ARLINGTON, VA— President Obama’s goal of computerizing the nation’s medical records by 2014 became more attainable when Congress passed the American Recovery and Reinvestment Act in 2009, according to Charles Friedman, PhD, chief scientific officer for the Office of the National Coordinator for Health Information Technology in HHS.

Speaking at a conference in late April, Friedman said that the ARRA included the Health Information Technology for Economic and Clinical Health Act (HITECH Act). That act included $2 billion in appropriations for the Office of the National Coordinator for Health Information Technology to support the movement towards interoperable health IT. A second component of the act authorizes CMS to provide incentive payments to providers and hospitals to adopt electronic health records (EHRs).

Adopting EHRs

Broad use of EHRs is thought to have the potential to increase efficiency, decrease paperwork, reduce errors, and improve population health. However, there is much work that needs to be done to increase the use of computerized medical records.

Friedman said that a 2009 survey found that 20.5% of office-based physician practices have an electronic system in place that meets the criteria of a basic system. Systems defined as basic included the functions of patient demographic information, patient problem lists, clinical notes, orders for prescriptions, and viewing laboratory and imaging results.

The survey found that 6.3% of those 20.5% office-based practices reported a fully functional system. Systems defined as fully functional include all functionalities of basic systems plus the following: medical history and follow-up, orders for tests, prescription and test orders sent electronically, warnings of drug interactions or contraindications, highlighting of out-of-range test levels, electronic images returned, and reminders for guideline-based interventions.

When it comes to hospitals, a 2009 New England Journal of Medicine study found that only 1.5% of US hospitals have a comprehensive electronic records system.

Promoting “Meaningful Use”

The HITECH Act promotes adoption of certified EHRs by providing incentive payments to providers and hospitals that become “meaningful users” of certified EHRs. Meaningful use emphasizes how EHRs are used rather than simply having an EHR, according to Friedman. “Meaningful use is clearly a key concept … It recognizes that just having an EHR is not going to by itself increase the quality, efficiency, or safety of healthcare. What will do that is the way the technology is used.”

A final rule is expected to be released in early spring or late summer that will define in detail the features that EHR systems must include to receive “meaningful use” status.

The incentive payments to providers who achieve meaningful use will begin in 2011, with the criteria of “meaningful use” escalating in 2013 and 2015. Starting in 2015, providers are expected to have adopted and be actively utilizing an EHR in compliance with the “meaningful use” definition or they will be subject to financial penalties under Medicare.

In addition to the incentive payments to promote meaningful use of EHRs, the HITECH Act authorizes a Health Information Technology Extension Program. This program consists of Health Information Technology Regional Extension Centers (RECs) and a national Health Information Technology Research Center (HITRC).

The RECs are designed to offer technical assistance to support the efforts of providers to become meaningful users of EHRs. The goal is to provide outreach and support services to at least 100,000 priority primary care providers within two years. “We have now awarded 60 regional extension grants. Each extension center has a defined catchment area and will be supporting adoption and will be providing boots on the ground assistance,” said Friedman.

Friedman said that workforce grants to promote the development of the health IT workforce have also been distributed. In addition, his office has also funded four sites to conduct breakthrough health IT research to support meaningful use goals for 2013, 2015, and beyond.

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