Will new administration clear the way for widespread HIT?

An infusion of federal investment to advance adoption of electronic medical records and electronic prescribing may give states greater ability to leverage their own resources for health information technology (HIT).

According to Vernon K. Smith, PhD, principal of Health Manage-ment Associates in Washington, DC, "the key to HIT is developing the infrastructure. It is something that government almost has to be involved in."

Dr. Smith says the Obama administration will "certainly be committed to developing the infrastructure, but this all will take a lot of time. Still, the direction is clearly toward greater use of IT in health care, in particular with information exchange, electronic health records [EHRs] and e-prescribing."

This will definitely help the entire health system work more efficiently, says Dr. Smith, and contribute to improvements in quality and patient safety. "It is hard to calculate ROI for HIT," he says. "It is like building roads. The benefits accrue over a long time and to many people, including a lot of people who didn't make the initial investment. However, the ultimate return benefits everyone."

Carol Steckel, MPH, Commis-sioner of the Alabama Medicaid Agency, says she is "very optimistic" about the new administration's focus on health care. "They seem to understand that HIT is a critical component, not only for efficiency and making us better at paying claims and providing services, but also the quality component-making sure we are paying for the right services and paying for better outcomes," says Ms. Steckel. "From everything that I'm reading and seeing and hearing, that is going to be a priority for President-elect Obama and HHS Secretary designee Daschle. And that is exciting."

Ms. Steckel says she is concerned, however, that additional funding for HIT include Medicaid as well as Medicare. "Alabama Medicaid has one of the electronic health record demo site grants from Medicare, but that leaves out the pediatricians," she says. "So it leaves out a large portion of the primary care providers that we need in the Medicaid program. If you look at all the physician incentives, all of that has happened on the Medicare side. We really need it to be on the Medicaid side also."

Though optimistic, Ms. Steckel says that she would caution President-Elect Obama, his team, and Congress that if they want states to invest in HIT, additional resources must be provided. "And I think it can be done in such a way that the federal government gets a return on its investment, just like the states would," she says. "When you are looking at your bare necessities, it's hard to spend a lot of time focusing on the future. But we are. We're trying."

Funding is biggest barrier

Many states currently are working to develop electronic health records, says Ann Kohler, director of health policy for the National Association of State Medicaid Directors in Washington DC. "I expect that there will be more under the new administration. We are seeing states expand their use of electronic health records or health IT for quality improvements. Medicaid directors are very supportive of this effort."

Wider adoption of electronic medical records, prescribing, and patient registries may give states a greater ability to conduct population health studies and monitoring, says Lisa M. Duchon, PhD, a senior consultant at Health Management Associates in Washington, DC.

"I think that as the efficiency of analyzing medical information over large populations vastly improves, we will see a continued push toward more physician organization and integrated systems of care, and payment reforms that lead us toward regional health care programs, if not a single payer," she says.

Dr. Duchon says she also thinks new technologies will continue to emerge that put people in charge of their own health monitoring and self-care. "I can envision a revolution in 'personal health technologies' that combine with personal e-health records and telemedicine to actually reduce overall sick care utilization and the unit costs of some types of care," she says. "We will be seeing more of these 'disruptive innovations' over the next decade."

Funding is the biggest impediment for states looking to implement HIT. "Alabama is not unique. All of us collectively are having to look at program cuts and reductions in our budgets," says Ms. Steckel. "But it's an essential need to invest in quality that looks at high-cost patients and improving their outcomes and lowering our costs, and prevention services. And all of that can be gotten through electronic health records."

Ms. Steckel says "there is a whole gamut of good things that can come from the investment in HIT," such as doctors having additional data on patients so better decisions can be made. "But the entry-level point is money and resources," she says. "The second issue is: How do you get all the stakeholders invested in making it happen in a state? And that's not an easy chore. I don't want to say that once you have all the money you need, everything flies through very quickly and easily. But it can be done."

Grant money 'primed the pump'

A number of states have joined the Multi-State Collaboration on Medicaid Health System Transformation to expand the use of health information exchange and electronic health records.

As a participant in the collaborative, Ms. Steckel says best practices have been shared from "whoever is ahead of the curve" on issues such as privacy, health information exchanges, decision support, and Medicaid fraud detection programs.

Alabama was one of the states that received a Medicaid Transformation Grant from the Centers for Medicare & Medicaid Services, to expand the use of technology to improve quality. "Part of the fun of being part of the collaborative is hearing how truly transformative those grants are for the states that got them, in helping the state agencies think differently, and putting the pieces of the puzzle together differently," says Ms. Steckel. "So, it's a very exciting initiative."

Alabama received $7.6 million dollars. "While that's a lot of money, in the world of HIT, it's not a huge amount of money," says Ms. Steckel. "And we have done phenomenal work with that money. We have gotten our stakeholders involved and invested in what we are doing. It 'primed the pump' is the best way of putting it, and got us ahead of the ballgame on EHR records. And I think you'd see that in a lot of other states, if it weren't for economic reality that we're dealing with."

Many states are "in the position of hanging on by our fingertips to our basic programs," says Ms. Steckel. "The 'luxury' of HIT gets put on the shelf for another day, unfortunately."

HIT can "take the way you've conducted business for the past 40 years and truly transform it," says Ms. Steckel. For example, in Alabama, eligibility always had been done the same way until about five years ago. A joint application was developed with Medicaid; the state's State Children's Health Insurance Program (SCHIP), which is run by the health department; and the state's Blue Cross/Blue Shield program, which covers children who are not eligible for either Medicaid or SCHIP. A family member now only has to fill out one application to see if they're eligible for any of those three programs.

The application process can be started as soon as an individual gets on a computer in their library or home, up to the point where the applicant has to bring in his or her original birth certificate and citizenship and identity documents.

Also, since records are electronic, if an eligibility worker is out on leave, no one has to be moved into his or her physical location. "It's much more efficient. And our time for processing applications goes down. It's that type of thinking that we are starting to think of throughout the agency," says Ms. Steckel. "Everybody thinks about EHRs, but what we are doing in Alabama is EHRs and electronic clinical support tool and case management. Then the last piece is interoperability with other state agencies. But I think it goes much further than just those components. I have people thinking very differently than before we got the transformation grant. And there is the power of that."

Contact Dr. Duchon at (202) 785-3669, ext. 15 or lduchon@healthmanagement.com; Ms. Kohler at (202) 682-0100 or Ann.Kohler@aphsa.org; and Ms. Steckel at (334) 242-5000.