Manatt Says HITECH Needs Changes

The HITECH Act could dramatically improve healthcare in the United States, but such an outcome will only take place if some current trends in its implementation are altered, according to a recent report from Manatt Health Solutions; commissioned by the California HealthCare Foundation, The Colorado Health Foundation and the United Hospital Fund.

"I think the concern raised in this report -- and I think probably reflected in many of the comments received by the federal government in response to the (Meaningful Use) NPRM -- is that they went a little too far, and there are too many requirements," said William Bernstein, a Partner with Manatt, Phelps & Phillips, LLP, and chair of the firm's Healthcare Division. "Therefore, it's not going to lead to the adoption results they want. There is no magic way to do this -- it's more of a judgment call as to how much is too much."

In his recommendations, Bernstein -- who co-authored the report with Helen Pfister and Susan Ingargiola -- stated that the Centers for Medicare and Medicaid (CMS) should revise the Meaningful Use criteria "so they are more achievable and reflect the ability of current systems to support providers as they seek to integrate ambitious new EHR capabilities into their clinical routines and daily workflows."

In addition to the government requiring too much, the report also observed the NPRM was requiring providers to move too fast.

"I think the too fast comment is that there is a concern many people haven't started this journey at all and, if they are just starting now, that considering the time necessary to procure and implement something, we could easily find ourselves in a position where large parts of those in most need of making this transformation don't benefit from the act, and I think that would be really unfortunate," explained Bernstein.

To ease the time crunch, and allow providers to better strategize today with tomorrow's requirements in mind, Manatt recommended that CMS release the full Meaningful Use roadmap -- which would include Stages 2 and 3 -- by the end of 2010 and adopt an incremental approach to reaching those goals over a longer period of time.

In what he described as one of the most interesting findings of the report, Bernstein said not enough focus was being put on interoperability, with the possible result that electronic silos will simply replace paper ones. Leveraging NHIN Direct, he added, did not constitute a solution.

"I think everybody agrees standards are necessary, but are in themselves not sufficient. In some ways, the desire to make it simple to connect is behind what people are now referring to as NHIN Direct, which is really a transport layer, or what's being called simple interoperability. The problem with that being the focus, I think everybody would generally agree, is that's not where the real value comes in terms of exchanging information," Bernstein said. "It's these more complex networks, which allow the right information to get to the right place at the right time, that are required. I don't think we -- the healthcare community -- have figured out how to support the development of these more sophisticated and complex networks that will really give us the value we need, which is the whole purpose of HITECH."

Bernstein and his co-authors recommended that there should be a greater connection between those who invest in EHRs and state-funded health information exchanges (HIEs). He said it would make sense to insist that providers must participate in one of these emerging publicly supported networks to qualify for stimulus funds, "because we think if that were to be the policy, over time it would create a lot more value for stakeholders."

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