According to an editorial written by HealthAffairs editor-in-chief, Susan Dentzer, about one dollar in every five of the entire American Recovery and Reinvestment Act of 2009 (ARRA) is going to the health sector in some fashion. For example, the federal government is making a significant bet on health IT. Tens of billions of dollars in incentives are being offered to physicians and hospitals if they implement and use electronic health records. Of course, there’s a catch. To qualify for the incentives hospitals and doctors must be able to prove that they are meeting so-called “meaningful use” criteria with their shiny new EMR as outlined by federal officials. That has proved to be a bit of a stumbling block; first in getting a clear definition of meaningful use from the Feds, and second getting hospitals and doctors up to speed on what they’ll need to do to prove to the government that they are meeting “meaningful use” requirements.
While many large hospitals and clinics are moving forward with a kind of “damn the torpedoes” enthusiasm, smaller hospitals and especially physician practices are being more cautious. In fact, there is some evidence that all the incentive hoopla is actually holding back the EMR market rather than stimulating it. Chris Thorman writes for Software Advice, a free online resource that profiles health record software for doctors. Here, in his own words, is what he’s been observing.
In February 2009, the federal government passed the American Recovery and Reinvestment Act (ARRA). The ~$20 billion set aside for electronic health record (EHR) incentive payments caught the attention of nearly every healthcare provider. While we believe the ARRA will increase EHR adoption over the long term, many in the EHR community feel the program has increased "tire kicking" and slowed actual purchases. What's behind this?
After ARRA was signed, many providers set out to research EHR software in order to qualify for the roughly $44,000 in incentive payments (spread out over five years). We fielded calls every day from optimistic buyers asking how to qualify for EHR incentives. Here are some of the comments we heard:
"She is aware of the stimulus bill and will do what it takes to receive stimulus payments."
"Hey, its free. Why not implement an EHR?"
After the initial fervor wore off, and as the government's various health IT committees began to drudge through actually defining "meaningful use" and "certified EHR technology," we began to field more calls that went like this:
"The doctor doesn't want to jump into something and not meet the stimulus bill requirements."
"We are looking to implement an EMR so they aren't penalized by the government."
"Given healthcare reform and Medicare cuts, I'm not sure we can afford to do anything. We'll see what comes of the ARRA program."
In other words, buyers appear to be more cautious but still heavily focused on earning stimulus bill incentives.
When the Center for Medicaid & Medicare Services (CMS) released documents in late December further detailing the EHR incentive program, we saw another jump in interest. However, our experience has seen the number of providers searching for EHR software decrease in February and March 2010.
While we're aware of other reasons that could have caused this decrease in searches, some of the feedback we've received is that providers are so fixated on qualifying for stimulus incentives that they're freezing up until the requirements are spelled out in plain English, black and white. They want to make absolutely sure that they have an EHR that will qualify for incentives.
Another challenge with the stimulus program is that it may create the wrong EHR implementation incentives. Doctors might choose EHR software with the goal of receiving incentive dollars, rather than working working toward traditional EHR benefits like improved efficiency and patient care. We don't mean to imply that the money is prioritized above patients. Instead, we are saying that doctors might approach their EHR implementation - a very significant change management project - without the requisite discipline. After all, when you get something for free, you value it less. If doctors pay dearly for an EHR system, they will be more likely to approach the implementation with rigor.
In order for the goals of the stimulus bill (e.g. nationwide health records interoperability) to be fulfilled, providers need to be focused less on stimulus funds and more on executing a successful EHR implementation.
I think Chris is offering sound advice. As stated here on HealthBlog in previous articles, in the end it’s not even the EMR that’s as important as what we do with electronic health data once we have it at our disposal. Health IT offers a tremendous opportunity to improve care quality in America, and better engage our patients in care decisions. It will also enable new ways to deliver health information and medical services thereby relieving some of the capacity pressures on our physical healthcare facilities.
If you need help deciding what to do for your hospital, clinic or practice, you might want to take a look at some of the resources we have developed here and here. You might also want to click on over to the Software Advice site and take a look at what they have to say about the wide variety of EMR solutions on the market.
Bill Crounse, MD Senior Director, Worldwide Health Microsoft