“It's not the technology that's important, but its effect,” Blumenthal said. “That's the purpose of the stimulus bill.”
The American Recovery and Reinvestment Act of 2009 included Medicare and Medicaid incentives to eligible providers such as physicians and hospitals to boost adoption of EHRs. To receive the incentive payments, providers must demonstrate “meaningful use” of a certified EHR. The CMS, in conjunction with Blumenthal's office, is developing the proposed rule that provides greater detail on the incentive program and a definition of meaningful use. The stimulus law, enacted in February, appropriated $2 billion to Blumenthal's office to create the infrastructure for meaningful use.
After a comment period, the final rule on meaningful use will be released in the spring, Blumenthal said.
While Blumenthal declined to give a specific definition of meaningful use, he offered some hints. People working in health IT should think about EHRs “not as a technology project, but as a change-management project,” he said. Components of meaningful use include sociology, psychology, behavior change and the “mobilization of levers to change complex systems and improve their performance,” he added.
Through the stimulus law, Congress mandated that meaningful use become more focused over time, with yearly benchmarks. There has been a “lively discussion” in the Obama administration of that timetable in the proposed rulemaking of meaningful use, Blumenthal said.
“We will be looking for your feedback,” Blumenthal told the assembled association of nearly 2,000 members who attended the conference held at the Hilton San Francisco Union Square this week. “Rulemaking is not the end of the conversation.”
Privacy and security are absolutely critical to the widespread adoption of health IT, Bluementhal said, adding that this is also on top of his agenda. “Without the trust of the public, we will not be successful in getting everything out of the potential of health informatics.”
In the next few months, his office will convene a working group on privacy and security to look at what else is necessary to ensure the public's trust beyond what is instructed by Congress in the stimulus law, he said.
“We need to be extremely vigilant and aggressive in terms of developing standards around privacy and security,” Blumenthal said.
And his office is moving forward with its first grant programs under the stimulus law. Last summer, Blumenthal announced two grant programs mandated by the stimulus law. The first is $700 million in grants to establish up to 70 health IT regional extension centers nationwide, which will offer technical assistance, guidance and information on best practices to support and accelerate providers' efforts to become meaningful users of EHRs. The second program offers $560 million in grants to states to develop health information exchange capacities among providers.
The first round of grant recipients will be announced soon, Blumenthal said. HHS received about 90 applications for the first 20 slots in the health IT regional extension center program, he said, adding that he was encouraged by the volume and quality of the grant applications.
“The grants to states, we believe, are another good bet,” he said.
Blumenthal also gave some hints on his office's plans to develop and announce programs to increase the supply of trained health IT workers.
“The skills needed are not necessarily what our teenage children have,” Blumenthal said, which brought laughter from the crowd.
Specifically, the nation needs professionals who understand meaningful use and improved processes of care, the ability to redesign workplaces to integrate the new technology and to help providers use the technology to its full potential, he said.
“The training needed is well beyond the installation of information technology,” he said.
Blumenthal expressed great confidence that health IT can be a foundation for fundamental change in the healthcare system.
“I believe it will be a short time before EHRs are as common in medicine as the stethoscope, the cardiogram, the MRI and other core tools,” he said. “I think we're already moving in that direction.”
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