There are two big buckets of money in ARRA set aside for Health IT. The largest, by far ($36B gross, $19B net) is for hospitals and doctors to move from paper to electronic medical systems. These incentives come at the back-end of the Health Care provider's implementation project, in the form of multipliers to the reimbursement the practice receives from Medicare or Medicaid. Hospitals are gearing up to take advantage of these incentives, as it may mean somewhere between $2-$7M per hospital. However, the average doctor will receive $40,00-$60,000 over four years, not covering the cost of most implementations. Needless to say, the doctors are lukewarm to negative about this incentive package, and aren't rushing to the door to convert their practices.
There is a smaller bucket of ARRA money that doesn't get nearly as much press coverage, but may have a much bigger bang for the buck. That is money set aside for States to build Health Information Exchanges. These would be public "backbones" that will ultimately connect all the hospitals and physicians in each State. The announcement, made by Vice President Biden, and HHS Secretary Kathleen Sebelius on August 20th, set aside $564M for the States to build Health Information Exchanges. Because of the particulars of ARRA funding, States will have to respond and build quickly. The States submitted Letters of Intent on September 17th, and have to submit grant proposals by October 14th. Then, the Federal government will announce the grant recipients by December 1st. Having managed procurement for a major private institution, this is very fast turn-around indeed.
Here's the kicker. If the States want the Federal Government to pay their whole tab, then they must have their project completed within two years. After that time, State matching funds must apply to the project. Given the in-the-red status of most States, they will hurry, hurry, hurry.
That could be great, or it could be setting the table for failed implementations. A lot will depend on whether each state adopts four basic principles outlined below. If you want your state to provide a backbone for a health information exchange, feel free to cut and paste from this blog and send this to your State's Governor. Each state applying usually sets up some kind of Authority to manage the process (in my state, it is the NC Health and Wellness Trust Fund), but that Authority will be determined by the Governor.
1) Set up the State for easy Communication with the Federal Agencies at a low price
A state's Health Information Exchange's design should mirror the National Health Information Network’s open source CONNECT design. States should not recreate the wheel. Using the CONNECT design, the State will be able to seamlessly connect with Federal Agencies such as Medicare and Medicaid, the Department of Defense and the Veterans Administration. Additionally the flexible open source design keeps medical information resident in the existing systems within doctors and physicians’ practices and avoids the need for a statewide medical database--a fear for many citizens.
2) Keep Costs Low and Improve Interoperability by Mandating the Use of Data Standards by Companies involved with Health Care Information in the State
States should promote long-term sustainability by mandating that all companies doing business with the State, including laboratories, imaging centers, hospitals, and Physician offices make their results available in the ANSI-approved standards known as HL-7 (there are other relevant standards, as well). If a system is old or a vendor does not know how to do this, then they must put their interface technology in the public domain so that third parties can convert it to industry standards. We have learned from the 200 plus HIE's that were created and not sustained that the largest cost of both building and operating exchanges is due to proprietary, point-to-point non-standard connections between legacy hospital and lab systems.
3) Plan Personal Health Information to be the Centerpiece of the Exchange
A State should design its Exchange with the patient front and center. Currently, most HIEs are business-to-business, with only 2 HIEs making data available to the patient, though many have plans. We believe the key to getting long-term health care costs down is to educate patients. American consumers are very savvy, and they will learn what they need to in order to make good life decisions. They just need the information.
In addition to the broad principals, patient-centric records specifically will help patients with complex and chronic diseases make sure that all information is getting to every doctor and practitioner involved in their care. This is particularly useful for caretakers of sick children or aging parents.
4) Design For Public Health and Research Use By Building De-Identification Functionality into The Exchange
This same data can and should be repurposed for Public Policy Health Care, tracking of illness, and demographics. Often, Public Health Data comes from some other place or project that was financed independently of the Exchange (as most states have some kind of Public Health repository but may not have a Health Information Exchange). In addition to spotting key health rends like flus, the de-identification of data can be used to find clinical trial subjects, a costly and expensive proposition for Universities, Pharmaceutical companies, and Contract Research Organizations, ultimately bringing down the cost of getting new drugs and procedures to market.
A state's Health Information Exchange's design should mirror the National Health Information Network’s open source CONNECT design. States should not recreate the wheel. Using the CONNECT design, the State will be able to seamlessly connect with Federal Agencies such as Medicare and Medicaid, the Department of Defense and the Veterans Administration. Additionally the flexible open source design keeps medical information resident in the existing systems within doctors and physicians’ practices and avoids the need for a statewide medical database--a fear for many citizens.
2) Keep Costs Low and Improve Interoperability by Mandating the Use of Data Standards by Companies involved with Health Care Information in the State
States should promote long-term sustainability by mandating that all companies doing business with the State, including laboratories, imaging centers, hospitals, and Physician offices make their results available in the ANSI-approved standards known as HL-7 (there are other relevant standards, as well). If a system is old or a vendor does not know how to do this, then they must put their interface technology in the public domain so that third parties can convert it to industry standards. We have learned from the 200 plus HIE's that were created and not sustained that the largest cost of both building and operating exchanges is due to proprietary, point-to-point non-standard connections between legacy hospital and lab systems.
3) Plan Personal Health Information to be the Centerpiece of the Exchange
A State should design its Exchange with the patient front and center. Currently, most HIEs are business-to-business, with only 2 HIEs making data available to the patient, though many have plans. We believe the key to getting long-term health care costs down is to educate patients. American consumers are very savvy, and they will learn what they need to in order to make good life decisions. They just need the information.
In addition to the broad principals, patient-centric records specifically will help patients with complex and chronic diseases make sure that all information is getting to every doctor and practitioner involved in their care. This is particularly useful for caretakers of sick children or aging parents.
4) Design For Public Health and Research Use By Building De-Identification Functionality into The Exchange
This same data can and should be repurposed for Public Policy Health Care, tracking of illness, and demographics. Often, Public Health Data comes from some other place or project that was financed independently of the Exchange (as most states have some kind of Public Health repository but may not have a Health Information Exchange). In addition to spotting key health rends like flus, the de-identification of data can be used to find clinical trial subjects, a costly and expensive proposition for Universities, Pharmaceutical companies, and Contract Research Organizations, ultimately bringing down the cost of getting new drugs and procedures to market.
Sometimes news that doesn't make headlines really matters. This is one of those times. You can make a difference in your state as well. If all 50 States followed these simple, logical design principles, we'd all be better off.
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