From legislative policy development to fielding questions from industry stakeholders, HIT coordinators are helping guide the shift to electronic health records (EHR) and health information exchanges for each state. But the change hasn’t been easy.
The work is well funded, thanks in part to the $25.8 billion devoted to health IT investments in the American Recovery and Reinvestment Act of 2009. But the influx of cash has also accelerated the pace of the technology’s adoption, leading to myriad communication and administrative challenges for states.
Medical providers, insurance companies, agencies and all the parties involved in this increasingly electronic landscape have interests that don’t necessarily align with one another. So it’s up to HIT coordinators to foster those relationships in order to provide the best health care for each state’s citizens as EHRs and health information exchanges are being deployed.
Dr. Steve Cline, North Carolina’s HIT coordinator and assistant secretary of the Office of Health Information Technology, spends much of his time bringing attention to the issue. He referred to himself as a “change agent” and the visible “go-to” person for anything and everything related to health IT.
But like many administrative posts, there are a mountain of conference calls and groups, which keep HIT coordinators oftentimes too busy to make significant progress.
As North Dakota was developing its strategic and operational plan for rolling out health IT, state representatives took two weeks to question providers and other parties about their needs, said Sheldon Wolf, the state’s health IT director.
“We have really tried in North Dakota to have an all-inclusive process where people who want to be involved, can be and provide input we [can use to] develop our plans,” Wolf explained. “It can be a challenge, but you need to get out there and spread the word. We do a lot of presentations at association meetings. We try to go out and provide information.”
Cline said the demands are essentially unavoidable, given how quickly health IT is being embraced. “We would never get where we need to be in health IT if we tried to do a calculated, sequential master plan,” Cline said. “So that does create some inefficiencies and some uncertainty ... but I think that’s what it is going to take to get us moving.”
Laura Zaremba, director of the Illinois Office of Health Information Technology and the state’s HIT coordinator, said HIT coordinators should be flexible with technology implementation as health policy changes continue to happen nationwide.
“It requires a lot of thinking, a lot of resources, and there is a high degree of complexity,” Zaremba said. “It is very time consuming to really make the connections that you need with colleagues in and out of the public sector to make sure this is successful.”
EHRs the Key to Success
EHRs compile a plethora of information on patients, including medical history, medications, vital signs, immunizations, laboratory data and much more. By sharing all the information in one electronic record, physicians across the state, or eventually nationwide, can easily access a patient’s complete file, streamlining workflow and making patient care more thorough.The EHR Incentive Program is part of the Health Information Technology for Economic and Clinical Health (HITECH) Act, which was signed by President Barack Obama as an economic stimulus bill through the Recovery Act. As part of the program, starting this year and running through 2015, eligible health-care providers are being offered financial incentives for EHR use. HITECH also provides grants for training personnel needed to support statewide health IT infrastructure.
Physicians adopting, implementing and/or upgrading EHRs under the Medicaid EHR Incentive Program can receive up to $65,000 in reimbursements. Those under the Medicare version of the program will receive as much as $44,000 in reimbursements for showing “meaningful use” of EHRs — which includes components like e-prescribing — according to the HITECH Act. Hospitals can receive funds from both, tallying millions of dollars.
Although health IT doesn’t end with EHRs, it is a key first step in enabling a digitized health-care world with health information exchanges.
Lynn O’Mara, Nevada’s state HIT coordinator, called the implementation of EHRs “at the [federal] level, why the HITECH Act was passed.” She said the financial incentives to do so are clearly a carrot to push providers and states along.
Zaremba maintained that just as the development of health information exchange infrastructure is crucial to health-care transformation efforts, adoption and use of EHRs are foundational to the entire process.
“There will be no change unless we change the rate of [EHR] adoption among providers,” Zaremba said. “That’s really a critical milestone for 2011 — how much we can move the needle on EHR adoption.”
HIT coordinators are responsible for helping those purchasing EHRs understand the requirements of HITECH in order to receive reimbursements.
In North Dakota, the Regional Extension Assistance Center for Health Information Technology handles many of the provider questions about meaningful use of EHRs. But Wolf admitted there was pressure on his office to get EHRs operational.
