Wait and See: What’s Unclear or To-Be-Determined (TBD) About HITECH.


Sometimes laws are passed and the statute itself represents 95% of the work — there aren’t many details to figure out or loose ends to tidy up.

That isn’t the case with HITECH. The HITECH statute is just the beginning.

Whether you’re a cat or a dog, you’ll have hopes and fears about aspects of HITECH that are unclear or yet to-be-determined (TBD).

These include:

  • Appointment of specific people to fill key positions and committee roles
  • Developing policies to enact the legislative intent of HITECH
  • Drafting regulations to implement HITECH
  • Conducting and interpreting many studies and reports commissioned by the legislation
  • Distributing discretionary funds authorized by HITECH
  • …and others

Here’s just one example of a major TBD item — implementing the responsibilities of the Office of the National Coordinator (ONC) now located within the Department of Health and Human Services:

  • Developing an annual strategic plan that reports on specific objectives, milestones, and metrics including the use of an EHR for each person in the U.S. by 2014
  • Providing oversight and coordination of both the HIT Policy and HIT Standards Committees
  • Reporting to Congress within 12 months on any additional funding or authority needed to ensure full participation of stakeholders in the national health IT infrastructure
  • Establishing a governance mechanism for the nationwide health information network [California HealthCare Foundation, An Unprecedented Opportunity: Using Federal Stimulus Funds to Advance Health IT in California ]

Which TBD items are most important?

Writing the the latest issue of the NEJM , newly named National Coordinator for Health Information Technology David Blumenthal, M.D., M.P.P. lists three:

  1. clarification of EHR “certification” requirements
  2. definition of “meaningful use” of EHRs
  3. changing payment incentives

His insights are noteworthy:

…much will depend on the federal government’s skill in defining two critical terms: "certified EHR" and "meaningful use." ONCHIT currently contracts with a private organization, the Certification Commission for Health Information Technology, to certify EHRs as having the basic capabilities the federal government believes they need. But many certified EHRs are neither user-friendly nor designed to meet HITECH’s ambitious goal of improving quality and efficiency in the health care system. Tightening the certification process is a critical early challenge for ONCHIT .

Similarly, if EHRs are to catalyze quality improvement and cost control, physicians and hospitals will have to use them effectively. That means taking advantage of embedded clinical decision supports that help physicians take better care of their patients. By tying Medicare and Medicaid financial incentives to "meaningful use," Congress has given the administration an important tool for motivating providers to take full advantage of EHRs , but if the requirements are set too high, many physicians and hospitals may rebel — petitioning Congress to change the law or just resigning themselves to forgoing incentives and accepting penalties.

Finally, realizing the full potential of HIT depends in no small measure on changing the health care system’s overall payment incentives so that providers benefit from improving the quality and efficiency of the services they provide. Only then will they be motivated to take full advantage of the power of EHRs  (emphasis added).

Dogs and cats alike will need to be patient.

2 thoughts on “Wait and See: What’s Unclear or To-Be-Determined (TBD) About HITECH.

  1. We are finding that healthcare providers in general continue to be somewhat wary about adopting an EMR system at this point – with nearly all of the variables still being wildcards. It seems though that the general notions of common business practices on a crowded market *should* (hopefully? perhaps?) be heeded. 2008 CCHIT Certification is a must right now – it’s just too risky to buy a system that doesn’t have 2008 certification… despite the problems with the certification process. Ensuring that providers are ‘meaningfully using’ the system will definitely include electronic prescribing and interoperability – so also musts. Finally, the EMR should actually improve patient outcomes… but I can’t imagine that is going to be tied to the stimulus.

  2. Nice job, Vince, as usual. It makes little sense to read too much into David B’s (DB2 ?) statements, but rather to be patient and let him get staffed up and ready to talk about the details of executing the statute. Regards, DCK

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