“Meaningful use” of health IT no longer rhetoric

By Jianggan Li | 24 June 2009 | Permanent link | 0 comments

President Obama is more zealous about healthcare than probably most Health Ministers in the world – every week you can see him in the news talking about healthcare reform.

And it’s not only rhetoric; there are tangible and laudable actions. US$19 billion has been allocated as incentive payments for doctors and hospitals who adopt “meaningfully use” of electronic health records. Health IT Policy and Standard committees have been formed to advise Dr David Blumenthal, the National Coordinator for Health Information Technology; both committees just had their second meetings.

The classical ‘carrot and stick’ approach is applied to push for adoption – while those who comply early receive grants, financial penalties will be imposed on those which miss the deadlines.

A combination of goals and timelines has been set up: criteria for data sharing and capture in 2011, care processes aimed to achieve desirable population health outcomes established in 2003, and ‘measuring and achieving those outcomes’ by 2015.

NOT surprisingly, when the notion of “meaningful use of health IT” was first announced, no clear definition was given, prompting different interpretations and even proposals in the field and especially the medical blogosphere.

In fact, one of the first tasks of the Policy Committee is to define the national vision - ‘meaningful use’ as one of its first tasks, and it is reasonable to assume that the focus will be on outcomes, rather than software or other technologies. That affects how the stimulus fund is allocated.

And the Secretary is expected to approve the first set of standards by the end of this year.

Things seem to be moving pretty fast. The zeal of Superstar number one President Obama certainly played a vital role – but more importantly, he managed to make all these requirements and actions into law.

Health Information Technology for Economic and Clinical Health Act (conveniently abbreviated as ‘HITECH’), was passed by the Congress and signed off by Obama in February. HITECH formed part of the American Recovery and Reinvestment Act – the stimulus legislation.

The law appropriates US$2 billion funding to the Office of the National Coordinator for Health Information Technology (ONC). It also codifies the duty of Dr Blumenthal, who is in charge of the ONC.

The ONC was established in 2004 by President Bush’s Executive Order, and had never been really very active before HITECH was adopted. Well, there was more rhetoric than action back then, and the previous legislation had too many other priorities to focus on.

And an executive order is different from law, which is more binding and much easier to enforce.

HITECH also expands security and privacy provisions and penalties associated with HIPAA compliances.

Congress Budget Office estimates that the incentive mechanisms in the HITECH Act will boost those adoption rates to about 70 per cent for hospitals and about 90 per cent for physicians by 2019.

Many in Asia find it difficult to push through changes in healthcare, especially in the areas of information exchange and privacy. Perhaps the exciting progress in the US can offer us some inspiration.