The Stimulus Package and the States: How EHR Development is Developing
By Kaye Eisele
With the American Recovery and Reinvestment Act (ARRA) of 2009 set in motion, $45 billion has been allocated for the development of national electronic healthcare records (EHRs). Approximately $17 billion of these federal funds has been appropriated for state Medicaid organizations that have already begun distributing these funds to individual states. As of February 2010, 14 states have received anywhere between $142,000 (Idaho) to $5.91 million (New York), with Iowa being the first to receive funding for EHR development at $1.6 million in November 2009.
According to the Center for Medicare and Medicaid Services (CMS), ARRA will provide 90 percent in matching funds for states to plan activities that center around EHR development and also for actual EHR development. States will receive incentive payments through audits conducted to ensure proper payments are being made. Through Health Information Exchange (HIE), states will be able to share medical information of patients first with their own states, then throughout regions and finally throughout the nation.
Initially, most states will use the funding to plan and conduct full analyses of their current health information technology (HIT) status. For the states that have received funding, according to CMS, they are defining and identifying barriers to EHR usage as well as determining eligibility of providers. Eligible providers are identified by CMS as healthcare professionals employed in hospital or non-hospital settings; providers within acute care hospitals; non-hospital-based pediatricians, providers in children’s hospitals; rural health clinic providers; and providers working in federally qualified health centers.
Other than children’s hospitals, which do not require Medicaid patient volume, Medicaid patients must represent anywhere between 10 to 30 percent of the total patient population served by professional healthcare providers, in order to receive these federal funds for EHR development. For instance, acute care hospitals may receive incentive payments if their Medicare or Medicaid patient population is at least 10 percent, while professionals in non-hospital settings must provide care to 30 percent of Medicaid eligible patients. Incentive payments were to begin by October 2010, according to CMS, but that has been moved back to January 2011.
Willing and Able
All of the states that have received initial funding have fully demonstrated to CMS that they are willing and able to standardize the way EHR information is exchanged between healthcare organizations and providers. These states have provided ample criteria that reflects standards which will enable an electronic exchange of medical information among providers and organizations, and that their standards will thoroughly support meaningful use guidelines. They are poised to qualify for the Medicare and Medicaid incentives.
Most states, however, have yet to outline how they will use federal funding to support behavioral health EHRs. The state of Pennsylvania, which received $1.2 million in federal funding for the development of EHRs in January 2010, is one of the few states that has provided working details as to behavioral EHRs. Pennsylvania plans to develop an Electronic Quality Improvement Project (EQUIP) which will collaborate with providers while keeping consumers in mind, and will simultaneously work with providers to develop meaningful use standards throughout the process. Much of this will be done through the Pennsylvania Health Information Exchange (PHIX).
EQUIP clinical data will focus on depression screening, antipsychotic medication adherence, post-hospitalization tracking and follow up, as well as lab results for patients prescribed to antipsychotics. According to the PA Office of Medical Assistance Programs, this will also entail participation in a multi-state pediatric psychotic utilization project. These EHRs will provide information regarding depression in pregnant woman and pharmacy management intervention, along with sharing of pharmaceutical and laboratory data between behavioral healthcare providers and other patient-shared professional healthcare providers.
Spending the Budget
All states have demonstrated to CMS that they will use recent federal funds for the important tasks of building trust and fostering education of HIT and HIE along with safeguarding privacy and security of EHRs. But the funds also have many other uses, including:
- Building an appropriately trained and skilled health IT workforce.
- Hardware and software
- Technical support for providers
- Overall implementation of coordinating activity resources
- Strong legal expertise funding for security and EHR confidentiality issues
According to CMS and the Office of the National Coordinator for Health Information Technology (ONC), funding will be and is provided for pilot HIEs which will concentrate on HIE functionality in controlled phases. Moving forward to 2012, HIEs should be routine for healthcare providers with gradual additions of provider types and further functionality of EHRs. In other words, funding that has currently been received should pave the way for EHRs to be fully operational. By then, barriers should have been identified and dissolved, which will foster an enabling environment for EHRs.
States are fortunate to have this federal funding education as they try to navigate their way through EHR development. Monitoring within states to ensure interoperability of EHRs will be necessary, and current funding will also be used to ascertain efficient systems and confidential medical data distribution.
Most states that have already received the current funding have some capabilities in place of networking medical information between themselves and other regions. They will build on their existing systems and utilize current functional networks. Iowa HealthNetconnect (HNc) is a rural healthcare pilot program which received $7.8 million from the Federal Communications Commission in order to link a 3,200-mile fiber optic network which spans four states while directly connecting to metropolitan cities from Colorado to Illinois. HNc is connected to two major networks (Internet2 and National Lamba Rail) and is one of the first functional networks for rural healthcare organizations in the nation. In addition, seven rural northern Iowa hospitals are included in this first-of-its-kind EHR system in a rural United States healthcare setting. Current planning and implementation of EHR usage is headed up by the Iowa Department of Public Health, among other agencies.
All 14 states that have received the current federal funding will be focusing on technical support, which will prove essential for any state adopting wide range EHR usage. And like Iowa, most states will – or have – implemented a series of focus groups and surveys to monitor the pulse of HIT systems already being utilized and those which still must be developed.
HIT bandwidth will be determined as well as work capacity estimates by individual states. Special attention must be paid to EHR privacy and security issues. While most states have yet to demonstrate and put funding into security issues, all have indicated strongly to CMS their commitment to confidentiality in electronic health records. They have proven to CMS that this is a serious commitment, yet it is one that must expand every bit as fast as technical issues when implementing EHRs. It will be interesting in the weeks and months to see what will develop along these lines. A good start needs a proper finish, and many will be focused on the confidentiality issues that surround EHRs.