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HR 1: Stimulus Package and HIT

by John Moore | January 26, 2009

cashJust finished reading/scanning HR 1, the House Stimulus bill focusing on the HIT section, to which some $20B greenbacks will flow. This Bill just went just the Appropriations Committee and will likely pass the full house later this week. The HITECH Act (HIT for Economic and Clinical Health), is massive at some 190 pages, beginning on page 395 covering everything from codifying the Office of the National Coordinator (ONCHIT), to the numerous reports that ONCHIT has been instructed to fund, to how that $20B will be spent.

HITECH Act also carries with it a legacy of the Bush era: “The utilization of a certified EHR for each person in the US by 2014.”

Following are some quick, interesting highlights:

ONCHIT budget to soar over 4x to $250M for FY09 from the $61M it received in FY08.  Guess they’ll need all that money to fund those research reports, as well as support the new version of HITSP and AHIC, which is now called NeHC.

Both HITSP and NeHC become key advising entities to ONCHIT, HITSP on standards and NeHC on HIT policy.  Quite sure the folks in both groups are happy to hear this, especially NeHC as there was some question as to their survival if the feds did not dump $$$ in their coffers.

National Institute of Standards & Technology (NIST) to take a leadership role in testing standards and implementation specifications.

Substantial amount of writing on privacy, particularly consumer notification process should their health information be compromised.  Even had a special section on notification process for PHR vendors going so far as to reference third part data repositories (e.g, Dossia, GHealth and HealthVault).  Good to see formal procedures put in place, at the federal level to guide notification process – it’s about time!

Continuing on privacy, Bill also instructs ONC chief to appoint a CPO, Chief Privacy Officer.  This individual will have the uneviable task of attempting to coordinate helth data privacy policies across this great land of ours where it seems as though every State has their own unique twist.  Without some reconciliation on these privacy policies, the whole NHIN is nothing but a pipe dream.

A whooping $300M or RHIOs.  All those small RHIO software vendors must be licking their chops as this is a significant amount of money (about double the market size in 2008).  Expect to see consolidation and acquisitions as bigger HIT players look to get into this lucrative market.

Establishing an Extension Program for HIT.  Much like the existing Land Grant and Sea Grant programs and their extension services for agriculture and marine industries, the Bill proposes the establishment of a similar program for  HIT.  At one point in my career, I actually worked for Sea Grant, thus I know the model intimately and have mixed feelings.  Yes, it can be a very good model to reach out to small business and assist them in adopting best practices in the adoption and use of HIT, but often these programs, while well-intended, are not terribly efficient.  There is a universal benefit, however, in that often these extension services are located in academic institutions and thus can foster undergraduates and graduates to pursue research/careers in this field and right now, we can’t have too many.

trainFor the most part, we are comfortable with the above, but where the Bill really flies off the tracks is with the term:

“Certified EHR”

This term is used throughout the HITECH Act and refers to an EHR that is “certified” as:

‘‘(A) IN GENERAL.—The National Coordinator, in consultation with the Director of the  National Institute of Standards and Technology, shall develop a program (either directly or by contract) for the voluntary certification of health information technology as being in compliance with applicable certification criteria adopted under this subtitle… (want to dig deeper – go to page 407)

Basically what this states is that any reimbursements, payments, anything coming out of that $20B largess towards the support for adoption of HIT will only go to those instances where a “certified” EHR has been adopted or used.  And what it implies is that funding/reimbursements/incentives will onlygo to those who adopt nd use a CCHIT certified EHR.

This is a MASSIVE MISTAKE for the simple reason that it results in technology lock – technology locked to specific, “certified” criteria/standards resulting not in new innovative products, but actually retarding their introduction.

Need evidence?

Turn to the EPA and the Clean Air Act (CAA) (I did quite a bit of research at MIT for EPA on technology adoption in regulated markets, hmm, is healthcare much different, surprisingly no). The CAA when first promulgated specified specific technologies to be used to control and measure stack gases.

Benefit: Clear articulation of what technologies industry needed to adopt to comply to the CAA.

Outcome: Rapid adoption and use of these technologies leading to dramatic reductions in air pollutants.

Unintended consequence: When new and better technologies arrived on the scene, the EPA had no ready approach to get industry to adopt better technologies (without an Act of Congress) and as for diagnostic techniques for measuring stack gases, they were stuck as well.

Result: This stifled the US market for technology developers and subsequently, new technologies, once the regs were changed to incentives (trading emission credits) came from overseas, where the market was structured to advance their development and use.

