On Jan. 24, 2009, newly sworn in President Obama uttered a bold promise: “To lower healthcare costs, cut medical errors, and improve care, we'll computerize the nation's health records in five years, saving billions of dollars in healthcare costs and countless lives.” It's those words that marked the beginning of healthcare reform. In the 18 months since that first weekly address, a number of significant events have unfolded. This article will take a look at how we got to where we are today, the challenges along the way, and measures taken to ensure alignment with radiology's scope of practice. It will also review solutions that will be at the forefront in this new era of healthcare.
WHERE WE ARE TODAY
On Feb. 13, 2009, less than four weeks after Obama's inauguration, Congress passed the American Recovery and Reinvestment Act of 2009 in direct response to the economic crisis. Four days later, the president signed the $787 billion dollar act into law. Out of this act, the Health Information Technology for Economic and Clinical Health (HITECH) Act was born. This subset of ARRA provides more than $20 billion in funding to improve healthcare IT in the U.S.
At the forefront of these health IT efforts is the Office of the National Coordinator for Health Information Technology (ONC). This organization, located within the Office of the Secretary of Health and Human Services, acts as a resource to support the adoption of health information technology and improve patient care through implementation of a nationwide health information exchange (HIE).
On March 20, 2009, the Obama administration appointed a Massachusetts General Hospital colleague, David Blumenthal, M.D., M.P.P. (master of public policy), as national coordinator of health information technology for the ONC with his primary objective being to lead the implementation of a nationwide interoperable and protected health information technology infrastructure as called for by ARRA. Subsequently, Dr. Blumenthal recruited Partners Healthcare System's chief information officer, John Glaser, Ph.D., as a special advisor to the ONC.
At the same time, and under the auspices of the Federal Advisory Committee Act, the Health IT Policy Committee and Health IT Standards Committee were formed. Both are charged with making recommendations to Dr. Blumenthal. The policy committee focuses primarily on the national health information infrastructure and helps establish medical information exchange standards, while the standards committee is responsible for implementation specifications and electronic exchange certification criteria and focuses on policies developed by the policy committee. These groups, under the ONC, became responsible for providing recommendations to the Centers for Medicare and Medicaid Services, the group responsible for defining meaningful use criteria.
On Dec. 30, 2009, after months of deliberation, the ONC issued its Interim Final Rule, a summary of recommendations on meaningful use. The interim rule proposed the initial set of standards and certification criteria as well as implementation specifications. That same day, CMS issued a Notice of Proposed Rulemaking, which outlined three incentive programs and the provisions governing each program, including the communication of results to patients, communication with electronic medical records (EMRs) outside the enterprise, and the use of five decision support rules.
