obama administration accepted the final rules for 5010 and ICD-10, intended to improve patient care quality, enhance claims processing, improve reporting and promote interoperability.
Third, on March 23, 2010, the President signed the Patient Protection and Affordable Care Act (PPACA), which includes provisions that address many of the challenges facing electronic health information exchange, as well as innovative new methods to reimburse expenses for quality care.
We have come far in these past two years and these developments will move us even further. However, we must not waiver in these efforts. If we do, this perfect opportunity might blow right over and we could miss the chance to transform healthcare and health outcomes of people across the country.
While many of the requirements under ARRA present cultural and technical challenges to healthcare providers, they are necessary next steps in transforming healthcare through the use of health IT to improve quality and patient safety.
According to research by HIMSS Analytics, the use of EHRs among healthcare providers has steadily increased over the past four years.
According to the HIMSS Analytics EMR Adoption Model (EMRAM), hospitals in "Stage 4" are best positioned to meet the 2011 meaningful use requirements.
As of May, 2010, 15.2 percent of U.S. hospitals (794 of 5,223) have achieved "Stage 4" or higher. This is up from 3.7 percent at the end of calendar year 2006. Moreover, half of U.S. hospitals have achieved "Stage 3" and are poised to make the advances needed to meet the meaningful use requirements.
Earlier this year, HIMSS worked with its membership and other key stakeholders to develop comments on the Department of Health and Human Services' Notice of Proposed Rule Making (NPRM) on Meaningful Use, the Interim Final Rule (IFR) on Standards and Certification Criteria, and the NPRM on the Certification Process.
Included in the discussion were members representing all facets of the healthcare community, including physicians, nurses, hospital and clinical practice leaders, consumers, IT specialists, consultants, lawyers, vendors, and representatives from HIEs.
HIMSS's public comments on meaningful use and certification included recommendations to:
• Correct the unintended impact of using CMS Certification Numbers (CCN) to identify hospitals for incentive payments.
• Clarify the definition of hospital-based eligible professional to reflect Congressional intent.
• Streamline meaningful use criteria, recognizing the impact on workflow; placing an emphasis on more realistic metrics; eliminating some metrics; and allowing some objectives and measures to be deferred to Stage 2.
• Expand the definition of eligible professionals and care settings for the EHR incentive programs under ARRA to maximize the benefits of health IT across the continuum of care.
• Significantly reduce the number of Clinical Quality Measures ensuring that measures can be health IT-enabled as part of the care process.
• Shift the balance from highly detailed meaningful use criteria/measures and the aggressive timeline to a smaller number of required criteria/measures with lower thresholds for achievement while maintaining the current 5-year implementation timeline.
• Establish a temporary certification process without delay.
Our community is ready to make the necessary steps to improve healthcare outcomes, and we are confident that we prevail in these efforts to positively transform our nation's healthcare landscape for many years to come by using health IT.
-- David W. Roberts, MPA, FHIMSS, is vice president of government relations for the Healthcare Information and Management Systems Society.
