EMR Stimulus Follow-up

A recent webinar by the Information Technology and Innovation Foundation (ITIF) and IBM addressed some of the concerns I voiced in my previous post on stimulus spending on EMRs.

The strategy of the EMR and larger IT portion of the stimulus bill was informed in large part by a report created by the two organizations. This report outlined the job creation potential and downstream benefits of IT infrastructure subsidies. Logistically, the process will go something like this:

Governmental agency publish guidelines -->
Hospitals and physicians purchase and implement EMR systems according to guidelines, possibly with the help of govermental loans -->
Time is allowed to prove adherence to guidelines and possibly effectiveness -->
Hospitals and physicians are reimbursed for EMR system

Therefore, the argument that EMR spending will not generate immediate jobs is actually false, provided that the ONC publishes guidelines in a timely manner and loans are set up to foot the bill. Since analysts are now telling us that the job market is likely to stay slumpy through the end of this year, I wouldn't be surprised to see EMR jobs begin to flow before that time.

Strategically, the stimulus bill states these following goals for funding EMRs:

1. Create a Office of the National Coordinator (ONC) that oversees the "[development of] HIT infrastucture to improve quality, reduce costs, and protect privacy" ($2B). Dr. David Blumenthal, director of the Institute for Health Policy at Mass Gen and a Professor of Medicine at Harvard, was recently appointed to head the ONC.
2. 90% adoption of Electronic Health Records for physicians, 70% for hospitals ($17.2B).
3. Health information exchanges to support information sharing ($300M).
4. Comparative effectiveness research to "reduce inappropriate and unnecessary care." This "would not be used by the government to mandate use of clinical guidelines for payment, coverage, or treatment" ($1.1B).

In my previous post, I stated two major concerns. First, without a focus on overall organization and information exchange, a wide EMR implementation will just be a big expensive undertaking without any of its potential cost-reducting and care-improving benefits. Second, the needs of physicians who work in private groups or rural areas need to be addressed (and guidelines created) differently than those of hospitals. The stimulus goals address the first issue by creating the ONC and including information exchange as part of its reimbursement guidelines (presumably, as these have yet to be developed and published). The research goal is like icing on the cake; it shows that lawmakers have the long-run in mind. But my second concern is still not adequately addressed. Will guidlines be different for individual group practices and rural physicians? Will different products be recommended (or new product development encouraged) for these groups versus hospitals and larget networks? How is the heavy burden of the upfront cost for small group providers going to be tided over to ensure their survival? I expect more answers will come forth in the actual content of the guidelines.