Thursday, September 16, 2010

A Summary of Meaningful Use for Non-US Readers

This post comes at the request of some of my colleages from outside the US who want to understand more about what we are doing in our "National Healthcare Programme".  It might also be helpful for US readers that have been hiding under a rock for the last 12 months.

The US Federal governent allocated something like $33,000 Million to our "Ministry of Health" (called the Department of Health and Human Services, or HHS).  This is to support use of Electronic Health Records as part of our Economic Recovery.  This originated as a spending bill for economic recovery, so just about everything in it is rapidly paced because recovery $ need to be spent to be effective.

PurposeAllocation ($M US)
Medicare/Medicaid Incentives20,819
Broadband Access4,700
Distance Learning, Telemedicine and Broadband2,500
Office of the National Coordinator2,000
Health centers1,500
Comparative Effectiveness Research1,100
Social Security Administration500
Indian Health Services85
Veteran's Administration50

About $20,000 Million of this is allocated to "Incentive Payments" for hosptials and individual physicians and group practices to use electronic health records.  These incentive payments stretch out over four to five years, and can be as much as $44,000 to $64,000 per healthcare provider depending upon which Federal programs they provide treatment under.  Medicare is our Federally funded healthcare mostly for retirees, and Medicaid are Federal grants to the States to provide healthcare for poor and at risk populations.  The incentive payments are staged so that the biggest chunk shows up first, and then smaller and smaller chunks.  The criteria for recieving payments are also staged.  Just entering the door is probably the hardest, and also has the biggest ROI and payments.  But there will be subsequent requirements staged about 2 years apart that raise the bar incrementally, and those also have additional payments associated with them.  After 2015, instead of incentive payments (the carrot), healthcare providers that are NOT using HIT will start getting penalties which increase yearly (the stick).

As part of that law, Congress formally created the "Office of the National Coordinator of Healthcare IT".  Formerly shortend to ONCHIT, it now goes by the acronym ONC in most circles (until someone gets annoyed at them again).  This week they are ONC to me.  That office was given $2,000 million to spend on different programs. That office was originally created by a memo from the President in 2004 to our Chief Minsister of Health (the Secretary of HHS).  That office had spearheaded the development of 4 prior programs, HITSP, HISPC, CCHIT, and NHIN, and now is responsible for quite a bit more.
($M US)
643Regional Extension Centers
547State HIE Funding
265Beacon Community Grants
118Workforce Development 
60SHARP Grants

Regional Extension Centers are organizations designed to help educate healthcare providers about electronic health records, and to help them choose and implement them.  These are mostly organized around the states.  Besides educating doctors and helping them with implementations, these organizations are also approving and developing purchasing agreements with healthcare product vendors.

State HIE Grants to help build healthcare information exchanges.

I believe $20 Million of the ONC funds were transferred to our National Insitute of Standards and Technology (but it may simply have been a $20M appropriate, NIST has the money either way).  This is the same organization that built the reference implementation of XDS and supports a great deal of IHE Connectathon testing -- not just here in the US, but also internationally.

There are also 11 Federally funded contracts to build what is called the Standards and Interoperability framework. I don't know how this is going to turn out, but it could wind up being something like the Canadian Standards Collaborative that Mike Nusbaum wrote for me in A Canadian Perspective on Standards Harmonization. Of course, things will definately have a US rather than Canadian flavor, but we all speak the same language, Eh?

In order to recieve Incentive payments, physicians must use certified EHR technology.  That means that there has to be a certifying body.  There used to be only one under a prior federal contract, CCHIT, but now there is also the Drummond Group, and there are expected to be more.  I've heard as many as 12 have applied to be in the role.

To be a certified product, EHR Vendors must show that their EHR systems meet some or all of the criteria specified in federal regulations (see links above).  Those criteria require the use of certain standards, most notably the HL7 CCD for patient summaries (but they may also use CCR, pretty much a standard only used in the US), and HL7 V2.3.1 or V2.5.1 for labs, immunizations, and public health reporting.   Eventually, we will have an accrediting body (much like our ANSI accredits standards organinzations), certifying bodies (like CCHIT and Drummond), and testing laboratories, but for now, we just have certifying bodies and the rest of the infrastructure is expected to show up in a year or so.

Overseeing all this are two "Federal Advisory Committees", one which addresses Healthcare Policy, setting national goals, et cetera, and the other which addresses Healthcare Standards.  These bodies ADVISE our government though, and so even their recommendations can be ignored.  Our Secretary of Health and Human Services (you can think of her as our Minister of Health) is the one that has the final say on what gets done and what doesn't get done.

Now, I mentioned that Healthcare Providers have to use Certified EHR technology.  In fact, the way the regulations are written, they have to use it in certain ways prescribed by the regulation, and show that they have in order to recieve the incentive payments.  That includes using it to exchange information using standards, recieve lab results, prescribe medications, and to gather and report on a number of different quality measures considered to be national priorities.

Not quite one page, and no cartoons, but there it is.


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