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February 20, 2009
by Neal Ganguly
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The Stimulus Bill - Some Next Steps...

The industry has spent the last few weeks watching the Obama Administration’s Stimulus Bill move rapidly through the Congress. This unprecedented piece of legislation is intended to stimulate the economy and, importantly for healthcare, to infuse billions of dollars specifically to facilitate the adoption of healthcare IT. That’s billions more than were ever infused before and it’s unleashed an unending stream of update emails from professional organizations, advocacy groups, conference planners, and others who are all giving us their summary of the bill and what it means to the industry. Trying to keep up with it all is enough to make your head spin – I’ll spare everyone from another bill summary because there are plenty of sites that have done a nice job (here’s a good link: http://www.himss.org/content/files/HIMSSSummaryOfARRA.pdf )

The immediate question is: What should we do now?

As healthcare IT leaders we need to prepare ourselves for the impending confusion. Here are a few suggested steps.

  1. Educate Yourself Try not to get overwhelmed by the multitude of ‘educators’ that are clamoring for your attention. Pick a limited number of trusted sources and read up.

  1. Register to Vote – Do not underestimate the power of a real voter talking to a legislator. Particularly at the state level, where a significant number of dollars are likely to end up. Learn who your local legislators are so you can contact them.

  1. Contact Your Legislators – Actually contact them. Ask them what their position is on Healthcare IT. They may not have one, but if enough people ask, it will get on their radar and they’ll develop one – which you may have a chance to influence.

  1. State Your Position – Let your local legislators know that you are concerned about Healthcare IT and how available federal stimulus dollars will be used to benefit your community.

  1. Get Involved – Join the local chapter of one of the industry professional organizations. They are strong sources of advocacy support, and legislators are more receptive to large noisy groups. Good groups include HIMSS, CHIME, ACHE and HFMA.

There is much that is still up in the air about how funds will be distributed. Remember, we’re ultimately talking about distributing our hard earned tax dollars – so we have plenty of skin in the game. Get involved and most importantly,

  1. Demand Accountability – Let your legislator’s know that you are watching to see how they spend these stimulus dollars.

This is a great opportunity for us all - let's not blow it.



That's a great summary. In the spirit of 'Educate Yourself' and 'Demand Accountability,' there's the implicit aspect of understanding the issues. In that spirit, I'll offer the following link:


The specific issue I'd like to call out from that document is:

"Strict attention should be paid to selecting HITSP Interoperability Specifications that are market tested."

Most people reading this have been involved in internal development and/or working with a commercial vendor on a new solution.  The recurring, humbling lesson is that getting the specification correct and appropriate to the real world (costs, workflows, existing rules and incentives, etc) is an iterative process.  The understandable yet instrumental mindset of "Get 'er done" on a specific timeframe always leads to waste and delays, when there's an inadequate specification in place.  It also can lead to broken glass in important relationships, and, at times, potentially increased morbidity and mortality.

We love the HITSP specifications; they tend to be based on proven HL7 messages and clear use cases.  They are our best hope to practically achieve semantic interoperability.  And, just like the recent (2006) JC led move to important medication reconciliation, the standards and use cases required every institution deploying them to proto-cycle a solution.  The implementation varied by care setting within each hospital.  Twenty to Seventy iterations of a solution was usually necessary, despite the work and quality of the initially specified solution.

That exuberant march towards untested solutions is important to guard against.  To the spirit of your posting, one cannot apply 'strict attention' without having clear, reductions of these critical issues.  Let's not overstimulate on inadequate specifications (aka specifications that are not market tested.)  Let's also not fall into the trap of apathy and inaction.  There are specifications that are market tested and there are mechanisms, like grants, to drive other specifications into that category. 

Thanks for raising the topic for discussion.