Want to apply for stimulus funds? Start preparing now.
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| John Glaser | |
The American Recovery and Reinvestment Act is law. By now, most health care leaders are aware that $19 billion of federal funds is being directed to advance the adoption and effective use of interoperable electronic health records.
As health care leaders head up the learning curve and endure a period of hype, anxiety, hope, salivation and confusion, they should individually and collectively be thoughtful about the following implications of the bill.
Knowns and Unknowns
It will take months before the details of several important sections of the legislation are clarified. Two pressing issues are how states can apply for grants and how “meaningful use” of EHRs is defined. To fully answer the question “What do I need to do?” the government has to develop specific regulations, policies and procedures.
Despite areas of uncertainty, hospital and health system leaders can take steps to prepare themselves. They can start by analyzing the financial incentives’ revenue potential and assessing the effort and expense to ensure they are using certified EHRs. They can also initiate two important conversations: first, with state officials about their intended approach to pursuing the regional and statewide health information exchange planning and implementation grants; and second, with local colleges regarding their interest in providing education for the information technology workforce that will be needed.
The uncertainty around the legislation does not mean organizations can delay planning until there is comprehensive clarity. There is not a lot of time until the initial availability of incentives in 2011.
Fundamentals Remain Unchanged, but Money Goes Away
The near-term availability of funds should not obscure well-known factors critical to the success of an EHR implementation: Processes must be thoughtfully re-engineered, and clinicians must be meaningfully engaged. Giving these activities short shrift in a stampede to get money could leave the organization with angry clinicians and a government-funded EHR that fails to improve care.
Stimulus funds should not lead an organization to abandon its overall IT approach. It might not be prudent to materially alter a sound strategy and a planned set of application initiatives to pursue the incentives. If an EHR is part of that plan, there are opportunities to defray the costs of the investment. But if the EHR is a secondary piece of a larger initiative, the organization’s strategic opportunity costs might be greater than its stimulus gain.
The stimulus funds, while large, are not infinite. At some point, money for initiatives such as health information exchanges and research will probably disappear. Organizations that pursue these funds must think through how to sustain the activity once the stimulus bolus runs dry. Cheap capital can become an expensive operating budget.
In the Long Term
The industry has a short-term focus on stimulus opportunities and challenges. This is appropriate; there is a lot of work to be done in a brief time period. Nonetheless, it’s likely that the result of the $19 billion will not be simply a broader adoption of interoperable EHRs among providers. The stimulus has set in motion deep and lasting changes in the industry, and upcoming health care reform discussions may lead to additional shifts.
For the foreseeable future, a portion of Medicare and Medicaid reimbursements will be based on effective use of EHRs. The size of the reward or penalty is significant and may grow over time. We should also expect that the definition of meaningful use will become more robust over time.
The development agenda for EHR vendors will be increasingly driven by the demands of certification, interoperability and effective use requirements. While higher reimbursement for providers and better care for patients will follow, this agenda also limits vendors’ ability to make customer-specific modifications and engage in promising, early stage innovations.
Health care and IT leaders need to become very involved in regional and state forums that discuss and implement standards, data use agreements, privacy mechanisms and health information exchange governance. State and regional efforts to connect providers mean organizations will be less able to pursue IT agendas that ignore the actions of other stakeholders.
Some organizations view the adoption of an EHR as a form of competitive advantage or differentiation. In fact, an EHR will progressively distinguish no one. Advantage or differentiation will depend on EHR-leveraged improvements in care efficiency, quality and safety. These advances will require excellent process improvement skills, effective use of clinical decision support, and sophisticated use of data to understand performance and continuously drive change.
The stimulus bill has provided a dramatic boost to the nation’s efforts to improve care delivery through the adoption and effective use of electronic health records. Although much of the industry is still trying to understand the specifics of the legislation, it’s clear that addressing the resulting challenges and opportunities can’t wait. Despite this new urgency, the fundamentals of sound IT planning and implementation have not changed.
John Glaser is vice president and CIO of Partners HealthCare in Boston, senior advisor at Deloitte Center for Health Solutions, and a regular contributor to H&HN Weekly.
Hospitals & Health Networks welcomes your comment on this article. E-mail your comments to hhn@healthforum.com, fax them to H&HN Editor at (312) 422-4500, or mail them to Editor, Hospitals & Health Networks, Health Forum, One North Franklin, Chicago, IL 60606.
