|
LESLIE: It's become an everyday occurrence. People in all walks of life are talking about electronic medical records--from news reporters to my family, friends and neighbors. Did you ever imagine that the topic of medical records would become mainstream conversation and a staple in the daily media coverage? The American Recovery and Reinvestment Act (ARRA), also known as Recovery Act, Public Law 111-5 or the stimulus bill, is largely responsible for shining the spotlight on medical records. For the first time ever, HIT and HIM are included in an economic stimulus package.
PATTY: This is all very exciting for HIT and for the HIM profession. Last month when we attended the American Health Information Management Association (AHIMA) Team Talks and the AHIMA Foundation's Corporate Vendor Briefing meetings in Washington, DC, we had a chance to review the ARRA components in greater detail and better understand the role that AHIMA, state associations and HIM professionals need to play in the implementation of ARRA. Let's talk about the insights we gained during these meetings that directly affect HIM.
LESLIE: I think the most exciting part of the ARRA discussion was the information provided on work force. This is the section of the bill that specifically mentions the importance of education programs in medical informatics and HIM. Work force needs are now on the radar of the Office of the National Coordinator (ONC), which is charged with providing counsel to the Secretary of Health and Human Services and leadership for the implementation of interoperable HIT infrastructure. As part of the ONC role, they are responsible for tracking work force needs, including the need for HIM professionals.
PATTY: Linda Kloss, AHIMA's CEO, reported at Team Talks that ONC has been in contact with AHIMA to discuss how to advance the goal of ensuring a sufficient work force to support the implementation of EHRs in hospitals and physician practices and to support health information exchange initiatives across the country.
LESLIE: Some recent studies cited at Team Talks identified that for each $10 billion in spending on EHRs and related HIT projects, 200,000 new jobs will be created to provide EHR training, implementation and project management. Some 40,000 health information workers may be needed for the hospital market alone. This is serious job creation!
PATTY: You are so right. Those are significant projections and I think it is great news for HIM programs. In particular, it's an opportunity for HIM programs to seek funding from both the government and private foundations for the educational initiatives related to EHR course work that are so desperately needed to quickly provide an EHR-savvy work force.
Now, let's talk about some of the other aspects of ARRA.
LESLIE: I'd like to go to the big picture for a moment--ARRA includes more than $19 billion for HIT initiatives. Approximately $17 billion will be directed toward payment incentives for achieving "meaningful use" of certified EHR systems. The bonus incentive will start to be distributed in 2011 primarily through Medicaid and Medicare programs.
PATTY: The inclusion of the phrase "meaningful use" in the ARRA is interesting isn't it? This phrase has yet to be defined clearly. In all likelihood, it will at least mean that implementation of an EHR has improved the quality of care and streamlined costly administrative processes. But we don't really know what criteria will be applied to make that determination.
LESLIE: I wonder how physicians will respond to the planned incentives. I understand they will have to pursue grants and/or state loans to obtain funding to offset some of the investment costs and maintenance of an EHR.
PATTY: In a recent ADVANCE article, "Physicians Want EHR Incentives," the author cited a survey conducted by Allscripts, which revealed physician groups are interested in incentives to adopt EHRs. The study indicated that government e-prescribing incentives have been effective and there is reason to believe that EHR incentives will be also. The most interesting part of the debate is whether incentive payments should be provided up front to purchase an EHR or after implementation when "meaningful use" is demonstrated.
LESLIE: Nevertheless, the survey data about incentives is encouraging. Of course, the alternative of not implementing an EHR is worse. ARRA includes penalties to be implemented by 2015. Providers who have not demonstrated meaningful use of an EHR will begin receiving reduced Medicare payments!
PATTY: The provisions of the law will be rolling out in more detail over the coming months and this is one area we should definitely watch closely and communicate the details to providers.
