Policy study on the federal government's strategy for implementing widescale health information technology

Abstract

This policy study analyzes the federal government's role in the widescale implementation of health IT across the U.S. Through an Executive Order, the Office of the National Coordinator for Health Information Technology (ONC) was created and tasked with overseeing and governing all health IT related activities. The ONC led several initiatives including the creation of regional extension centers (RECs) to provide technical assistance and help providers with implementing health IT. A workforce development program was also created in partnership with academic institutions across the U.S. in order to provide the education to develop skilled workers for the health IT industry. The Electronic Health Record (EHR) Incentive Program was also created under the ONC to entice providers into implementing an EHR system and using it in a manner that improves patient care. The last initiative led by the ONC was the state health information exchange (HIE) program which allocated grant money to each state and U.S. territory to build up the infrastructure in order to establish a nationwide health information network. A thorough analysis was conducted of the entire health IT landscape to identify potential areas of improvement and to provide insight into future potential scenarios. The federal government began playing a key role in health IT upon the creation of the ONC in 2004. The ONC is responsible for developing the standards and protocols for certified EHR systems. The timeline in which the standards and protocols have been coming out have been putting vendors and healthcare organizations in a disadvantageous position because systems already being used needed to be upgraded to comply with new standards. In order to alleviate this ongoing issue, creating a tiered timeline for certification and compliance would be ideal. Once the new standards and guidelines are finalized, vendors should be given a timeframe in which to comply. After that, the products can be made available in the marketplace and healthcare organizations would be given a different timeline to follow in order to implement and ensure the requirements for the EHR Incentive Program are met. Another issue currently plaguing the industry is that vendors are creating niche products for specific health IT functions. Part of the goal behind the Executive Order that started the health IT movement was to allow protected health information to be exchanged across different platforms, states, and organizations. Vendors offering niche products are not helping to facilitate HIE. The underlying issue is that big corporations that have systems capable of all the technical functionality to achieve the goals from the Executive Order have no desire to scale their products down for smaller organizations. This in turn forces smaller organizations to piecemeal their implementations. The recommendation is for the ONC to start a federally-funded financial matching program with the smaller organizations in order to double their financial resources. Through a federally-funded financial matching program, it would allow small health organizations to double their financial resources, which would in turn attract the large health IT vendors to build scalable products designed for them. This public-private partnership model has been a consistent way to fund projects nationwide at all levels of government and private organizations. In order to participate in the EHR Incentive Program and get reimbursed $44,000 or $63,750, the provider needs to see a certain amount of Medicare or Medicaid patients. Providers that do not treat Medicare or Medicaid patients do not qualify for the incentive program. The ONC would need to collaborate with private insurers nationwide to develop a funding model so those providers only seeing patients with private insurance can receive some type of incentive to implement an EHR system. Two of the main ONC programs were rolled out in the same year. The EHR Incentive Program launched in the fall of 2010 and is scheduled to run until 2021. The goal of the program is to get widescale implementation of certified EHR systems across the U.S. The state HIE program was also launched in 2010 with the goal being to achieve a nationwide health information network. Implementing a certified EHR system is the precursor to obtaining HIE functionality in that the EHR digitizes the patient record and gets all protected health information into an electronic format. The patient record needs to be in an electronic format prior to being exchanged. Staggering the launch of the state HIE program at least five (5) years after the start of the EHR Incentive Program could have led to more success with HIEs. A remaining question regarding the future of health IT is whether the ONC will continue to exist once all the monies have been expended. In the scenarios section, two scenarios are presented: one in which the ONC becomes a permanent federal agency and one in which the ONC dissolves. There is not much indication or of the future of the ONC, but through analysis and forecasting of the industry, it appears as if they will eventually dissolve. Should that occur, the ONC-appointed non-profit organizations tasked with overseeing the standards and future developments will play a much larger role moving forward.