GE: "Get Your Share Of The EHR Stimulus!"

GE's stock isn't doing so well lately, much to the chagrin of those of us who own some:

GE's problems stem from a multitude of sources, some not even their fault, and for what it's worth, I'm not at all happy about any of it.

But, clever to the end, GE Healthcare IT has latched on to something that might help. Vishal Wanchoo, President and CEO of the IT division, sent a letter to physicians (I didn't get one myself, but I have my sources) telling us about the "opportunity" offered by the Economic Stimulus Plan (ESP).

The ESP promises to bring extraordinary change to a variety of business sectors, including healthcare, where billions of dollars have been pledged to develop and support information technology.

The ESP opens up many opportunities as it is designed to accelerate the delivery of information technology to improve performance and connectivity in healthcare, ultimately reducing costs and improving patient care. The bill, which strongly promotes electronic health records (EHRs), health information exchange, interoperability and quality, puts information at the center of driving real change in the industry. This focus is good news for healthcare, for you and your patients, and for us at GE Healthcare as it reinforces our combined vision.

Here's the critical part:

While there are many details yet to be resolved, the broader stimulus bill includes a package of approximately $31.2 billion for healthcare infrastructure and EHR investment, and this legislation is expected to impact providers and vendors quickly. The $31.2 billion is the gross investment that includes the Congressional Budget Office assumption that the program will save an estimated $12 billion from higher EHR adoption, resulting in a net cost to the federal government of $19.2 billion.

The investment will largely flow from Medicare and Medicaid incentives to physicians and hospitals for the "meaningful use" of certified EHRs, including those that currently have systems installed, as well as new installations or upgrades. With the incentives, non-hospital based physicians could receive up to $44,000 from Medicare or $64,000 from Medicaid (depending on the level of Medicaid patient volume) and hospitals with high Medicare and Medicaid volume and a large number of patient discharges could receive up to $11 million from both Medicare and Medicaid. These incentives will be paid out over a 4-5 year period, with initial eligibility starting in 2011.

And what does GE know about this? A lot. It seems they helped write some of the legislation!

GE Healthcare has had a number of team members dedicated to the ESP since November, working directly with government officials and legislators in Washington D.C. to shape the bill and champion for healthcare IT provisions. They will now shift their focus to tracking and guiding the implementation of this new law over the coming months. In addition, GE team members are actively engaged with the certifying and standards-setting bodies that may play a critical role in defining what is required in the EHR to enable provider organizations to take advantage of the ESP.

In other words, we know what's in it, so we'll help you (and us) profit from it.

The healthcare IT components of the bill are called the "HITECH Act," and the final text of the law can be found here. A quick search incidentally shows no mention of imaging as part of the EHR. Big omission in my book. Also, a sub-sub-sub-section of TITLE XXX--HEALTH INFORMATION TECHNOLOGY AND QUALITY creates an "HIT Policy Committee" consisting of:

‘‘(2) MEMBERSHIP.—The HIT Policy Committee shall be composed of members to be appointed as follows:
‘‘(A) 3 members shall be appointed by the Secretary,
1 of whom shall be appointed to represent the Department of Health and Human Services and 1 of whom shall be a public health official.
‘‘(B) 1 member shall be appointed by the majority leader of the Senate.
‘‘(C) 1 member shall be appointed by the minority leader of the Senate.
‘‘(D) 1 member shall be appointed by the Speaker of the House of Representatives.
‘‘(E) 1 member shall be appointed by the minority leader of the House of Representatives.
‘‘(F) Such other members as shall be appointed by the President as representatives of other relevant Federal agencies.
‘‘(G) 13 members shall be appointed by the Comptroller General of the United States of whom—
‘‘(i) 3 members shall advocates for patients or consumers;
‘‘(ii) 2 members shall represent health care providers, one of which shall be a physician;
‘‘(iii) 1 member shall be from a labor organization
representing health care workers;
‘‘(iv) 1 member shall have expertise in health information privacy and security;
‘‘(v) 1 member shall have expertise in improving the health of vulnerable populations;
‘‘(vi) 1 member shall be from the research community;
‘‘(vii) 1 member shall represent health plans or other third-party payers;
‘‘(viii) 1 member shall represent information technology vendors;
‘‘(ix) 1 member shall represent purchasers or employers; and
‘‘(x) 1 member shall have expertise in health care quality measurement and reporting.

Gotta love the insertion of a union member, and the opportunity for the President to add in folks from other agencies, thus stacking the deck. I'll volunteer to be the physician member. Fat chance of that. Have fun reading the rest of the document. It's no surprise that lawyer-lawmakers create these huge, bloated, picayune multi-hundred page extravaganzas that are full of. . . legalese!

