States to
Obama: Give Us That HITECH Grant Money!
July, 2009
On 2/16/09
the HITECH Act became law,
providing $19.2 billion for the purpose of
stimulating the uptake and use of health
information technology (HIT). Approximately
$2 billion will be spent
on states to allow
them to invest in an HIT infrastructure, and
in particular, for the development of
Regional Health
Information Organizations (RHIOs)
and health information exchanges (HIEs) both
of which in the past have resulted in
failure. Now many states are seeing the
HITECH money as an opportunity to
aggressively promote HIT to improve the
future of healthcare through the use of
certified electronic health records
(c-EHR) and
through these exchanges.1
The 6 states
discussed below have vastly different plans
for promoting HIT, from the aggressive to
the sublime.
Massachusetts
(MA)
Since 2004, MA has become a national leader
in implementing HIT. On 8/10/2008 SB 2863
set the groundwork for further state led HIT
initiatives, including the establishment of
the e-Health Institute to oversee state HIT
activities and adoption, including the
deployment of c-EHR systems networked
through a statewide HIE.
A recent 6/2008 survey to test how much HIT
uptake has been impacted after 4 years of
massive HIT funding questioned 18,282
physicians. Roughly 36% use all “basic”
c-EHR capabilities, which is about twice
what is seen nationally. In MA 20% of
prescriptions are sent electronically (eRx),
which is the highest level of eRx use in the
country.
2
Unfortunately only 5% of MA physicians
“significant use” advanced capabilities,
which is just 1% higher than what is found
nationally.
3,4,5
Arizona (AZ)
The uptake of EMR technology throughout
Arizona has been credited to a 2005
executive order by then-Gov. Janet
Napolitano that all healthcare providers
install EMRs by 2010. A recent report has
stated that there is a
marked increase in
physicians who are canceling their EMR
contracts and deinstalling their expensive
c-EHR software systems.
This is especially prevalent among smaller
physician groups.
6
Deinstallations and failed installations
will be among the biggest factors which will
keep a national HIE from becoming a reality.
New Jersey
(NJ)
On 1/8/2008 NJ passed the A. 4044 bill that
made it the first state to mandate a move
toward c-EHR. On 5/11/2009
another bill was proposed which would make
it illegal to sell or otherwise
distribute a non-CCHIT c-EMR in the state of
NJ, applying penalties of up to $5,000.
It seems that its main sponsor, Dr. Conaway,
has numerous financial ties with several
lobbying groups, including HIMSS, as
documented in his financial disclosures. The
idea of manipulating competition as a quid
pro quo by making the sale of a non-c-EHR
system illegal is bad policy.
7,8
Maryland (MD)
On 5/19/09 HB 706 was signed into law,
mandating that all commercial
state-regulated health insurance payers (not
just Medicare/Medicaid) need to provide
monetary incentives to health care providers
to adopt and use an c-EHR. This law is meant
to bolster the state's efforts to create a
HIE by 10/2009.
With this bill the state is trying to cut
off all physician choice concerning HIT by
making a practitioner subject to a host of
penalties from all insurers if he doesn’t
use a c-EHR.
9,10,11
Louisiana
(LA)
On 8/2007 the Health Resources and Services
Administration (HRSA) announced $31.4
million in grants to promote the growth of
HIT in 4 communities, including LA.
Unfortunately by 12/2008 only half the
applications for the 100 available $58,000
grants had been submitted.
The failure of this program may be the
forerunner of what will occur with the
HITECH Act and indicates that physicians
just can’t afford HIT, don’t want the extra
electronic paperwork, don’t want the
disruption in workflow caused by eRx and
CPOE, and don’t want to learn and use
complex c-EHRs.
12,13,14,15
New Mexico
(NM)
On 3/23/2009
SB
278 (the “EMR Act”) was signed into law,
encourageing more EMR use as well as to
provide for patient confidentiality. It
established an EMR as the legal equivalent
of an existing paper record.
The NM Department of Health also
has helped 122 providers in 36 communities
set up an EMR system in their practice. The
program remains optional for providers and
does not set any penalties for
nonparticipation.
16 Thumbs up to NM for
writing appropriate, prudent HIT law!
Conclusion
Several states are trying to aggressively
promote HIT, even though c-EHR systems have
only been adopted by 17% of physicians, with
only 4% of physicians “significantly using”
them. Those legislators rushing HIT bills
need to slow down, they need to show due
diligence in learning the nature and history
of EMR, and they should consider the overall
impact of HIT within the fiscal constraints
of a recession. They should stay clear of
improper lobbyist influence and associations
with companies that will ultimately benefit
from HIT legislation. The growth of HIT will
evolve slowly; it can’t be rushed with
poorly written laws.
Al Borges MD
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