In response, North Dakota created a loan program to help finance EHRs. The state distributed $5 million in low-interest loans that go through the state-owned Bank of North Dakota. Wolf said that in the current two-year legislative cycle, those loans were at a 1 percent interest rate, financed over 10 years. The state is working on further funding.
“The Legislature met from January through April, and we worked … to get an additional $5 million so that we can … loan out that money again to help providers,” Wolf said.
Cline said that while the incentive money has pushed things forward, he’s also seen a rise in EHR adoption among providers that aren’t eligible for the reimbursement programs.
“They are doing it for their own business reasons, and they are saying that it is going to happen and they want to be a part of it,” Cline said. “I think the whole industry is recognizing the potential for health information exchange and the necessity for having that information in a clinical format … to do that exchange.”
Nevada is seeing that trend as well. O’Mara said economic issues are preventing some health-care providers that aren’t eligible for reimbursements from moving to EHRs. But she was confident that the movement toward EHR implementation would eventually cascade.
“On the upside, we do have providers that are turning to our economic development authorities to bring it to their attention and make it a priority,” said O’Mara. “Our providers support the concept and a lot plan to do it in the next few years. We’re finding about 75 percent of our providers by 2015 expect to have an EHR system and use it.”
Not a Technical Role
Despite technology’s vital role in streamlining and providing more accessible health communication and information, many HIT coordinators don’t have a technical background.Wolf said his position is more of an administrative post and his background is in accounting, auditing and budget management.
While Wolf’s job is located within North Dakota’s IT department, he said his function is to help enhance the use of health IT, not debugging or providing insight into the actual technology and how it works.
Similarly Cline has no IT experience. He’s a dentist and spent 28 years in public health, serving as North Carolina’s deputy state health director for 14 years before being appointed to his current position.
But Cline has also made it a priority to have a technology person on board for the more tech-centric discussions he’s involved in, particularly as they relate to health information exchanges and the technical architecture for North Carolina’s state-level exchange.
“I try to go to those, but I make sure that my technology lead is there because he understands that and is helping to shape [it],” Cline said.
O’Mara and Zaremba, however, do have some technology experience. O’Mara worked for an electronics firm that did work for the U.S. Department of Defense. Her background is in corporate marketing, business development and communications. Zaremba’s career has been focused on public health policy, which has involved technology.
Typically the HIT coordinator position is an allowable expense under grant monies that stem from the federally funded State Health Information Exchange Cooperative Agreement Program. The program aims to advance appropriate and secure health information exchanges across the health-care system. Cline’s post, however, is state-funded.
The difference allows more flexibility for North Carolina Gov. Bev Perdue and state leaders to shape Cline’s role based on the state’s needs. Besides being the point of contact on the various health IT initiatives and grants in North Carolina, Cline provides leadership and strategic planning as it relates to health IT, spanning a multitude of state agencies.
North Carolina’s lawmakers also have charged Cline’s office with having a statewide oversight role. Every quarter he must produce a report to the state’s general assembly on various aspects of health IT and what’s going on statewide.
“It is kind of an undoable task, but it’s being their point person to hold responsible for looking across the whole state landscape of health IT, both public and private … and trying to make sure North Carolina is staying in good standing with the [federal government],” Cline said.
Forward Thinking
A shortage of health IT professionals is one issue coordinators see cropping up. While there is some funding available under HITECH for training programs, states such as Nevada are hoping the demand spurs business development opportunities.O’Mara said she suspects that Nevada will need 2,500 to 3,000 health IT professionals by 2016 in order to support all of the EHRs and the health information exchange throughout the state.
“A doctor’s office is not going to hire a full-time health IT person,” O’Mara said. “But they are going to want the equivalent of a service that comes in that helps them — kind of like Best Buy’s Geek Squad.”
In Illinois, there is a “unanimous consensus” among various physicians, hospitals and government agencies that there will be a lack of trained health IT personnel, according to Zaremba.
Regardless of the shortage, officials are optimistic that progress is inevitable and the challenges will work themselves out as the systems are put in place.
“We have tolerated low IT in health care more than any other industry I can think of,” Cline said. “Everyone else sees the value of it ... but health care has really been slow to embrace what IT can do for it. I think that this is the time for that change.”
