The stimulus law provides an estimated $14.1 billion to $27.3 billion in federal subsidies to hospitals and office-based physicians to purchase EHR systems, contingent upon providers demonstrating they are using the EHRs in a “meaningful manner.”
The first “payment year” begins Oct. 1 under the Medicare portion of the EHR subsidy program, through which the bulk of its federal funds are expected to flow.
Congress specifically mandated in the stimulus law that providers must 1) use their EHR systems to electronically prescribe; 2) have systems that are “connected in a matter that provides … for the electronic exchange of health information to improve the quality of healthcare, such as promoting healthcare coordination"; and 3) use the technology to submit clinical quality and other measures chosen by HHS.
The trouble is, a majority of healthcare providers don't even have EHR systems yet, and the very real concern is that, in addition to their struggles with purchasing and installing an EHR system, the complexities of connecting to the NHIN will prove too much of a technological and resource leap for many smaller providers, according to David Blumenthal, head of HHS' Office of the National Coordinator for Health Information Technology.
That doesn't mean HHS is abandoning the NHIN, according to Blumenthal.
“We continue to fully support that model and see it as extremely useful and essential to achieving the goals of many organizations that want robust, complete, sophisticated exchange of information,” Blumenthal told members of the Health IT Standards Committee at its March 24 meeting.
Blumenthal quickly added that, “We have been urged and are thinking through the possibility that other options may also be useful for simpler levels of exchange that are on the pathway toward more complicated exchange and consistent with it.”
Blumenthal urged those who are working at developing state and regional information exchanges with an eye toward connecting to the NHIN “to keep working at it.” Still, he said, “We think we need to make it possible to meet providers where they are, not just where we'd like them to be.”
“If we have only one option for groups that want to be meaningful users and they can't organize themselves sufficiently to get to that option, then we all may have accomplished much less than we hoped they would,” he said.
Doug Fridsma, acting director of the Interoperability and Standards Office at the ONC, said NHIN Direct is “focused on this notion of secure routing.” Fridsma said many of the examples of instances where lightweight messaging might be useful came from a blog by Wes Rishel, that, Fridsma said, “I thought nicely summarized the kinds of exchanges that could occur.”
Rishel is a vice president and distinguished analyst for Gartner, a technology market research firm.
Fridsma said the core use cases, or tasks, that NHIN Direct hopes to address come from two federal rules issued late last year by the CMS and ONC governing the federal EHR subsidy program.
“And those include things like a primary-care provider who refers a patient to a specialist and includes a summary care record, or they refer the patient to a hospital and includes those sorts of things,” Fridsma said. Other examples Fridsma gave include a secure message a specialist might send containing a summary of care information back to a referring provider or hospitals communicating to providers' laboratory results or a continuity of care report.
“We've also taken a look at sort of the extended use cases and many of those involve provider to patient” communication, Fridsma said, “so making sure that patients can get an electronic copy of their health information, clinical summary records at the end of a visit provided to the patient or electronic clinical summary at the discharge from the hospital.”
Other possible uses of NHIN Direct in the future are reports of quality measures to the CMS or the state and “medication therapy management in consultation with the primary-care provider,” he said.
The NHIN Direct Project is using a Web site, NHINDirect.org, for capturing and recording information being generated.
Arien Malec is serving as the coordinator of the project under an HHS contract with A+ Consulting, according to a biographical posting on the NHINDirect.org Web site. Malec is on a leave of absence from RelayHealth, a subsidiary of giant pharmaceutical wholesaler and heath IT system vendor, McKesson Corp.
RelayHealth provides e-prescribing and computerized health communication services for physicians and hospitals.
Rishel, who is also a member of the Health IT Standards Committee, wryly suggested on his blog that he'd been co-opted by the government.
“As a child of the '60s I was getting a big kick out of playing the role of speaking truth to power,” Rishel wrote. “Here was my chance to stick it to ‘the man,' taunt him with reality. It is nonplussing to have ‘the man' say, ‘Right, good idea, let's do it.' ”
“Now I've got to find some other way to rebel,” Rishel said.
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