Computer training, Kloss said, has been a part of the educational programs of AHIMA since the 1970s. “I can recall marching students in cold rooms filled with IBM computers and punch cards,” Kloss said. In 1991, the American Medical Records Association changed its name to AHIMA because “we saw a digital future and have been preparing for it for decades.”
AHIMA helped fund the Institute of Medicine's research that resulted in its seminal work on HIT, “The Computer-based Patient Record: An Essential Technology for Healthcare” and supported the launch of the Computer-based Patient Record Institute, one of the early booster organizations for HIT.
In the years leading up to passage of the Health Insurance Portability and Accountability Act of 1996, or HIPAA, “AHIMA was an all-but-alone voice” calling for federal pre-emption of state privacy rules by one, uniform national standard, and “at this point, I think we would be pleased if that had happened” instead of leaving what she called “a patchwork” of state privacy laws that remain today. Kloss said AHIMA led the fight for a ban on the use of genetic information to discriminate against individuals and also for uniform data standards for claims processing, the latter being a fight not yet won some 15 years after the passage of HIPAA and its provisions on administrative simplification.
AHIMA, she said, has “advocated the replacement of ICD-9 for almost two decades,” and finally saw passage this April of a final rule mandating its replacement with the ICD-10 used almost everywhere else in the world. AHIMA also has pushed for the secondary use of clinical information for research, quality improvement and fighting insurance fraud and other forms of payment fraud.
“Our mantra is collect once and repurpose many times and piece by piece, we are making tangible progress,” Kloss said.
AHIMA was one of three organizations that helped launch the not-for-profit Certification Commission for Health Information Technology, a program envisioned by the first ONC head, David Brailer, to boost physician adoption of electronic health-record systems by reducing the risk of purchase through testing and certification. Kloss recalled how AHIMA “gave them a home, computers and telephones,” adding “We're very proud of the role we played in moving that organization forward.”
Kloss also noted that the Bureau of Labor Statistics has estimated the need for 100,000 new workers in HIT, and that the American Recovery and Reinvestment Act of 2009, which includes billions of dollars in federal support for HIT, acknowledged the need for federal support for workforce training. (At a news conference after Blumenthal's speech, Kloss said she was satisfied with Blumenthal's statement that “We know there are at least 50,000 new jobs needed in this field” and that the government is bringing “to fruition” workforce training programs demanded by Congress.)
Kloss said from AHIMA's perspective, there remain “three critical issues” in promoting HIT adoption and “meaningful use,” referring to the language in the federal stimulus bill, which requires healthcare providers demonstrate they are using EHRs in a “meaningful manner” as a condition for receiving federal stimulus funds for the purchase and maintenance of EHR systems.
Many providers “are stuck in a high-risk state” still creating some medical records on paper while partially using electronic systems, Kloss said. And yet, current EHR products are not optimized to protect data and support all back-office functions, she said, adding the cost to the healthcare system of these nonstandard and proprietary IT systems “is very high indeed.”
In addition to standards development, the government needs to work on improving the process of promulgating standards, citing the “shock” to the industry that converting to ICD-10 will entail. “Adoption of standards is just not enough. We need to look forward. How do we do this so the next set of transitions is seamless?”
Finally, Kloss said, while the health information management profession fully supports the federal goals of improving patient safety and clinical outcomes, improving administrative processes also must be a government priority. An estimated 15% of national healthcare expenditures are lost to administrative complexity and another 3% to 10% is lost to fraud, Kloss said. “Our feet will be held to the fire to reduce administrative costs under any medical reform solutions,” she said.
“So, Dr. Blumenthal, you can see you are indeed in the company of colleagues who share your urgency,” Kloss said, addressing the man still offstage. “We're right here with you in any way we can help.”
Blumenthal, who received standing ovations from about half of the audience when he walked on and off the stage, said at the beginning of his speech that “I did learn a lot from Linda about your organization” and congratulated AHIMA “on your long history of service,” adding, “I stand on the shoulders of pioneers like yourselves.”
Blumenthal, certainly not a healthcare novice, was chosen by President Barack Obama to head the ONC after serving as director of the Institute for Health Policy at Massachusetts General Hospital, Boston, and, before that, serving as a healthcare policy adviser to then-Sen. Edward Kennedy. A practicing family physician for almost 30 years, Blumenthal conceded that he comes to HIT as “a rather newcomer. I wasn't oriented that much to healthcare IT. I took it for granted,” he said, adding, “As a physician of a certain age, I wasn't particularly enamored” of the change in his practice that switching from paper to an EHR required. But younger physicians, including ones he was teaching at Harvard Medical School where he was a member of the faculty, took to the system quickly, so, he said, he forced himself to use it at least in part to keep up.
Soon afterward, however, “I came to realize that something very important was happening, I was becoming a better physician because of the availability of the information that record brought to me. Patients who couldn't get through to the specialist could come to me for the results of their tests and I would have them. I was meeting their needs.
“That realization sustains me through difficult times,” Blumenthal said. “I know it's not going to be easy” adopting EHRs throughout the country, he said. “I know we're going to need your help to bring this vision to reality and I know we're going to need more people like you.”
“We're not used to hearing Congress referred to as brilliant,” but inclusion of the meaningful use requirement as a criterion for EHR subsidies was just that, he said. The full definition of "meaningful use" is still being worked out by CMS in consultation with his office, and a draft definition should be released for public comment by the end of the year, he said, but what Congress called for in the law “focuses us on the need to change the sociology” of healthcare delivery, he said. It focuses on improving outcomes, efficiency, patient satisfaction and family involvement, “all of the things that are essential to make a health system better.”
The law also requires that someone be appointed to the newly created position of chief privacy officer under ONC, Blumenthal said. That person must be named by February 2010. And it added new, more stringent privacy protections that are needed to make a “21st century” national HIT network viable, he said.
In the area of workforce development, Blumenthal said he hopes he'll be able to announce “in weeks and months” details of an IT workforce training and support program, concluding, “This is a big problem, a big challenge.”
Commenting later on Blumenthal's speech, Kloss said there are about 270 accredited programs in health information management, ranging from the certificate level to post-graduate degrees. Those existing programs should be supported and even expanded with federal help, she said. AHIMA will not be involved directly in training to compete with these established programs.
“Where AHIMA might step up is for the retooling, the retraining for the professionals who have not had the opportunity to work with electronic health records,” Kloss said. “The responsible thing to do,” she said, is to create a path to careers in HIM and not simply fund six-month jobs installing EHRs.
“We need those people to grow professionally,” Kloss said.
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