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HITECH Revisited

June 17, 2010
by Jennifer Prestigiacomo
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Web-Exclusive Interview: Helen Pfister, J.D., Manatt Health Solutions

Earlier this month, the New York- and Los Angeles-based Manatt Health Solutions released “ HITECH Revisted ,” a study that assessed the Health Information Technology for Economic and Clinical Health (HITECH) Act and made recommendations to Congress. The report was informed by 24 healthcare IT leaders who have been actively involved with federal policy or are in advisory roles in the current administration. Helen Pfister, one of the authors of the report, spoke recently with HCI Associate Editor Jennifer Prestigiacomo to discuss some of its highlights.

Healthcare Informatics: What do you think the most important finding was in “HITECH Revisited”?

Helen Pfister: The two that I’d say were the most important ones are, first, the need to set out a meaningful use roadmap, so that healthcare providers know now where they’re going to need to be over the course of time to achieve meaningful use. And the other is the [report’s]finding on the need for a strategy on achieving interoperability. I think that is a significant gap for HITECH to be implemented and could conceivably be a major barrier to achieve its goals.

HCI: Did any of study’s findings strike you as surprising?

Pfister: Currently the Notice for Proposed Rulemaking (NPRM) only focuses on individual hospitals. What some interviewees viewed as a problem, and the report identifies as a potential issue, is that a hospital system cannot achieve meaningful use on a system-wide basis. A lot of hospital systems have made tremendous progress on implementing EHRs, but instead of looking at the entire system and evaluating that, each hospital is viewed on an individual basis, and that is not the necessarily most efficient way to deal with this.

Pfister: We got a lot of support for the Act in general and for the federal government’s efforts in this area. I think people were less critical than I anticipated.

HCI: Do you think the expectations of CMS (the federal Centers for Medicare and Medicaid Services) for meaningful use implementation are too great?

Pfister: I don’t think so. I think the requirements they have put out need to be restructured. A lot of it is addressed in our report—setting up a roadmap in advance to give some guidance to providers so they know where they need to be going. Instead of having it be “all or nothing,” where if you fail to meet even one of the requirements you don’t qualify for meaningful use. [CMS should] allow a little more flexibility.

HCI: Which of the study’s findings do you think is going to be the hardest for CMS to put into action?

Pfister: The most difficult item is the [study’s] last finding, which is about payment reform. Obviously, there was a significant health reform package that was passed earlier this year, but that is just the starting point. In the end for all of this to work, it all has to be tied to payment reform and that is much easier said than done.

HCI: What do you see as the critical resource gaps for organizations to comply with meaningful use guidelines?

Pfister: I don’t think there is any one-size-fits-all answer. It really depends on the organization. Some may not have the staff that they need at this point in time; some may not have the money they need; some may have invested in systems that aren’t going to get them to achieve meaningful use. It could be any number of different reasons, and I’m not sure there’s one that I can pinpoint as the most significant.

HCI: What do you think CMS should do to help fill in these resource gaps?

Pfister: What CMS can do is really revise the meaningful use requirements to make them more flexible and more manageable for these organizations, while still giving them enough teeth so that providers really are adopting EHRs.

HCI: Why do you think small and medium practice physicians aren’t using quality improvement activities in their EHRs?

Pfister: I think it’s the reason why a lot of small and medium practices haven’t implemented EHRs in the first place. It takes a fair amount of resources to learn to use an EHR and use it to its fullest capacity. I don’t think a lot of physicians have a lot of resources to do that or don’t really realize the benefits that come along with that.

HCI: What are the problems for large hospital systems, as opposed to individual hospitals?

Pfister: Currently the Notice for Proposed Rulemaking (NPRM) only focuses on individual hospitals. What some interviewees viewed as a problem, and the report identifies as a potential issue, is that a hospital system cannot achieve meaningful use on a system-wide basis. A lot of hospital systems have made tremendous progress on implementing EHRs, but instead of looking at the entire system and evaluating that, each hospital is viewed on an individual basis, and that is not the necessarily most efficient way to deal with this.

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