Stimulus Cash Could Revolutionize Health Care IT, At Last

The Obama administration is facing a number of challenges in the health care industry, and chief among them will be the process of reconciling health care and information technology. The country has been slow in transferring health care information to the Web, mainly out of fear for privacy concerns and the high cost of adopting new standards and systems.

Proponents say digitizing health information will increase the standard of care by providing personalized and easily accessible health care information, increased communication between medical professionals and more comprehensive disease data for research purposes. Opponents cite privacy concerns and the high cost of adopting these systems, especially for smaller, physician-centered practices.

The industry is at a crossroads. A recent study from the New England Journal of Medicine found that only 1.5 percent of 3,049 U.S. hospitals surveyed have comprehensive electronic medical record systems.

However, the Obama administration has made several promises on how they will attempt to seamlesly integrate health care and information technology. Beyond including money for efforts to digitize health care in the stimulus package, the administration has also worked to secure several influential players to govern the industry.

The iniatitive will be spearheaded  by health care reform czar Nancy-Ann DeParle, who brings unique experience from both the private and public sector. DeParle served as the director of four different health care companies and was the administrator who oversaw Medicare and Medicaid as director of the Health Care Financing Administration in the Clinton administration.

Another key player is current Kansas Gov. Kathleen Sebelius, who is President Obama's choice for secretary of Health and Human Services after former Sen. Tom Daschle withdrew his name from consideration earlier this year.  Sebelius is on Capitol Hill for confirmation hearings this week.

The next step for the administration is the implementation of $19 billion included in the $787 billion stimulus package, which is supposed to go toward creating a nationwide system of electronic health records for every American by 2014.  The Office of the National Coordinator for Health Information Technology, an office of the Department of Health and Human Services, is responsible for implementing the new system.

The office is led by the National Coordinator, who is appointed by the Secretary of Health and Human Services and is responsible for making policy and standards recommendations to the secretary for the electronic records system. 

The National Coordinator is also responsible for updating a strategic plan for health information technology originally created in June of 2003 with specific goals, milestones, and ways to measure success.  Other duties of the coordinator include evaluating the costs and benefits of the system, assessing the impact of the system on medically underserved people, and preparing a report on lessons learned from public and private groups that have already started electronic health record systems.

The coordinator also serves as a liason between two committees created in the bill to help with the policy and standards decisions.  The Health Information Technology Policy Committee is a 20-person, bi-partisan committee that will recommend policy decisions to the coordinator, including policies on issues such as encryption of the records, collecting demographic and public health data from electronic records, biosurveillance, patients' access to their own records, families' access to a patient's records, using records for medical and clinical research, and many others. 

The Health Information Technology Standards Committe deals more with the technological side of the equation, recommending standards for the computer systems used.  The standards committee is made up of a diverse group of people, including  health care providers, consumers, technology vendors, researchers, and others.  There is no specific number of members in the standards committee, but there is a provision that says each group within the committee must be equally represented.

The office must come up with a set of standards for the records system by the end of the year, but there is a provision in the bill that says they don't have to start from scratch--they can build on the work completed under the previous strategic plan.

In addition to setting up the mechanism to decide policy, the law also provides a way to get the new technology needed off the ground.  The law establishes a program that would combine the research power of the National Institute of Standards and Technology, the National Science Foundation, universities, private companies, and federal labs to develop the technology infrastructure needed for the electronic records system. 

The bill also starts a grant system to develop or expand new health informatics programs at colleges and universities to get more people into the health care information technology field, and provides a grant system for education of current health care professionals on how to use the new system.  The bill puts grant programs in place to encourage states to adopt the system, and sets up another competitive grant program to provide loans needed to adopt the system.

Finally, there is a lengthy subsection on privacy of the records, and lays out procedures and penalties for unauthorized disclosure of electronic medical records.  All current medical privacy laws would apply to the new electronic records system.