Guerra On Healthcare: Will Congress Cut HITECH?

As legislators look to reduce federal spending, funding for electronic health records looks to be right in their crosshairs -- and maybe that's not so bad.
Two of last week's headlines provided a vivid contrast in how Republicans and Democrats each view the fiscal condition of the nation, along with their feelings about the Health Information Technology for Economic and Clinical Health (HITECH) Act.

On the one hand, we have the Republicans, now gunning to reduce discretionary spending. Plain in their sights -- in what amounts to a big, fat $27 billion apple -- is the funding set aside for meaningful use incentive payments, along with cash for healthcare IT educational programs and Regional Extension Centers (RECs). The proposed "Spending Reduction Act of 2011" would cut overall spending by more than $2 trillion over the next decade.

It does seem odd, when you think about it, that a stimulus package created to pull the nation from the brink of economic collapse stretches out five years. If you ask me, this program was just begging to have funding for its out-years eventually fall into the cross-hairs.

On the other side of the aisle, you have the Democrats, in the form of Obama Administration-appointed National Coordinator David Blumenthal, MD, who just announced another $80 million in funding for community college programs, RECs, and health information exchanges (HIEs). Mind you, this additional funding will continue supporting the RECs to the tune of 90% for two years beyond the initial two stipulated. Since two years, it seems, wasn't enough to make them solvent, why an additional two years of government largess will right the ship is beyond me.

Though a number of political insiders seem doubtful the Republican bill will pass, that doesn't mean the HITECH money is forever out of the government's reach. The best hope the healthcare IT industry had was that spending hawks would miss its relatively small $27 billion needle when sifting through the federal budget haystack, but it hasn't worked out that way.

But perhaps the healthcare IT industry doesn't love HITECH as much as one might think. In fact, I've already communicated with a number of folks who would love to see the whole program just go away, so they could get back to the good work they'd been doing before the government assumed the role of boards setting organizational strategy.

Specifically, issues around certification are just driving people up the wall. I've talked to CIOs who are sending requests for clarification to any and all industry bodies that might have an answer about which modules must come from their core electronic medical record (EMR) vendor, what has to be certified, and how it must be done.

That's not to mention the most appropriate of all hospital certification programs -- the Certification Commission for Healthcare Information Technology (CCHIT) EHR Alternative Certification for Hospitals (EACH) -- sounds like it requires much more than most hospitals will be able to give the process. I mean, wasn't certification supposed to be a way for unsophisticated EMR buyers -- mostly docs shopping for office systems -- to be sure they could do everything the government might ultimately require? How does the current self-certification regimen for hospitals do that?

So as Republicans look to get the money back, and ONC looks to get it spent, hospitals and eligible providers wonder if they'll see any at all. Once again it seems the best way to deal with government incentive programs is to send in the application and go on with your life, because the only clear thing about meaningful use right now -- on every level -- is universal confusion.


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Anthony Guerra is the founder and editor of, a site dedicated to serving the strategic information needs of healthcare CIOs. He can be reached at [email protected].

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