Implications of the Stimulus Package for Health IT - SIIM News Spring 2009

A Report on the American Recovery and Reinvestment Act of 2009, with Implications for Health Information Technology

Janice Honeyman-Buck, PhD, FSIIM
Editor-in-Chief, Journal of Digital Imaging

On February 17, President Obama signed into law the American Recovery and Reinvestment Act of 2009 (ARRA 2009).  Whether you agree with this economic stimulus plan or not is a topic for usually heated debate, even between family members and colleagues.  I have tried to wade through the Act to see how it might apply to the field of Health Informatics Technology (HIT).  I am not claiming to be an expert on this bill; this column is simply a guideline for those wishing to find out more and to possibly start discussions on how this Act can impact research and development in our field. 

One of the President’s campaign promises was to move the U.S. health care system to broad adoption of standards-based electronic health information systems, including electronic health records within five years.  This may not be a reasonable time frame, but he pledged to invest a considerable amount toward reaching his goal. 

The ARRA 2009 has significant provisions for funding to help reach his goal.  Although I do not advocate the use of Wikipedia as a sole source of information about important topics, it is a good place to start when attempting to read this Act.  According to the Wikipedia, the Act sets aside $19 billion for Health Information Technology.  To get to the actual bill on the Internet, the easiest way I’ve found is to go to http://recovery.gov and follow the links to the full bill.  When I followed the links, I found a PDF file with the full bill and on page 112 of 407, I found the beginning of Title XIII – Health Informatics Technology.  There will probably be more funding available in other parts of the Act, but this is the main funding for HIT.

The Act allows for two new committees and a National Coordinator who will be appointed by the Secretary of Health and Human Services.  The new committees are the HIT Policy Committee and the HIT Standards Committee, and both are described below. The Health Information Technology website is http://www.hhs.gov/healthit/.

The main goal is the utilization of an electronic health record (EHR) for each person in the United States by 2014.  This includes a mandate to develop methods to foster public understanding of health information technology and strategies to enhance the use of HIT in improving quality of health care, reducing medical errors, and reducing health disparities.

HIT Policy Committee 

The committee recommends a policy framework for development and adoption of a nationwide HIT infrastructure.  The HIT Policy Committee shall recommend areas in which standards, implementation specs, and certification criteria are needed and shall recommend the order of priority for development, harmonization, and recognition of standards, specs, and certification.  Standards shall include named standards, architectures and software schemes for authentication and security of individually identifiable health information.  Areas required for consideration:

• Technologies that protect privacy;
• Infrastructure that allows the electronic use and accurate exchange of health information;
• Use of certified EHR by each person in the United States by 2014;
• Accounting information;
• Using Certified EHR to improve quality of health care, reducing medical errors;
• Security technologies to keep private information private;
• Electronic systems to ensure comprehensive collection of patient demographic data including at least race, ethnicity, primary language and gender; and
• Technologies that address the needs of children.

Other areas for consideration:

• Appropriate uses of a nationwide information infrastructure to collect quality data and public reporting, biosurveillance and public health, medical and clinical research and drug safety;
• Self-service technologies that facilitate the use and exchange of patient information and reduce wait times;
• Telemedicine;
• Technologies that facilitate home health care and monitoring of patients recuperating at home;
• Technologies that reduce medical errors;
• Technologies that facilitate the continuity of care among health settings;
• Technologies that meet the needs of diverse populations; and
• Methods to facilitate secure access.

Membership of the HIT policy committee will be appointed as follows:

• Three members appointed by the secretary, one of whom will represent the Department of Health and Human services and one of whom shall be a public health official;
• One member appointed by the Majority Leader of Senate;
• One member appointed by the Minority Leader of Senate; 
• One member appointed by the Speaker of House;
• One member appointed by the Minority Leader of the House;
• Other members appointed by the President as representatives of other relevant Federal Agencies
  • 13 members appointed by the Comptroller General of the United States, including:
  • Three advocates for patients or consumers;
  • Two members representing health care providers; one should be a physician;
  • One member from a labor organization representing health care workers;
  • One member with expertise in HI privacy and security;
  • One member with expertise in improving the health of vulnerable populations;
  • One member from the research community;
  • One member representing health plans or third-party payers;
  • One member representing information technology vendors;
  • One member representing purchasers; and
  • One member with expertise in health care quality measurement and reporting.

HIT Standards Committee

The HIT Standards Committee has the assigned duty to work on standards development and to create a forum for the participation of a broad range of stakeholders to provide input.  Within 90 days, the committee shall develop a schedule for assessment of policy recommendations.

This appears to be where the major spending will be:

• Implementation or acquisition of health information technology systems;
• Broad collection and submission of health information;
• Study that examines methods to create efficient reimbursement incentives for improving health care quality in federally qualified health centers, rural health clinics and free clinics;
• Study of matters relating to the potential use of new aging services technology to assist seniors, individuals with disabilities, and their caregivers;
• Pilot testing of standards and implementation specifications; and
  • Create multidisciplinary Centers for Health Care Information Enterprise Integration (established by the National Science Foundation).  Research may include:
  • Interfaces between human information and communications technology systems
  • Voice recognition systems.
  • Software that improve interoperability and connectivity among health information systems.
  • Software dependability in systems critical to health care delivery.
  • Measurement of impact of information technologies on quality and productivity of health care.
  • Health information enterprise management.
  • Health information technology security and integrity.
  • Relevant health information technology to reduce medical errors.

In addition Grants and Loans funding will include:

• Development of health information technology architecture supporting nationwide electronic exchange;
• Development and adoption of appropriate certified electronic health records;
• Training and dissemination of information on best practices to integrate health information technology including electronic health records into provider’s delivery of care;
• Infrastructure and tools for telemedicine;
• Promotion of interoperability of clinical data repositories;
• Promotion of technologies and best practices that enhance the protection of PHI; and
• Improvement and expansion of the use of HIT by public health departments.

What does President Obama’s stimulus package mean for you and your institution? Join the discussion on SIIM's JDI blog.