President Obama, in his address to Congress this week, emphasized that he wants electronic health records (EHR) to be established for all Americans over the next five years. His recently passed American Recovery and Reinvestment Act earmarked $19 billion for health information technology spending, $17 billion of which is designated for incentive payments for EHR use beginning in 2011. To date, only about 25% of the nation's 5,000 hospitals have rolled out EHR systems, and only a small fraction of physician practices have done the same.
The EHR funds will be controlled by the U.S. Health and Human Services (HHS), which has discretionary use over $2 billion of the funds.
The legislation also allocates, among other things, $85 million for health technology investments to the Indian Health Service, $1.5 billion for Community Health Centers and $50 million to HHS to improve its technology security.
Computerworld spoke with three health technology experts from private corporations and the IT vendor side to get their take on the new bill and whether the billions being spent will succeed in establishing EHRs.
The three experts are:
Dr. Charles Kennedy, senior vice president for health IT at Indianapolis-based WellPoint Inc., the country's largest health benefits provider. WellPoint provides health coverage to about 34 million members through its subsidiaries, primarily under the Blue Cross and Blue Shield name. Kennedy is a founding member of the certification commission for Healthcare Information Technology and a board member of the National eHealth Collaborative.
Frances Dare, director of the health care consulting practice at the Cisco Internet Business Solutions Group. Dare recently testified on Capitol Hill and has advised the Obama administration regarding the stimulus package. She has spent more than 25 years in the health care industry as a hospital administrator for two facilities.
Phil Fasano, CIO at Oakland, Calif.-based Kaiser Permanente, a $38 billion nonprofit health care system. Kaiser Permanente offers health care services through a network of nearly 14,000 physicians at Permanente Medical Groups; 32 medical centers and more than 400 medical offices that form the Kaiser Foundation Hospitals; and the Kaiser Foundation Health Plan, which has 8.7 million members. Kaiser is finishing up a five-year EHR system implementation that cost $5 billion and created 5 petabytes of data on spinning disk serving 32 hospitals, more than 400 medical clinics and 14,000 physicians.
The following is an edited version of those interviews.
How will the billions of dollars help spur adoption, particularly when you consider many small hospitals and physician practices have not even started an EHR rollout?
Kennedy: Well, that's where the challenge is. If you look at the penetration of [electronic medical records], they're highest where there's enough of a facility there to be able to support the infrastructure costs. When you look at solo and small physician groups, which still represent the majority of how physicians practice, we are going to have to take advantage of the inherent scalability of the Internet as well as some of the existing infrastructure.
For example, most health plans have a provider portal. Those infrastructures could potentially be leveraged to make the deployment of these tools easier and more effective. I also think we're going to look at [application service provider] models and strategies. Many of the EMRs have been constructed where application itself has been on site. That has to be hosted and supported and maintained by the group. I'm really just saying that should be done centrally and all the physicians' office has to have is Internet access.
Fasano: The country's [technology] challenges are larger than that initial $17 billion installment, and that's what I think it's going to turn out to be, an installment for electronic medical records and for making the entire health care industry electronic. ... I know what it took for [Kaiser Permanente] to implement our electronic medical record system [$5 billion over five years] and know what it costs us to support that on an ongoing basis [$100+ million annually], and it's a significant amount of money and commitment on the part of any organization like ours. And I suspect when you get down to smaller individual physician practices, it will be a substantial cost and something that will need continued support from our government. I think it will require the paying model to be changed somewhat to help support that investment over time. There will consistently be need for maintenance.
Dare: It's important to note there are specific time frames in the bill. Those incentives are first available as early as 2011. What the bill does provide is time frame certainties and especially in the case of physicians, specific numbers in terms of the dollars available to them in the incentive payments. If you're a physician, and you get your system up in place, you're eligible for a total of $44,000 in incentives over a four-year period. If you're a physician that practices in a professional shortage [rural areas], it is as much as $48,000.