Unfortunately, it does not appear that today’s legislature, nor those in HHS remember what happened at EPA with the CAA and have created an incentive program within this Bill that will result in exactly the same outcome as we saw in the environmental sector, rapid adoption, widely deployed HIT, technology lock-in with archaic standards such as HL7’s CCD and ultimately a technology frozen wasteland with other countries beginning to take the lead in HIT development, deployment and use.

Rather than follow this path, the Senate, in negotiation with the House, can strike the term certified from this legislation and instead encourage the adoption of HIT in support of scenarios that are based on information sharing and not just within an IDN but across a more expansive network.  For example, information sharing could be demonstrated by a physician being able to export of a health record, at a customer’s request, to that consumer’s personally-controlled online health account using CCR, CCD or other standard. Is that not in support of the objectives of data portability?  Of course, there is also the example of sharing health information within the context of an HIE or RHIO or other, more loosely formed network.

Therefore, it is not so much requiring that an EHR comply to specific criteria to be certified and thereby, the adoption of only certified EHRs will be reimbursed, rather it is to provide incentives that encourage what is our ultimate goal, putting health information into a digital form factor that can be securely shared among all relevant stakeholders in support of a healthier public.  After all, at the end of the day, is this not what we are all trying to accomplish?

11 responses to “HR 1: Stimulus Package and HIT”

  1. healthITgirl says:

    Thank you for an excellent post. The example of the EPA being unable to encourage adoption of better technologies without an Act of Congress should be a cautionary tale for congress regardless of what bill they are considering. Beware unintended consequences!

  2. Kathleen says:

    Thank you for this summary of HR 1, the House Stimulus bill and the HITECH Act (HIT for Economic and Clinical Health). Many of us trust your analysis and so you’ve spared us much reading time. It sounds like you vehemently disagree with some of the proposals, as I do.

    How can we best convey a better proposal and plan?

    • John says:

      HealthITgirl, thanks for the kind words and yes, the road we are heading down with the HITECH Act is shaping up to be a bumpy one that hits a wall at the end. Unfortunate as there is certainly a lot of missed potential.

      And Kathleen, I’m not sure how we can stop this steamroller. Heard from a contact yesterday that EMR vendor, AllScripts, is circulating a petition among its clients to push for rapid passage of HITECH Act. A lot of vested interests behind this Act with far greater resources than I. Best advice, call your representatives up on the Hill and even send something in to the new administration.

  3. rockyostrand says:

    Caution, Achtung, Cuidado,

    Non-profit trade associations like HIMSS are waiting in the wings and closets at beltway bandit locations all over Maryland, Virginia and D.C. with their hands and cash buckets out waiting for the ink to dry.

    Get ready for that giant sucking sound to make the tax dodging 501 (C) 6 “C- Suite” a lot richer.

    Don’t you think its time to get the CCHIT and HITSP people out of the mix? its clear at this point they are after the checkbook , the other stuff about HIT is just the game they are playing to get at it. The thing about CCHIT- its an outgrowth of HIMSS and started at 230 E. Ohio St in Chicago, literally a HIMSS subsidiary spinoff residing residing under the same roof. Try looking into the CEO of CCHIT. You will find he is the CMO of HIMSS- gee what small world… YEESSS , Mark Leavitt, possible relation to Mike Leavitt, HHS Secretary.
    Rocky Ostrand

  4. maggiemaePhD says:

    Considering the plight of the American people, the humane thing would be an amputation of the non-profit 501 C6 organizations that bleed tax payer equity for the development of what will become an HIT Cartel if a ligature is not applied.

    The sad fact is people enjoy the carnies, the Jackie Gleason type thieves who run the tax dodge games, the people are absolutely in love with the hype and promises printed on thin air that never materialize and they are willing to pay big bucks for the thrill of believing.

    Go to a HIMSS annual conference and see it with your own eyes- its like a giant Tupperware convention or a Tony Robbins thrill ride. It doesn’t matter if that they are selling a dream as long as they have the taxpayer checkbook working for them behind the curtains and they most likely will evidenced by guest speakers like Allan Greenspan, Mike Leavitt, Dennis Quaid….
    Ontologically, I think Don Corleon and La Cosa Nostra would be a better fit, at least from the blood letting point of view.

    maggiemae, Phd

  5. […] considerable discussion and debate going on regarding healthcare reform and the <a href=” http://chilmarkresearch.com/2009/01/26/hr-1-stmulus-package-and-hit/”>HITECH Act</a>, and I will dedicate posts to those topics as well.  For starters, I am very […]

  6. Calvin Jablonski, 501(c)(6) expert says:

    HIMSS has a $25 billion bailout recommendation for the HIT industry, in an open letter to President Obama. HIMSS has its hand out at the state and federal levels, but denies it is a “Healthcare” organization in response to violations of public policy directed at them, when their own CEO, H. Stephen Lieber, states HIMSS is a healthcare org in his own bio.

