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Stimulating HIT- Morning in America?

February 20, 2009
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Over the past couple of weeks I’ve been living with the ARRA (the “Stimulus Act- we’d best get used to another new acronym.) There are plenty of good resources available to bone up on the provisions. As Neal suggests, the HIMSS summary is excellent.

If you’re really hungry to feed your inner wonk, there’s a navigable HTML version at the government’s Thomas site. You can also link from there to the GPO’s pdf version- it’s 407 pages.

(A couple of nights ago I was working on a presentation about the subject for a meeting of our organization’s managers. It was getting late, I was getting punchy, and it occurred to me that the cost of the whole thing is almost $2 billion per page.)

For what it’s worth, let me share a few random thoughts:

· Are the HIT provisions “stimulative”? Those critics who are (A): conservative and (B): non-HIT literate seem to choke a little on the provisions that have excited most of us. I listened in on a webcast a couple of days ago that featured Allscripts CEO- and Obama supporter- Glen Tullman and David Merritt of Newt Gingerich’s Center for Health Transformation. Merritt made the point that, while Gingerich was outspoken in much of his criticism of the bill as a whole, you didn’t hear a peep of protest about the HIT pieces. Here’s a statement on the subject from Merritt. That said, I am a bit disappointed that the Medicare incentive payments won’t show up until 2011.

· How likely is it that $20 Billion will make a difference? OK, that’s probably a stupid question, but if you’re like me, once numbers get to be that big they don’t mean much. Tullman made a helpful point in an interview with Investor’s Business Daily, when he pointed out that “the entire industry for electronic records and e-prescribing is probably $2 billion.”

· Sounds like a pretty good time to be selling HIT. Yes, it does. And during a time when stocks in general are going down the toilet, a quick glance at some of the important publically traded HIT companies show them outperforming NASDAQ by 20-50 percent over the past three months. No surprise, they’ve had a really good week.

· Who gets credit? There has been a lot of work, education, blood, sweat, and tears invested in trying to get the message out over the last few years. It wasn’t long ago that President Bush threw a brief mention of HIT into the State of the Union and we all felt that we had arrived. While I don’t pretend to know who really had the ear of those who drafted this legislation, I was especially interested in comparing the recommendations from the Call To Action report that HIMSS published in December with what made the final bill. HIMSS was either remarkably prescient, or someone was listening.

· How’s it all going to play out? While there are parts of the bill that are pretty prescriptive (the declining payment schedule for the Medicare incentives is spelled out quite specifically), there is still a lot of wiggle room on how the provisions will be administered. Expect state governments and federal cabinet officials to have wide latitude when it comes to deciding how money will be spent. And expect them to have plenty of help figuring it out. You would do well to let your voice be heard. If you happen to live or work in the state of Ohio, Advocacy Day is Wednesday, Feb. 25 in Columbus.

· The importance of the Broadband incentives have been overlooked. People who live close to civilization take their broadband access for granted. It’s been a major source of discussion in our corner of Appalachia for a while. The ARRA includes funding for broadband initiatives in two different sections; the total of the two adds up to $7.2 Billion. (Part of that is targeted for distance learning and telemedicine too.)

So what could possibly go wrong?

Well, we might have trouble finding enough HIT people to create, implement, maintain, and support these systems.

A lot of systems might get sold, but not implemented well enough to make a difference.

We might all get so buried in this economy that we find ourselves focusing on survival rather than “Quadrant Two” activities, like implementing HIT. I’ll talk about prospects for our business in today’s economy soon.

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Comments

Mark,
I was at three of those "ARRA/what does it really mean" meetings this past week. In the spirit of responding to rhetorical questions, I'll share two common observations regarding 'what could possibly go wrong?"

1. Timing
2. Legislative Definition

Timing is a reference to the fact that substantive HCIT projects routinely take months to years. Some reporting and access projects being notable exceptions. Even if we reduce delays associated with vendor selection, implementation projects have many steps that need to happen in sequence and can be a bit irreducible in time requirement. Build, testing and training each can be lengthy when the basic complexity is significant. So, in ARRA terms, is achieving 'meaningful use' by 2011;' this may not be the slam-dunk that's implied or hoped for by the policy makers.

The presence of existing, proven and operational systems adds an interesting wrinkle. How many of those are considered 'certified?'  What are the lifecycle issues there?  How much grandfathering (grandmothering) is wanted/needed and possible?

Legislative Definition is another one of those 'what could possibly go wrong' issues. We all know that the details and interpretation of the ARRA is work will receive definition under the leadership of the Secretary.

A very prominent legal firm that has looked at the legislation at the word level has concluded, for example, that the definition of physician is inadequately specified. Same with 'Charity Care.' And, of course, 'meaningful use.'  These are not new or unique-to-ARRA issues.  That means they're not problems; they are predicaments.  They can't be 'solved,' only managed through.

The attorney practice lead noted that similar healthcare legislation has historically been passed and interpreted badly from the perspective of the authors intent.

Mark, I think your call (and Neal's) for attentive vigilance is very well placed.

(And, incidentally, I strongly agree with your concerns regarding manpower and education. My two points are 'additional', not ranking!)