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'Meaningful Use' Standard Draws Scrutiny as Health IT Finds its Footing

By John Reichard, CQ HealthBeat Editor

Who knew? It may be that President Obama's big win on health care already happened—just weeks after he took office.

On Feb. 17 last year, Obama signed into law an economic stimulus provision jump-starting health information technology—puny stuff compared to the overhaul proposals now stalled on Capitol Hill. It is likely nonetheless to leave a lasting mark on the nation's health care system.

"Health IT" may be something Washington is getting right on health care, thanks to an estimated $36 billion that will flow over the next decade through Medicare and Medicaid to doctors, hospitals and clinics that make "meaningful use" of technology. That is the proposed new regulatory test announced Dec. 30 to ensure that new systems don't remain crated in boxes and are actually used to improve care and cut costs.

New standards are coming to certify that systems work together. Seventy new "Regional Extension Centers" are springing up to teach caregivers how to use IT the way that agricultural extension agents teach farmers new techniques. Fifteen "Beacon Communities" are planned to serve as models of how lab results, medical images, prescriptions, and other medical data can zip instantly and securely around communities to streamline care.

The whole federal effort is under the leadership of David Blumenthal, the former Harvard Medical School professor Obama named last March as his National Coordinator for Health Information Technology.

But like everything involved in the quaint notion of "fixing" health care, getting IT right is enormously complex, a process that will take years, if not decades, and require doctors, nurses, and administrators to abandon familiar ways and learn to do their jobs all over again using technology that may make them feel inept.

The difficulty involved, and the carrot-and-stick approach designed to lower payments to caregivers who don't use IT meaningfully, may make the proposed rules among the most heavily commented upon in the history of federal health regulations. The volume may dwarf even the 100,000 comments filed in the years-long rulemaking on privacy and streamlining health care data, predicts Neal Neuberger, head of the Institute for e-Health Policy, an IT think tank.

The complaints are as varied as the stakeholders in health care. The American Hospital Association says fewer than five percent of hospitals overall now could qualify for higher payments because the proposed "meaningful use" standard is too tough. Rural hospitals say they lack IT expertise, capital, and broadband to transmit data.

Meanwhile, it's unclear what systems will qualify for reimbursement, yet providers face pressure to buy systems now. Lawmakers like Sen. Charles E. Grassley, R-Iowa are promising tough scrutiny of stimulus dollars spent on IT, expressing concern about faulty software that produces incorrect drug doses, for example.

Help from Computers
How Congress and the administration respond to the many questions that arise over the implementation of the regulations will help determine whether the ingredients of success now on the table can be assembled into effective policy.

To that end, it helps to have someone in charge who can relate to techies and non-techies alike, as well as to older doctors who tend to have a distaste for new information technology. Blumenthal's Harvard chops and 30 years as a primary care doctor get respect in the worlds of policy and medicine, but he also relates easily to those who aren't turned on by IT.

"My wife thinks it's a huge failure of vetting when I got this job because she takes care of the computers at home," Blumenthal joked in a speech to rural hospital administrators recently. "But what I do have is experience using an electronic health record. One arrived on my desk about a decade ago and I gradually came to terms with it."

Two vivid experiences made him a champion of the technology, Blumenthal said. In one case he tried to order a sulfa drug for a patient being discharged from the hospital. "The computer said to me, in big, red, bold letters across the screen, 'this patient is allergic to sulfa.' I was very grateful."

Another time, he tried to order a CT scan of a patient's kidney. The computer asked "are you sure you want to do that?" It told him the patient had received a similar scan weeks before, allowing Blumenthal to cancel a costly test and spare the patient exposure to radiation.

But few doctors practice in organized systems like Blumenthal's, where electronic medical records capture and transmit data throughout a network of providers. So many Americans will not see such a system for years.

In the meantime, there's likely to be intense pressure from lawmakers to surmount obstacles to health IT because of hopes it can cut rising health costs without harming care. Said Sheldon Whitehouse, D-R.I., to a group of IT professionals at a Capitol Hill seminar last month: "You are doing God's work."

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