The delivery of healthcare in the U.S. is entering a period of transformation. Patients, providers, and leaders from all facets of the industry will be challenged to stay ahead of the impending changes brought about by new legislation, new funding flows, and new information technology capabilities. Here are some of the recent "game changers" we are helping our partners make sense of and benefit from.

• On the Federal front ARRA is changing everything for the better, we hope...
  The American Recovery and Reinvestment Act of 2009 (ARRA) is generating a great deal of activity as thousands of leaders from all
  sectors attempt to modernize our country's health information systems. It may be several years before the benefits of ARRA are realized but the Federal money is now starting to flow through the whole industry and we are starting to see the ARRA vision move from just a set of good ideas to a set of actual programs implemented throughout the country.
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• Meaningful Use
  The ARRA "main event" in healthcare is meaningful use. This program is being implemented by the Centers for Medicare
  and Medicaid (CMS) and is essentially a subsidy to help eligible providers and hospitals offset the costs of adopting Electronic Health Record (EHR) systems followed by fee schedule reductions for those that have not gotten on board with the program by 2015. At $45 Billion, the money is non-trivial equating to a bonus payment of up to $44,000 per clinician under Medicare and up to $63,750 per clinician under Medicaid. The genius of Meaningful Use is that bonus payments are tied to actual use of health information, not just purchase of technology. However, the program presents CMS (and ONC) with many sizable hurdles including defining who is eligible to receive payment, defining and measuring meaningful use criteria, defining interoperability standards, certifying electronic health record products, and implementing the Recovery Act privacy and security provisions. For more information on the CMS role in implementation of meaningful use see http://www.cms.gov/Recovery/11_HealthIT.asp
  
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• ONC Programs
  Supporting the "main event" are many new programs under the Office of the National Coordinator for Health Information Technology (ONC) designed to directly assist providers on the ground, State
  government planners, employers, and researchers.

  Through the Health Information Technology Extension Program (HITEP), ONC is subsidizing 60 Regional Extension Centers with $598 Million to assist priority primary care physicians to implement and meaningfully use EHRs. Extension Center partners have been selected and are now at various stages of planning and launch. With the charge of bringing 100,000 priority primary care providers from across the country to meaningful use within two years, the extension centers are now recruiting participants, solidifying relationships with vendors, and initiating programs to guide clinicians through EHR implementations. For more information on the HITEP program see http://healthit.hhs.gov/portal/server.pt?open=512&objID=1495&
  parentname=CommunityPage&parentid=58&mode=2&in
  _hi_userid=11113&cached=true

  ONC is providing ~$548 Million in funding and assistance to help State and U.S. Territory leaders plan for and implement health information exchange infrastructure. The States that did not have a complete strategic and operational plan for statewide health information exchange at the end of 2009 are now working to shore up plans. The States that did have well developed plans are now moving to an implementation phase. For more information on the State Information Exchange program see
  http://healthit.hhs.gov/portal/server.pt?open=512&objID=1488&
  parentname=CommunityPage&parentid=3&mode=2&in_hi_
  userid=10741&cached=true

  ONC is providing ~$120 Million in funding to universities and community colleges to develop curricula and to train an "HIT savvy" future workforce. For more information on the Health IT Workforce Development Program see
  http://healthit.hhs.gov/portal/server.pt?open=512&objID=
  1432&mode=2

  ONC is providing ~$250 Million in funding to 15+ "Beacon Communities" to showcase the possibilities of community wide HIE and to disseminate learning. For more information on the Beacon Community program see http://healthit.hhs.gov/portal/server.pt?open=512&
  objID=1805&parentname=CommunityPage&parentid=9&
  mode=2&in_hi_userid=10741&cached=true

  ONC is providing $60M through the Strategic Health IT Advanced Research Projects (SHARP) program for research aimed at breaking through several hurdles that have impeded widespread adoption of health IT to date. The program is focused on research on HIT security, human factors for Clinical Decision Support, application and network platform architectures, and secondary use of EHR data. For more information on the SHARP program see http://healthit.hhs.gov/portal/server.pt?open=512&
  objID=1806&parentname=CommunityPage&parentid=11&
  mode=2&in_hi_userid=10741&cached=true

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• On the home front here in Massachusetts, Chapter 305 comes with its own carrots, sticks, and support infrastructure
  Massachusetts enacted Chapter 305, An Act to Promote Cost Containment, Transparency and Efficiency in the Delivery of Quality
  Health Care, in August 2008. The Act set a 2015 target for the implementation and integration of EHR systems in all provider settings. Chapter 305 includes much bigger sticks than the Federal HIT initiatives including ineligibility for license renewal for physicians that don't demonstrate EHR competency and loss of state public health department recertification for hospitals that are not using computerized physician order-entry systems and certified EHR systems. For more information on Chapter 305 see http://www.mass.gov/legis/laws/seslaw08/sl080305.htm

  Chapter 305 also led to the creation of the Massachusetts eHealth Institute (MeHI) which is the organization charged with convening stakeholders for the creation of the Commonwealth's strategic and operational plans. MeHI is also responsible for coordination of "Implementation and Optimization Organizations" (IOO) throughout the state to support deployment of EHRs to priority primary care providers under the Chapter 305 and HITEP programs. For more information on MeHI see
  http://www.maehi.org/

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