When the annual Government Health IT conference (GHIT11) takes place next month in Washington, D.C., Jessica Kahn, technical director for health IT at the Centers for Medicare and Medicaid Services, will be among the presenters.
Kahn spoke with Government Health IT Editor Tom Sullivan about her upcoming discussion – "Early lessons learned about Medicaid providers adoption of certified EHRs." She offers a glimpse of those lessons, how they lay the foundation for the big-picture NHIN effort, where usability matters most, and why there’s still hope for the beltway.
Q: What are the most important lessons learned for federal and state health IT pros to know about?
A: The first one that we focus on is that the ability to move quickly has been most enabled when they focused on business service re-usability. So where they were able to leverage existing business processes, provider portals, call centers, outreach mediums, so that they were not starting from scratch but looking at what they already had and could build upon. They also were able to share resources across states. There are a lot of examples where states have collaborated with a single vendor to build a solution that was then re-used. Of course, this saves financial and personnel resources, but it also saves time because then CMS only needs to test a smaller number of interfaces with fewer systems so we can onboard a larger number of states in a short timeframe. It’s much more efficient for states in these economic times, and it's also been easier for them to sell to state leadership why they should invest in health IT because they can show that they’re leveraging an IT system, they’re not starting from scratch, and they’re using something that has re-usability across their agency and their enterprise. And that’s why they’ve been able to move it through their CIOs and their state leadership, to keep it on the radar, even in these economic times.
Q: With 15 states already involved, at what point do you envision having all 50 onboard?
A: As you probably know, all 50 states and some territories requested planning funds from us. We’ve awarded those, so they’re all working. Right now we’re looking at two to four states per month launching their programs through the end of this calendar year. There is of course a lot of provider enthusiasm and encouragement. Our emphasis for states has been 'What you’re creating here isn’t just for an incentive program. What you’re creating here is enabling health IT as a tool for the Medicaid enterprise.' And that has multiple benefits, so that’s helped. We’re also offering very intensive technical assistance to states. We’ve created communities where states can share their templates. We actually have bi-weekly all-state calls as well as individual consultation to make sure that the states aren’t doing it alone.
Q: So there are some really big picture agendas here, and I’m talking about state HIEs and NHIN, the National Healthcare Information Network. Is this laying a solid foundation for those?
A: I think it’s going to. It’s very early on, of course. We’re here in May and these programs launched in January and some of the states are still bringing them up. But they’re thinking that as health information exchange, the verb, as the most efficient way to operationalize this program and others like it that have quality measure reporting like CHIPRA (Children’s Health Insurance Program Reauthorization Act) or ACA (Affordable Care Act) or things related to payment policy that require the exchange of clinical data or administrative data. It’s the most efficient for care-coordination, for cost, for resources. Public health is looking at it, so it’s certainly created quite a spotlight on what HIEs can do to enable these programs and that is good news for HIEs because there are more business cases for them.
Q: Are states building HIEs on their own, aligning with NHIN (the National Health Information Network), or how do those fit together?
A: The part that I would say is that when Medicaid considered allowing states to use our administrative match to support health information exchange, whether it's infrastructure development or it's already available and its maintenance – and we will actually be issuing a state Medicaid director’s letter in the next couple weeks to explain this – we fully expect to see strategies adopted by states that align with the characteristics that ONC has given out as most achievable, so we’re working very closely with ONC to, when these proposals come in, to evaluate them. The states are sort of building from the ground up, so they build from local, then to regional, then to state, then to national. So it varies by state. It’s very hard to make a generalization. There are some states that have been working on HIEs way before HITECH and they’ve already got the local to regional to state piece done and they’re ready to move onto an NHIN model. Other states are in a much earlier phase, so we’re assessing what they’re trying to do, how they can use HIE to enable their programs in an effective way but also being very conscientious about what approaches and models they plan to adopt. And that’s what the letter’s going to address, the guidance we’re going to give to them.
Q: What are the untold EHR or HIE stories that federal or state health IT shops would do well to understand?
A: It’s actually embedded in the incentive programs itself. I’ve worked in state and federal health IT and I would say, and I think most people would agree with me, that the EHR incentive program and HITECH in general is one of the best examples of cross-federal collaboration that we’ve seen. It’s really unprecedented, the level of inter-agency discussion about policy alignment and maximizing resources and efficiencies, and being consistent with messaging. When you’re talking to federal health IT professionals we sometimes, and being one myself, we can sometimes seem quite skeptical of that. And at the state and the provider level they sometimes feel like we’re not coordinated, but I think if it’s not clear to anyone on the outside that this is really a very important milestone to how we coordinate federal health IT. We talk to IHS (Indian Health Service), to HRSA (Health Resource and Services Administration), to CDC, and of course with ONC almost daily. So that’s what’s making this work. It’s not just a nice artifice, it's actually key to what’s making it so successful so far. There’s still hope for the Beltway.
Q: One of the EHR topics garnering a lot of attention lately is usability, specifically that certification does not demand enough of vendors in terms of usability. Did anything come out of those early lessons that might factor into the usability discussion?
A: Obviously that’s not specific just to Medicaid, the question of usability. I think that our Medicaid and attestation numbers do indicate that Medicaid providers are adopting certified EHR systems and are interested in it. There’s always room for improvement and our focus later this year is going to be on moving that cohort of adopters into the meaningful use camp, which is where usability really comes into play, not so much once you’ve adopted it but once you actually have to show the degree to which you are able to use it meaningfully, and that will be easier or harder depending on usability. So we’re working very closely with ONC and at the state and local level and the regional extension centers are really trying to focus on usability and peer support among those who have adopted EHRs. That’s a good example of a topic that threads through multiple agencies where we’re having conversations about how to address it.
Q: And now, back to your GHIT11 session. Anything else you’ll be discussing?
A: We’ll be talking about where the states are. We want to talk at that session about what’s involved in that so they can understand the tremendous progress and work that’s happening because we are hearing about providers that are concerned that their states haven’t launched their EHR incentive program yet and they’re not quite sure how and when they will. And they have to make a choice in some cases between Medicare and Medicaid so we want to shed a little more light on what that process is and how CMS is ensuring that they can get up and running this calendar year.
[Editor’s note: GHIT11 takes place June 14-15, 2011, at the Renaissance Washington D.C. Hotel. Registration is open.]
