This May I attended the 2010 Tribal Self-Governance Conference in Scottsdale, AZ. Self-Governance is a tribally-driven, congressional legislative option, through which American Indian tribes are authorized to negotiate annual appropriated funding and assume management of programs previously managed by the federal government. As of 2010 there are 260 self-governance tribes within the Department of the Interior –Indian Affairs (BIA) and 330 tribes within the Department of Health and Human Services –Indian Health Services (IHS).
One of the more interesting sessions I attended was conducted by Stephanie Klepacki, Meaningful Use Project Lead and IT Specialist for IHS. Ms. Klepacki’s presentation discussed the impact of ARRA (American Recovery and Reinvestment Act) funding on Indian health services. As stated on the ARRA website, “The American Recovery and Reinvestment Act of 2009 (ARRA) is an unprecedented effort to jumpstart our economy, create or save millions of jobs, and put a down payment on addressing long-neglected challenges so our country can thrive in the 21st century… preserve and improve affordable health care…” Included in ARRA is the Health Information Technology for Economic and Clinical Health (HITECH) Act, which “Seeks to improve American healthcare delivery and patient care through an unprecedented investment in health information technology”. This $19.2 billion portion of the overall ARRA funds that President Obama signed into law on February 17, 2009 promises to have dramatic and lasting effects on the adoption of electronic health records (EHR) in this country. The HITECH Act states that "Eligible professionals" (physicians) who demonstrate "meaningful use" of a "certified" EHR beginning in 2011 will be eligible to receive incentive payments of up to $44,000 from Medicare and $65,000 from Medicaid per individual physician to help cover the cost of EHR adoption. Needless to say, this legislation should have a profound impact on healthcare providers in Indian Country who, according to our experience, are underserved in the area of health information technology.
Ms. Klepacki’s presentation drew attention to two key phrases in the legislation: “Meaningful use” and “certified EHR”. Let’s start with the latter as it is the more clearly defined of the two. In short, a software provider who develops electronic health records has to have their software solution certified. Currently the only certifying agency is the Certification Commission for Health Information Technology (CCHIT). To date standards have been defined for ambulatory, emergency and prescription, but not defined in other areas such as behavioral health. CCHIT lists all the EHR software products that are certified to date. While a software solution such as RiteTrack is not strictly an EHR, it has many components of an EHR. In our preliminary review of the standards, RiteTrack already meets many of the requirements in areas such as security, document management, and audit logging, just to name a few. As a healthcare provider you will need to implement a certified EHR in order to qualify for HITECH funding.
The second requirement (“meaningful use”) falls on the provider. This deals with how you use the EHR after you implement. In order to qualify for HITECH funding, providers have to demonstrate that they are using their EHR in accordance with the “meaningful use” criteria. An example of meaningful use could be that at least 80% of the prescriptions are done electronically. The biggest challenge as of this writing is that the meaningful use criteria are still being defined. Centers for Medicare & Medicaid Services (CMS) who are defining the meaningful use criteria are still finalizing what constitutes meaningful use. Several groups are currently lobbying to relax these rules. Just earlier in May, a coalition of 53 medical organizations sent a letter to the U.S. Department of Health and Human Services secretary, Kathleen Sebelius, urging the government to extend its proposed meaningful use deadlines two years, from 2015 to 2017. A frequent complaint is that CMS are asking for too much, too soon. Experts that I talked to at the Self-Governance Conference this month believe that the final rule on "meaningful use" will be out this summer. At that point, healthcare providers should have a green light to pursue the implementation of an EHR system. In order to get HITECH funding, they will need to choose a certified EHR and also have a way to demonstrate that they are meeting the meaningful use criteria.
Here at Handel we are currently waiting for the final criteria for behavioral health certification. Several members of SATVA (Software and Technology Vendors Association), an organization Handel belongs to, are involved in defining the certification criteria for behavioral health. To learn more about these developments, please go to the SATVA web site. While originally excluded from the HITECH Act, an amendment to add behavioral health and substance abuse now include these providers as well.
If this all sounds very confusing, don’t worry. You are not alone in being confused. Fortunately, there are plenty of resources out on the Net to help demystify the HITECH Act and its implication on your organization. As the final rules are getting defined we are looking forward to seeing an increase in the adoption of electronic health records. For those of us tired of filling out the same documents every time we see a doctor, this can’t come a moment too soon. From the provider side, I am sure the majority out there are ready to embrace new technology so that they can spend more time serving their clients and less time doing paperwork. As always, this is one of our core missions here at Handel.
Happy summer,
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