As we celebrate the holidays and look forward to a new year, there just might be a few health IT gifts that will need to be unwrapped. Some were on our wish list, others are surprises. And, of course, there are still some disappointments.
Innovation for Everyone
High on my health IT wish list was a major focus on innovation. Last summer, I called for an advanced research projects agency for health. Well, what do you know? I just might get it (or something like it). And not once, but twice.
First, when David Blumenthal, National Coordinator for Health IT, announced the reorganization of the Office of the National Coordinator for Health IT, I was pleased to see a new ONC Office of the Chief Scientist, which will be responsible for research and for identifying innovations in information technology that can be applied in health care settings.
My conversations with senior staff at ONC indicate that this office will be responsible for looking over the horizon, tracking health IT and related developments in the private sector and outside the U.S. Importantly, this office will then ask the hard question -- what can private sector and international health IT innovations offer to improve the quality and performance of America's health care system?
The second is in health care reform legislation. The Senate bill (HR 3590) would establish the Center for Medicare and Medicaid Innovation, or CMI. CMI's purpose "is to test innovative payment and service delivery models to reduce program expenditures under the applicable titles while preserving or enhancing the quality of care. ... In selecting such models, the secretary shall give preference to models that also improve the coordination, quality and efficiency of health care services …"
While CMI is largely focused on payment and delivery systems innovations, supportive health IT will be essential to success. For instance, the Senate health care reform bill specifies that one area of CMI's focus should be: "Supporting care coordination for chronically-ill applicable individuals at high risk of hospitalization through a health information technology-enabled provider network that includes care coordinators, a chronic disease registry, and home telehealth technology."
Further, in selecting models for testing, CMI may consider ''whether the model utilizes technology, such as electronic health records and patient-based remote monitoring systems, to coordinate care over time and across settings."
Innovation, here we come.
Technology Is Not Enough, I Want Information.
Sure, I'm as much of a technology junkie as the next guy. But what I really want is information. Let's take that technology, capture data, transform them into information. Who knows, maybe we'll find some knowledge.
The House health care reform bill (HR 3962) seems to offer a gift that might just move in that direction. The House bill would create an HHS assistant secretary for health information (ASHI). At first blush, this might be seen as taking the responsibilities of the National Committee on Vital and Health Statistics and moving it up the bureaucratic food chain.
For instance, among ASHI's responsibilities is to "facilitate and coordinate the collection, collation, reporting, and publishing of information regarding the nation's health and the performance of the nation's health care." That, alone, would be a good thing, particularly as we move toward a data- and information-driven health system.
Consider what an ASHI might accomplish with an all-payer, all-claims database to support comparative effectiveness research.
HHS announced on Dec. 15 its interest in having such a database built, not only integrating several existing Medicare and Medicaid databases, but also capturing claims and clinical data from private sector databases. All to be used to support robust CER.
WOW. A single database with every claim from every payer. You've got to love their ambition.
Of course, such a database would be ideal for CER purposes. How else to assure the most comprehensive and reliable assessment of the effectiveness of health technologies and providers? Still, I'll be amazed if there isn't a robust debate over the existence of such a database.
As we all know, information is power and ASHI will have a lot of it.
Money, Money, Money
A favorite holiday gift for everyone is cash. As we all know, health IT ain't free, so a nice cash gift would be dandy. It's why we all did back flips when the American Recovery and Reinvestment Act passed, providing some $30 billion in new funding and potential savings to support the propagation of health IT to physicians, hospitals and others. But as we all know, the funds for physicians and hospitals are based on demonstrating "meaningful use" of certified electronic health records. That's great, of course, but what about the physicians who don't have the capital to acquire the necessary technology, training, etc. Many EHR vendors are making capital available for such acquisitions, and good for them.
But wait, our favorite government might just have another health IT gift for us. This gift is wrapped inside the Small Business Financing and Investment Act of 2009 (HR 3854), introduced by Rep. Kurt Schrader (D-Ore.). Among other things, Schrader's bill provides for a Small Business Health IT Financing Program that authorizes the Small Business Administration to makes loans to qualified professionals (up to $350,000) or groups of professionals (up to $2 million) to purchase health IT.
Do I have your attention?
This is great stuff. HR 3854 has already passed the House of Representatives and is pending in the Senate. This is the sort of legislation that has a very good chance of passage. If it does pass, there will be an important new source of capital for physicians and groups to acquire health IT and to then use the American Recovery and Reinvestment Act's incentive payments to pay off the loan.
So, we may find these, and perhaps a few other health IT gifts are being provided by our favorite government. If so, they would mark a fitting end to what has been a very full year for health IT.
Happy holidays to all of you.