Governors' alliance advises states on health IT adoption
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President Barack Obama has made the health information exchange (HIE) a cornerstone of his national goals to improve healthcare quality and efficiency, calling for it to be operational nationally by 2014.
"States must immediately begin planning how they will support this new direction and lead the way for broad deployment and use of HIE. The role of states in modernizing the healthcare system was already substantial, but it will dramatically expand as the HITECH Act is implemented," the report said. The alliance said it has been helping states develop initiatives, and many of its recommendations are relevant to advancing HITECH.
The report addressed the following issues:
- Prepare or update the state plan for HIE adoption;
- Engage stakeholders;
- Establish a state leadership office;
- Prepare state agencies to participate;
- Implement privacy and security strategies and reforms;
- Determine the HIE operational and business model;
- Create a communications strategy; and
- Establish opportunities for health IT training and education.
To receive an implementation grant, a state must have a state plan approved by the Department of Health and Human Services (HHS). Under a separate program, the legislation also allows HHS to establish a loan program for certified EHR technology purchase and implementation costs. The intent of the competitive program is to provide selected states or other grantees with funds to make guaranteed loans available to providers for the purchase and implementation expenses associated with adopting certified EHRs. Because training and workflow analysis and design are known to be critical to successful adoption, the loans could also cover some of the indirect costs, including staff training and maintenance. The alliance said that details on both of the grant programs are "forthcoming." Currently, there is no deadline for the release of the grants, but if the loan program is implemented, it cannot begin until 2010.
According to the report, the HITECH Act provides incentive payments under Medicare or Medicaid for eligible providers who have adopted certified EHR systems and who meet statutory requirements for meaningful use. To be eligible for Medicaid incentive payments, a certain percentage of the provider's patient caseload must be enrolled in Medicaid--generally, 30 percent of patients for physicians and 10 percent for hospitals.
Meaningful use of an EHR system, as defined in the law, includes three key components:
- The EHR system must be certified and include e-prescribing capabilities;
- The technology must provide for EHR exchange with other systems; and
- The system must produce reports using various yet-to-be-defined clinical and quality metrics.
The alliance said that Medicare also will establish a definition for meaningful use. Funds to support enhanced payment incentives could become available under Medicare as early as Oct. 1, 2010, for hospitals and other providers starting Jan. 1, 2011. However, the authors noted that Medicaid payments could begin sooner.
The alliance recommended that states should encourage their medical schools, nursing schools and schools of public health to apply for financial support that is available for health IT curriculum development. "Further, states should encourage education institutions, particularly their community college system and nonprofit groups to apply to participate in the regional extension center program. States should work to ensure complete access to these centers, so that both rural and urban providers can benefit from the educational opportunities," the alliance also noted.
The alliance, which is part of the National Governors' Association, will meet Friday at its semi-annual conference to further discuss state-level health IT initiatives.
Access the full report at: http://www.nga.org/Files/pdf/0908EHEALTHHITECH.PDF