LESLIE: Another $2 billion has been allocated to ONC with about $300 million allocated specifically to health information exchange projects. I understand that there are about 40 states making some progress toward health information exchange initiatives. These initiatives are critical--they are the foundation for truly achieving meaningful EHR usage in the United States. Without a national health information infrastructure to enable the exchange of information and support patient care as patients move about the health care system, we will have merely digitized health information and replicated the fragmented non-system that we have in the paper world.
PATTY: Health information exchange is an area where HIM professionals must be involved. With 40 states engaged in some level of planning and implementation there is ample opportunity and need for HIM participation.
LESLIE: Just by doing a quick search of the Internet, HIM professionals can learn more about the activities in their state and surrounding region.
PATTY: Rounding out the key funding initiatives, approximately $13.1 billion has been allocated to the National Institutes of Health, Public Health Service health centers, and for comparative effectiveness of medical treatments research and prevention and wellness.
LESLIE: The other aspect of ARRA of great interest to HIM professionals is the major changes to HIPAA. We are definitely entering what is fondly being referred to as HIPAA II.
PATTY: The ARRA calls for broader obligations for business associates, includes privacy and security requirements for personal health record vendors and new breach notifications provisions. It also includes expanded rules for accounting of disclosures, more clarification around minimum necessary and new enforcements andpenalties.
LESLIE: While HIPAA II may be arduous to implement, it has the potential to increase consumer confidence in EHR usage. The same effort that went into HIPAA I will be required all over again. Fortunately it isn't happening right away. Regulations still need to be drafted and we can all provide comments on draft regulations when they come out in the next several weeks. And then there will likely be the customary implementation period, which is usually more than a year or so.
PATTY: Given a glimpse of all of this, what is the HIM imperative?
LESLIE: I think there are a number of imperatives that need to be on the HIM professionals' to-do list. Here is a recap of some recommended focus areas shared at AHIMA's Team Talks:
- Engage in health information exchange initiatives within your state and local area. If you aren't sure where to start, contact your state HIM association leaders for guidance. This is on their radar too and they can help point you in the right direction.
- Support the HIM programs in your state. Be a practicum site, attend career fairs to encourage individuals to consider the HIM profession, sit on an HIM program's advisory board, and participate in grant development to secure work force funding for your state's HIM programs.
- Develop a work force plan for the long term for your organization and/or state to prepare for the implementation of EHR's in provider organizations.
- Review and comment on the proposed privacy and security regulations. (follow this link for AHIMA's analysis of the provisions) http://www.ahima.org/dc/documents/AnalysisofARRAPrivacy-fin-3-2009a.pdf
- Stay informed about your state's HISPC's activities. (Health Information Security and Privacy Collaboration).
- Raise your own profile. Become conversant in the ARRA and identify the role you can plan in your organization related to EHR adoption and HIPAA II implementation
- Stay the course with ICD-10-Implementation needs to begin today not tomorrow.
PATTY: Well there is certainly never a dull moment in our great profession. As you have said to me a number of times Leslie since ARRA was introduced, what a great time to be in this profession and what an even greater time to be entering it.
LESLIE: That's for sure! I would also like very much to hear from our readers what actions they are taking in their organizations to respond to the opportunities presented to HIM professionals by ARRA. If you want to have a discussion with us on this topic, please post your comments below to get the ball rolling.
PATTY: Great idea Leslie!
References
1. AHIMA Winter Team Talk Presentations
2. AHIMA's analysis of ARRA 's privacy and security provisions
3. "Characterizing the Health Information Technology Workforce: Analysis from the HIMSS Analytics™ Database," William Hersh, MD, Professor and Chair Department of Medical Informatics & Clinical Epidemiology Oregon Health & Science University
4. The Digital Road to Recovery: A Stimulus Plan to Create Jobs, Boost Productivity and Revitalize America by Robert Atkinson, Daniel Castro and Stephen Ezell, Jan. 7, 2009
Leslie Ann Fox is chief executive officer and Patty Thierry Sheridan is president, Care Communications Inc., Chicago. They invite readers to send their thoughts and opinions on this column to lfox@care-communications.com or ptsheridan@care-communications.com.
|