Health IT funding to create 50,000 jobs

Sixty regional IT help centers will help health care facilities implement electronic medical records

BOSTON -- Federal dollars being pumped into grant programs to spur students to enter IT careers in the health care industry should help to create between 45,000 and 50,000 jobs over the next five years, a top federal health official said on Thursday.

Speaking at the Health Information Technology (HIT) Conference here, Dr. David Blumenthal, National Coordinator for Health Information Technology, said a portion of $2 billion in discretionary spending under Office of the National Coordinator (ONC) is being targeted at education and training for electronic health record implementation.

A large part of the training is for people to staff 60 regional extension centers, which are public, private partnerships that will assist rural hospitals and physician practices with 10 or fewer doctors in rolling out electronic medical records (EMRs) and supporting technology.

"There's a shortage of workers who can staff these regional extension centers and provide the kind of support physicians and hospitals need to become meaningful users" [of EMRs], Blumenthal said.

Without specifying an amount, Blumenthal said the ONC has already handed out funding to 70 community colleges or other universities to create programs for workforce training for health information technology.

The HIT conference, hosted by the Massachusetts Health Data Consortium, focused not only how to create jobs in health information technology, but how that technology can reduce health costs while improving quality of care.

The ONC has released a 556-page draft rule that contains specifications and certification criteria for EMRs. Those rules, now available for public comment, set a four-year timeline beginning in 2011 for implementing the systems; they also spell out best practices.

A final version of the government's Notice of Proposed Rule Making helps define what type of technology should be used and spells out how $36 billion in incentives from the American Recovery and Reinvestment Act of 2009 should be paid out. A physician in private practice can receive up to $44,000 for rolling out EMRs and showing " meaningful use " of that technology.

Hospitals could potentially received millions of dollars in reimbursement.

Physicians and hospitals that don't roll out the EMR technology and prove that they are making "meaningful use" of it by 2015 face penalties in the form of reduced Medicare reimbursements.

Blumenthal also said an advisory committee he formed to investigate reports from members of Congress and the press that EHRs had cause some "adverse events and patient injuries" reported back to him about three weeks ago. He said the committee recommended collecting more information and that the ONC further study safety problems associated with EHRs, "and make sure we proceed thoughtfully and carefully."

Blumenthal said nothing the committee found had given it any pause as to the trust that the government, including Congress, had in the ONC's policies surrounding the rollout of EHRs.

"There was no question that the introduction of electronic health systems improve patient safety. The issue was how do we introduce those systems in ways that are as safe as possible," Blumenthal said.

The ranking member of the U.S. Senate Finance Committee has asked 31 hospitals and health-care systems to provide feedback on problems with computer systems associated with the government's efforts to incent the rollout of EHRs.

The government has uncovered prescription errors related to EHR systems that have been rolled out in private-sector hospitals. Sen. Charles E. Grassley (R-Iowa), sent a letter in January to some of the nation's largest health care facilities asking for any information on "issues or concerns that have been raised by your health care providers" over the past two years.

Sen. Grassley said the letter was prompted by concerns that had been brought to his attention in recent months with regard to EHR systems that included "administrative complications, formatting and usability issues, errors and interoperability."

In another example, the U.S. Department of Veterans Affairs recently reported its EHR network portal for Department of Defense employees contained errors in patient information.

Paula Griswold, executive director of the Massachusetts Coalition for the Prevention of Medical Errors, said too much of our current health care system still consists of bad processes, and adding technology will not solve those problems.

"Our real challenge is to redesign health care so that it's patient-centric, safe, effective, high quality for all individuals and affordable," Griswold said. "That redesigned healthcare system will use health information technology to achieve those goals.

She cautioned that IT is not a silver bullet, and that products need to be not only well designed but tested and carefully implemented with patient input.

Griswold was among a panel of industry experts who raised several key issues hindering the adoption of EHR systems and personal health record (PHR) technologies, where patients would be in charge of their own online medical information, including who gets to see it.

The main hurdles to adoption included the ability to aggregate medical data and organize it, how to share it without mature, robust information exchange networks, and the security of data once it is online.

John Moore, a managing partner with Chilmark Research, said that while 80% of people use the Internet to search for health information, a recent study showed that only 7% actually use PHRs.

PHR technology can be offered by health care providers such as Boston Children's Hospital's Indivo or private services, such as Google Health and Microsoft HealthVault.

"It's still way too hard to get health data. Most aren't going to go and get their paper records ... and enter that data themselves into a PHR; secondly there's trust and also privacy and security [issues]," Moore said.

Over the next two years, 58% of small physician practices plan to roll our EMRs, according to a recent survey . EMRs will share patient information between health care providers, ensuring a patient's treatment medical history, existing conditions and prescription medication warnings are made automatically available to a treating physician.

Over the next year, Blumenthal said his office will focus on finalizing "meaningful use" regulations, which should be published later this spring, and implementing the Beacon Community Grant program , which will use $220 million to build out health IT infrastructures and regional information exchange capabilities in 15 communities.

Blumenthal said so far 130 counties throughout the U.S. have applied for the grant money. The ONC will also focus on helping hospitals and other health facilities use the National Health Information Network (NHIN), which is a set of standards, services and policies that enable secure health information exchange over the Internet.

"What we want is a robust exchange [of health information], not a single solution," Blumenthal said, referring to a system that would be tailored to regional capabilities for information exchange around the country.

Speaking on the rate of EHR adoption in Massachusetts, Gov. Deval Patrick said it the state was the appropriate place for a national HIT conference because his state has the most comprehensive health care insurance coverage.

Patrick told hundreds in a packed conference room that 45% of the state's physicians have adopted EHRs - five times the national average -- and 97.5% of its citizens have health insurance coverage due to the Commonwealth's health care reform law, enacted in 2006.

The law mandated that nearly every resident must obtain a minimum level of healthcare insurance coverage, which also included state run insurance programs for low or no-cost.

But Patrick also acknowledged that significant hurdles remain in rolling out the technology for EHRs and health information exchange networks that will be the conduit for physicians, patients and hospitals to share medical information.

"This is a major change to one of the most complicated systems in our society. There will be significant hurdles along the way particularly for the small provider organizations experiencing so many other pressures," Patrick said.

"But, in a world where more and more average citizens are banking, shopping and communicating in an increasingly electronic world, it's time for the health care system to catch up."

Patrick pointed to New Zealand as the ideal for EHRs. "In New Zealand, when you are born, you get an electronic medical record. And that record is available in any hospital, clinic, doctor's office, or pharmacy anywhere in New Zealand for the rest of your life," he said.

"That's where I want to be. I want that kind of seamlessness, that kind of simplicity, that kind of efficiency."

Lucas Mearian covers storage, disaster recovery and business continuity, financial services infrastructure and health care IT for Computerworld . Follow Lucas on Twitter at @lucasmearian or subscribe to Lucas's RSS feed . His e-mail address is .

Read more about health care in Computerworld's Health Care Knowledge Center.

Copyright © 2010 IDG Communications, Inc.

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