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A New Milestone on the Long Journey to U.S. Adoption of Health IT

By John Reichard, CQ HealthBeat Editor

October 8, 2010 -- The federal office overseeing national efforts to spread the use of health information technology announced this week that it has begun publishing a list of products certified as eligible for Medicare and Medicaid bonus payments.

Publication of the list should help spur IT purchases by doctors and hospitals because only products certified as "interoperable"—compatible with other IT systems—will qualify for billions of dollars in Medicare and Medicaid bonus payments appropriated under the economic stimulus law (PL 111-5).

In addition to using certified products, providers also must demonstrate "meaningful use" of the technology to qualify for the bonus payments. What that means in concrete terms was spelled out by the Centers for Medicare and Medicaid Services (CMS) in a final rule issued in July.

The new list is the product of a temporary certification program established under the auspices of the HHS Office of the National Coordinator for Health Information Technology. David Blumenthal, the national coordinator, told lawmakers last week that his office is preparing a final rule due out later this year establishing a permanent, more rigorous certification program.

Blumenthal told a House subcommittee hearing Sept. 30 that the permanent program, which will be "fully operational" in 2012, will do more to incorporate international standards to make sure that IT systems work together well.

The entire health IT standard-setting effort, seen as key to adoption of the technology, came under review at the hearing by the Technology and Innovation Subcommittee of the House Science and Technology Committee.

More Work Needed

Testimony at the hearing made clear that while much progress has been made, an enormous amount of work remains before IT use is as routine in health care as elsewhere in the economy. The availability of systems meeting federal standards should help, though the standard-setting process has a long way to go.

"Many physicians, particularly those in small practices where most Americans get their health care, are hesitant to take on the considerable expense of a health IT system that, without common standards, may not work with the systems of a neighboring health care provider or may become prematurely obsolete," subcommittee Chairman David Wu, D-Ore., said at the hearing.

Wu said Blumenthal "has done an admirable job meeting tight deadlines and navigating the needs of many stakeholders" in developing standards, but "we still have a ways to go in promoting interoperability, coordinating the many health IT projects under way, governing the standards development process, and providing direction on privacy and security."

Witnesses at the hearing outlined additional areas in which standards are needed. Kamie Roberts, an official with the National Institute of Standards and Technology, which is part of the Commerce Department, is working with academia and the private sector to develop standards in telemedicine to make it easier for doctors to diagnose, treat, and monitor patients from many miles away.

Another focus is on developing standards so that "medical records can be retrieved regardless of the format and medium in which they were first created or stored," Roberts testified. "This preservation will allow doctors to create the medical records of children today, and enable access to those same medical records when those children are adults."

Standards Needed

Roberts added that standards are needed to encourage advances in medical image quality and to promote development of technology to allow doctors to more easily retrieve physician notes from electronic health records.

Richard Gibson, president of the Oregon Health Network, credited Blumenthal's office for "making rules as straightforward and pragmatic as possible." Gibson said vendors of electronic health records "now have a clear road map for the next two years of what will be required of their software as a minimum for clinician adoption."

But "we need to acknowledge that standards have relatively little application unless individual health care providers have electronic health records in the first place," Gibson said. Most of the 400,000 health care professionals eligible for bonus payments still need to acquire electronic health records for their medical practices, he said, estimating that bonus payments will only cover 47 to 67 percent of that cost.

Experts say electronic health records will prevent the prescribing of inappropriate drugs or dosages, head off medical errors stemming from hard-to-read handwriting, and reduce duplicative testing by providing a permanent place to store medical data, among other benefits.

But Gibson said use of the systems right now is very time-consuming for many doctors. In general, electronic health records are not yet at a point where they "allow providers to see more patients in a day, spend more quality time with their patients, or guarantee better or more consistent health outcomes for their patients," he said.

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