After more than a year of deliberation, the Centers for Medicare & Medicaid Services recently announced its final rule on the "meaningful use" of health information technology, effectively opening the door for physicians and hospitals to receive more than $18 billion in incentives set aside in last year's massive economic stimulus bill. This is a laudable example of federal recovery spending being matched with a public policy goal that, as of yet, hasn't been achieved by the private sector and market forces: transforming our nation's costly and often inefficient health care delivery system through the widespread adoption of new technology.
The question is: Will it work?
In Maryland, we have reason to be optimistic. A broad coalition of stakeholders has been working together for the last two years to bring the promised benefits of health information technology — like reducing costs by eliminating duplicative and unnecessary tests or procedures; better care coordination; and even improved outcomes — to physicians and patients across the state. For instance, in forming CRISP, a private nonprofit whose mission is to facilitate interorganizational sharing of health data for treatment purposes, four of the state's largest health care organizations (Johns Hopkins Medicine, the University of Maryland Medical System, MedStar Health and Erickson Retirement Communities) have agreed to set competitive impulses aside and work together for the good of all patients.
Collaborating closely with partners in state government, CRISP is implementing a health information exchange infrastructure that in the near future will connect all 47 of the state's hospitals with ambulatory care centers, physician practices, labs, radiology centers and other facilities throughout Maryland. On Tuesday, at a roundtable with health care leaders, Gov. Martin O'Malley encouraged universal participation; as of that meeting, more than half the state's hospitals had signed letters of intent to connect to CRISP.
Exchanging health information goes hand-in-hand with "meaningful use." By being deemed a "meaningful user" of health IT, a clinician can receive $40,000 to $60,000 in additional Medicare and Medicaid reimbursements over the next few years. (Reimbursement penalties will eventually be levied on clinicians who choose to stick with paper and continue to see Medicare and Medicaid patients.) This money is intended to defray the upfront costs of deploying and learning to use a new system. "Meaningful users" will be able to capture health information in a structured format, use that information to track key clinical conditions, communicate that information for care coordination purposes, and initiate the reporting of clinical quality measures and public health information.
While the benefits of investing in and using health IT are compelling, many physicians are cautious about moving forward. Their reasons range from worries about changing the way we practice medicine to concerns about privacy and security. Moreover, as the health IT marketplace has matured, every doctor has heard stories from peers about the challenges of implementation. As more and more practices look to move from paper-based to electronic recordkeeping, clinicians will need knowledgeable, reliable partners to guide them through the process — and ensure they learn how to use systems "meaningfully" to improve the quality of their practices.
We again are on sound footing in Maryland. Acting upon innovative legislation passed in Annapolis last year, the Maryland Health Care Commission has established a program to certify management services organizations, partner organizations that provide technology expertise and support to small practices. These organizations are working in conjunction with CRISP's stimulus-funded regional extension center for health information technology to serve these practices.
It is one thing for a hospital or a large specialty practice, with significant resources at its disposal, to implement health information technology. It's quite another for a small practice, particularly one in a rural or medically underserved area, operating on a shoestring and focused on its primary task of caring for patients, to do so. By working with a certified management service organization, such a practice can capitalize on economies of scale, outsource noncore functions like hosting and maintenance of technology, and feel confident that the training and service it receives meet or exceed industry standards.
The health care industry, not only in Maryland but across the country, is facing pressure to change on all sides. The pressure can feel daunting to all of us who are trained to focus on and care for our patients. But we are also presented with a unique opportunity, with the nexus of unprecedented federal investment and a maturing health information technology industry, to create a health care delivery system worthy of the 21st century — one that embraces innovation and change, and capitalizes on technology to drive down costs and improve the quality of care.
David Horrocks is the president of CRISP (the Chesapeake Regional Information System for Our Patients). His e-mail is david.horrocks@crisphealth.org. Dr. Murray Kalish is an anesthesiologist and the president of MedChi, the Maryland State Medical Society. His e-mail is makalish@gmail.com.