Q: What is the total investment associated with Healthcare IT Stimulus?
A: There are two categories of approved funding through American Recovery and Reinvestment Act of 2009 (ARRA)

• $2B to discretionary health IT through Office of the National Coordinator for Health Information Technology (ONCHIT)- earmarked for studies, creating regulatory bodies and even creating IT systems.
• $18B in investments & incentives to Medicare/Medicaid to implement “meaningful use” of EHR technology. This funding will provide payments to physicians between $44K-$64K over five years to implement certified EHR technology

Q: What is “meaningful use” of EHR technology?
A: Meaningful use is vaguely described in legislation as:

• Includes electronic prescribing
• Allows exchange of information to promote care coordination
• Reports clinical quality measures (TBD)

Q: How will information be exchanged between providers?
A: ARRA provides the creation and expansion of Health Information Exchanges (HIE) that lay the groundwork where EHR’s are shared in a regional and community basis.

Q: Do the physician incentives apply to hospital-based physicians?
A: No. Hospital based physicians (ED, OR, Pathologist, etc.) will still need to collect and report quality measures. The hospital will have access to incentive payments and not these physicians.

Q: What are some of the current barriers to EHR adoption for physician practices?
A: The following barriers may potentially impede adoption:

• Solutions must not only meet the need of the practice, but also need to support data exchange.
• Tremendous change in the EHR vendor environment as players are changing to meet the changes in the market. Physicians need to do significant due diligence.
• Focus on EHR is different from traditional offerings as it transforms from a system that supports data capture for code capture to a model that demonstrates value, outcomes and quality.
• Security that is HIPPA-driven has led to many early solutions that are installed locally within the physician’s office. The ASP model will evolve with greater security and lower cost.

Q: How does ARRA impact point of care communications?
A: Nursing documentation in an acute care setting must ultimatley be part of the patient EHR. The Department of Health and Human Services is defining the specification of “meaningful use” by the end of the year. Many feel that this evolving definition meaning  must include “use by nurses” in the final draft.  If this is the case, more focus will go into automating (less paperwork) the nursing care documentation which today is often a hybrid paper/electronic process.

Also, the ability for a hospital to efficiently measure and collect quality of care data will become important for reimbursements and financial survival. Effectively applying technologies that support quality and safety will become critical pieces.

Q: What are some of the issues behind improved systems for nursing documentation?
A: Issues  are as follows:

• Vendors have historically focused on areas where there is greater perceived benefit – CPOE and physician progress notes. Implementation is also slowed due to poor quality software (Software doesn’t support efficient processes and clinical workflow)
• Problems with data entry devices- COWS, tablets, voice-recognition
• Wireless connectivity issues
• Training and support issues

Q: What impact will Healthcare Stimulus have on IT purchases in 2009 and early 2010?

A: Given that the majority of hospitals won’t see any direct benefit of Stimulus for some time, the healthcare market will continue to evaluate technology investments on those projects that improve top-line revenues or can have a measurable cost-savings impact.  Unlike in recent years, it will be very uncommon to have  clinical leadership sponsor an initiative and get funding for any technology that can’t pass these financial tests.