It's not surprising that the federal stimulus package and the recently proposed "meaningful use" rules dominated the discussion at the eHealth Initiative's sixth annual conference in Washington, D.C. Starting on Jan. 25, about 400 attendees from various sectors of the health care industry filled a conference room at the Omni Shoreham Hotel to hear from experts in the field about "Delivering on the Promise of eHealth" -- the title of this year's event.
The session topics ranged from "Achieving the Promise of Electronic Prescribing" to "Laboratories for Change: State eHealth Leadership" to "Transforming the Patient-Provider Relationship Through eHealth." However, despite the variety of sessions, it was clear that HITECH -- the health IT provisions of the American Recovery and Reinvestment Act of 2009 -- was at the forefront of the minds of both panelists and audience members.
Ree Sailors -- a program director in the National Governor's Association's Health Division -- called it a "stroke of genius" that HITECH was included in the 2009 federal economic stimulus package rather than waiting for lawmakers to include funding for health IT in health care reform legislation.
Although nearly all of the conference panelists and attendees appeared to be strong proponents of health IT, there was a clear divergence of opinion when it came to whether the proposed meaningful use rules expected health care providers to do too much too soon or whether they didn't go far enough.
At the end of last year, federal officials released proposed regulations describing how health care providers can demonstrate meaningful use of electronic health records to qualify for incentive payments under the 2009 federal economic stimulus package. The public has until March 15 to submit comments on the proposed regulations, and federal officials are expected to issue a final rule later this year.
'On the Right Track?'
John Rother, executive vice president of policy and strategy at AARP, was scheduled to give a speech about health IT's role in supporting health reform. Roth explained to laughter in the audience that after the Jan. 19 Massachusetts election, he had "lost [his] crystal ball." Instead of discussing the uncertain future of health care reform, Rother focused on the challenge of consumer engagement.
Rother said that health IT tools are key to transforming health care delivery in the U.S. but that consumers need to better understand the benefits of health IT.
"E-health tools must become user friendly," he said, adding, "Ease of use and personalization will be key to consumer engagement."
Rother said that AARP believes that the proposed meaningful use requirements are "fairly modest" in phase 1 and that they are "generally on the right track."
He said that AARP feels that health care providers have been "dragging their feet" on health IT adoption.
He added that from patient standpoint, meaningful use must improve care. Rother said that AARP does not want the public to view EHRs as an invasion into the doctor-patient relationship but instead as "step forward," similar to the introduction of the telegraph and telephone.
Steven Findlay -- senior health policy analyst at Consumers Union and a member of the Health IT Standards Committee -- said health care providers are "quite understandably having moments of shock and awe" as they examine the proposed meaningful use rules. However, he said it was important to "push as far as we can" with the 2011 criteria.
Findlay stressed the importance of finding a balance between being sensitive to what is doable and not being shy to push the industry forward. He added that he is confident that the Office of the National Coordinator for Health IT will be "open minded" as comments on the proposed rules come rolling in.
'Way Too Much on the Table?'
Steven Stack -- an emergency department physician in Kentucky and a member of the American Medical Association's Board of Trustees -- said the proposed meaningful use roles "bite off too much too soon." He said that there still are some real barriers to health IT adoption and that it is "not ready for prime time yet." He added that offering physicians money will not change that.
Stack said that while he believes health IT is important; he thinks a smarter strategy would be to focus on a smaller list of health IT goals, such as electronic prescribing and laboratory data exchange. He said that he believes the government put "way too much on the table."
J. Leonard Lichtenfeld, deputy chief medical officer at the American Cancer Society, echoed Stack's plea for simpler meaningful use criteria. He warned that there "may be problems ahead."
Other speakers at the conference took issue with specific provisions of the proposed regulations.
For example, Rachel Block -- deputy commissioner for health IT at the New York State Department of Health and president of the eHealth Initiative Foundation's Board of Directors -- called a provision in proposed rules that prohibits states from imposing additional requirements for Medicaid funding under the federal stimulus package "problematic."
Meanwhile, Ronald Paulus -- executive vice president for clinical operations and chief innovation officer at Geisinger Health System in Pennsylvania -- questioned the proposed requirement that hospitals and physicians use EHR systems to report clinical quality measures, noting that many health care providers use patient data capture tools that are separate from their EHR systems.
Insight From ONC
Joshua Seidman, acting director of the meaningful use division of ONC's Office of Provider Adoption Support, said the goals of HITECH are not about technology but about improving health care and transforming health care through the meaningful use of health IT.
When asked why the proposed meaningful use criteria was essentially devoid of any mention of personal health records despite the federal government's call for increased patient engagement, Seidman said that federal health IT policymakers focused on defining functions rather than specifying the use of certain products in an effort to avoid stifling innovation. He added that some of the requirements of the proposed regulations could be facilitated by PHRs.
While acknowledging the ambitiousness of the federal government's health IT goals, Seidman detailed how ONC plans to provide support and resources to help health care providers meet the meaningful use requirements.
Seidman said ONC will announce "very soon" the first set of grant awards for regional health IT extension centers. In addition, ONC plans to establish a Health IT Research Center to offer support to the regional health IT extension centers.
He added that ONC is working on health information exchange infrastructure and is committed to building the workforce necessary to meet the country's health IT needs.