GE has been kind enough to provide the Cliff Notes for the HITECH Act. HIMSS has its own IT-pablumized version.

Typical of a governmental program, the pricetag is listed as $19.2 billion. In truth, the project will cost $31.2 billion, but since the Congressional Budget Office assumes a $12 billion savings over 10 years, we go with the difference. I wish I could work my finances that way. . . Honey. . . I'm going to buy this nice Ferrari. . . Oh well. . .

So what do we get for our $31.2 billion $19.2 billion? GE says:

The goals of the legislation are to create and expand the current U.S. healthcare IT infrastructure, promote
electronic data exchange, and substantially and rapidly increase EHR adoption to 90 percent for physicians
and 70 percent for hospitals by 2019. Initial spending will begin in 2009 and is projected to increase
considerably in 2010 and 2011. . .

In addition, the federal government projects that it will spend a net amount of $17.2 billion for Medicare
and Medicaid incentives that will be available to providers (physicians and hospitals) meeting specified
criteria (See Questions 5 and 6). The actual incentive dollars available through this program are
approximately $29.2 billion, as the $17.2 figure is net of estimated federal program savings from increased
EHR adoption.

Again with the deceptive numbers, but that's how your government works. To get the goodies, I mean incentives, physicians have to apply for the prize from either Medicare or Medicaid, but not both, and they have to demonstrate "meaningful use" More on that shortly. Hospitals, on the other hand, can get something from both programs if they use EHR meaningfully.

The dough is doled out yearly for five years. For docs, the scale slides like so:

And this is for the hospitals:

Notice the significant reward for early adoption.

We are all of course interested in getting our incentives using EHR meaningfully. Here is GE's synopsis of a "qualified EHR":

• Inclusion of patient demographic and clinical health information, such as medical history and
  problem lists
• The capacity to provide clinical decision support
• Support for physician order entry
• The ability to capture and query information relevant to healthcare quality
• Electronic health information exchange capabilities, including the ability to integrate such information from other sources into the EHR

Using all this in a "meaningful manner" entails:

• Use of electronic prescribing;
• Electronic exchange of health information, such as with health information exchange (HIE); and
• Quality reporting

As to what that all might translate to in the real world, David Harlow notes in HealthBlawg (Health Care Law Blog):

What does "meaningful use" of EHRs mean? Providers engaged in "meaningful use" of EHRs are eligible for the stimulus incentive payments. The term will have to be defined in regulations. John Glaser expressed the hope that "meaningful use" is defined so as to include a requirement of communicating aggregated patient data to enable further development of evidence-based medicine, one of the key justifications that has been offered for computerizing medical records.

Evidence-based medicine, eh? In other words, this is the method the yet-to-be-created National Health Plan will use to spy on us monitor us be sure we are good docs. Nice.

One cannot, of course, use just any EHR; you must use a system that is "Certified" by the HIT Standards Committee. Centricity EMR naturally will be fulfill these requirements, although we don't know what they are yet. Centricity EHR does meet CCHIT and ONC-recognized standards.

GE claims to have had a significant role in the design of HITECH:

GE drew on its extensive background in healthcare IT products, policy, and standards to formulate policy positions focused on achieving high levels of EHR adoption, a continued public/private approach to standards and certification, and appropriate security and privacy provisions.

GE government relations leaders were engaged actively in providing information and advocacy perspectives throughout the congressional consideration of the groundbreaking legislation, directly and through industry organizations. In addition, GE interacted with the Obama Administration’s Transition Team and the Obama Administration as the provision was crafted and enacted into law.

As members of the Electronic Record Health Association (EHRA), a team of GE Healthcare government relations experts have participated in ongoing policy deliberations, partnering with other industry members to present recommendations and advocate as work on the stimulus package progressed, right up until its final passage.

In addition, GE team members are actively engaged with the certifying and standards-setting bodies that may play a critical role in defining what is required in the EHR to enable provider organizations to take advantage of the HITECH Act incentives.

The list of GE participants in this process is rather long, but at the Federal level we have:

Health Information Technology & Standards Panel (HITSP)
– Board Member, 3 Co-Chairs
Certification Committee for Healthcare Information Technology (CCHIT)
– 2 Members, 3 Workgroup Members
National Health Information Network (NHIN)
– 3 NHIN Phase 1 Projects

I don't know...should we have a problem with a vendor setting the governmental standards that will be used to regulate said vendor's product? To be fair, nowhere does it say that you are guaranteed to get your incentives if you use Centricity, nor does it say you won't if you use Brand X. Perhaps the unwary could assume something like that.... But Centricity EHR users should take great comfort in the fact that GE not only aims to follow the rules, it has been involved in making them. As always, bringing good things to life.