    HIMSS is a 501(c)(6) tax-exempt healthcare organization that has HIPAA and other human rights complaints filed against them at several state and federal organizations, and has DENIED legitimate worker’s compensation to minority women who work at their organization. These women were dismissed as worker bees, whose meager salary ranks them below industry average.

    Before the Federal government gives any more money to organizations like HIMSS who put on an annual “dog and pony show” that makes $10 million a year in PROFIT, they must look under the hood and investigate the violations filed against them.

    Like the Wizard of Oz, the curtain has been drawn to expose the truth. Behind the curtain at HIMSS sits an arrogant CEO who makes $500K+ a year, and who feels he is entitled to do WHATEVER he wants: he pulls the strings of his lobbyists scattered around DC and tries to tell the govt how to spend billions of dollars in the HIT industry, enabling Lieber to build his HIT cartel, which will end up as part of the CEO compensation bonus.

    HIMSS has many dirty little secrets it does not want exposed. Shame on the Federal agencies who look the other way, while this “industry leader” carries on at tax payer expense and as a subcontractor for federal money. HIMSS should provide full disclosure and transparency to the HIT industry. HIMSS should not be able to accept any money until their violations are cleared up, and definitely should not be directing HIT policy.

  7. […] we mentioned in our previous post on the passage of HR 1, HITECH legislation is providing incentives for physicians to be reimbursed […]

  8. Calvin J says:

    Sorry, not subscribing to a reimbursement plan based upon the current architecture for healthcare delivery.

    I would subscribe to a model involving taxpayer equity, patient centered care, effective and efficient care, safe care and timely care. Notice reimbursement was not part of the IOM plan.

    If the tax payer is expected to take more financial risk then nationalize the healthcare system with a big bang technology product and open the education doors to increase the physician work force to lower the cost of care.

    A plan like that might actually attract people who want to help the sick rather than attracting people who want to become millionaires…

    Current proposals to reimburse for purchasing a “certified” EHR meaning CCHIT certified are misguiding. Lets start with the fact that CCCHIT was spawned by HIMSS- a flaming lobbyist organization and consider the fact that the chairman of CCHIT is the CMO of HIMSS. Of interest here while CCHIT used to occupy space in the HIMSS location at 230 E. Ohio Street, Chicago and then moved to Whacker Drive– the State of Illinois lists their registration as “Dissolved”. A little investigation reveals, INVOLUNTARY DISSOLUTION 04 11 08. Verify this at
    http://www.ilsos.gov/corporatellc/CorporateLlcController .

    So here we have lobbyists who specialize in artificial transactions claiming to be non-profit 501 (c) 6’s who spawn another non-profit, CCHIT, (Commission for Certification) a 501 (c)3 who is now defunct according to the state of Illinois but passing themselves off as the voice of change to the new administration (the only change these folks will bring is the change you have in your pocket going into theirs). CCHIT is the effector arm of HIMSS, a lobbyist, the certification is really just a pay for play scheme and thus reimbursement under HIMSS $25 Billion plan is just another form of pay for play Ponzi scheme. Is this evidence of intent to create a Cartel?

    A closing thought: about 80% of the physicians out there do not support adoption. Gee, I wonder why with all the carnival thieves telling them to implement while trying to legislate mandates for half baked ideas that are just more trouble on top of what is already a whopping mess.


  9. […] Adam Bosworth (former head of Google Health and one of the original developers of XML standard), Chilmark Research and many others rather than the approach that one legislator down in the Garden State of New Jersey […]

  10. […] 2) Of course once you say that the Federal government will pay out only to those purchasing certified products you then run into two other problems. First, the certification process is going to get somewhat politicized. Despite all the yakking about “volunteers” on all these committees, what we’re talking about is the people with a deep interest in EMRs et al being those “volunteers” and of course they are mostly from the vendor side or users who know the vendors well. I don’t see a way around that unless we really want to develop a civil service that has expertise in health care IT and also is prepared to stay in the job for 30 years like they do in Japan. Second, by its very nature the certification process is likely to run behind the development of technology, which means that vendors building for the certification process are like teachers prepping students for tests, not creating innovations. Again that may not be a terrible thing, but it’s not how innovation works in most other industries. (John Moors at Chilmark has a rather blunter, bleaker assessment of how this might work out) […]

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