The American Reinvestment and Recovery Act passed by Congress earlier this year itemized over $19 billion dollars for Health IT. Of that amount, $17 billion is directed toward fiscal incentives promoting the adoption of electronic health records (EHRs) by Medicare and Medicaid providers and toward hospitals. The Medicaid and hospital incentive programs are distributed on the state level; Medicaid providers are eligible if they carry at least a 30 percent Medicaid caseload. All the financial reimbursements are disbursed only if providers meet the ‘meaningful use’ benchmarks currently being determined by a EHR Standards Committee (per direction of ARRA).

And the other $2 billion? Well, that goes to the Office of the National Coordinator of HIT and is designated for competitive grants, health exchanges, HIT infrastructure and revisions to enhance privacy and security (http://cumc.columbia.edu/it/about/docs/gartner.pdf). So, if you were a physician, wouldn’t you be psyched to know that you could get up to $44,000 in return for moving from paper to digital?

The Dallas Morning News reports that physicians are wary of the government’s reimbursement program, postulating that the ARRA/EHR incentive program could either modernize the health care system or be a giveaway to software vendors on the taxpayers dime. As highlighted by Gartner, a technology research firm, the government goals of HIT have not changed from the Bush to Obama Administration; rather, the instruments are simply more “blunt” (pdf). In other words, instead of saying to providers, “please make the transition to digital,” the Obama Administration is saying, “make the transition to digital and we’ll pay you and if you don’t, we’ll fine you.”

Will the carrot and stick approach work? There are some doubters. Among them is Richard Kneipper, founder of a health information technology consulting group, PHNS, Inc. In an interview with the Dallas Morning News, Kneipper warns that the current effort surrounding ‘meaningful use’ is simply a ‘toll’ approach that allows providers through once they’ve purchased a certified software EHR product.

Kneipper argues for more far reaching criteria that demand better health outcomes as a result of EHR adoption. Echoing the concerns of many, Kneipper is frustrated that the software vendor group, Health Care Management and Information Systems Society (HIMSS), has such a prominent role in certification determination (one of the criteria for ‘meaningful use’.

Hospital CIO Pamela McNutt argues that the ARRA incentive program could backfire if hospitals feel burdened by the meaningful use criteria that is set to an aggressive timeline. The government argues that physicians and hospitals need a nudge. The American Hospital Association (AHA) maintains that the current draft timeline puts patients at risk by demanding that clinical orders are digitized by 2015. Sound like a lot of jumbo? Somewhat, yes.

The point is that the government is dangling dollars out for physicians if they do X, Y and Z. However, the counter argument is that in their effort to modernize medicine, they are betrothed to a somewhat nascent HIT industry. There is truth to both sides—the health system proves itself a late adopter on the technology curve yet the government is easily enticed by technology’s promises.

The last and important link, emphasized by Mark Leavitt, Chairman of the Certification Commission of Health Care Information Technology (CCHIT), is the health information exchange.  Exchanges are set up to promote data transfer between hospitals and doctors. Leavitt admits that there is more work to do with respect to certification and the ultimate goal of software interoperability but that in the end, exchanges are the “missing piece” but the feds have not pumped enough cash into it. In Texas, there are some small exchanges but hospitals are hesitant to spend the funds needed to support them. The main reason is competition; hospitals and doctors don’t want to share patient information that could affect patient referrals—their lifeblood. One example highlighted by Kneipper is an effort to get Dallas hospitals to share patient information about homeless patients that tend to use multiple emergency rooms, resulting in duplicative care. In the end, the project never evolved due to lack of financial investment. Exchanges could play a role in serving as a data hub—but in order to rise above market interests, the government needs to make it a serious part of its HIT plan or find other avenues of successful data sharing.

In sum, while the carrot and stick plan may succeed incrementally, the goal of interoperability remains in question. At the end of the day, success will be measured by EHR adoption—i.e. how many offices are wired up with electronic records. Is that the right way to measure success? The answer is not clear.

Also Interesting:

[+] States take bigger role in promoting EHR adoption

[+] HIT Stakeholders Argue ‘Meaningful Use’ Requirement too Aggressive

[+] GE offers no-interest loans to promote EHR software

[+] Community Health Centers: An EHR helping hand, please?

[+] Doctors aided by emerging offshoot of EHR software

[+] EHRs with the ease of an iPhone? Not so fast