The Obama Administration has made eHealth deployment a prioritized issue and through American Recovery and Reinvestment Act (ARRA) of 2009, approximately $ 19 billion was made available for spending in Healthcare IT infrastrucure.$ 17 billion were earmarked for incentive payments for the use of Electronic Health Records (EHRs); this program is now starting to take shape.
In the US, recent eHealth developments are dominated by the HHS’s Interim Final Rule (IFR) for Initial Set of Standards, Implementation Specifications and Certification Criteria for EHR Technology which was published in December 2009. The IFR is a product of the HITECH Stimulus Act which entails qualified physicians getting reimbursed for the implementation of certified EHR systems, so-called “meaningful EHR use” defined in a Notice of Proposed Rule Making (NPRM).
The IFR proposes adoption of standards for Healthcare IT and essentially works as a guidebook for developers and vendors who want to be eligible for compliance with the “meaningful use” definition. Among the promoted standards are e.g. HL7, SNOMED CT and LOINC.
The standards adopted in the IFR cover four main areas: Vocabulary- promotes the creation of a common language and codes to be applied in clinical problems and procedures; Content Exchange- setting guidelines to be followed when sharing information; Transport- for systems and processes which will transport information between healthcare systems; Privacy and Security- authentication and transmission security for safe handling of patient information.
Reactions to the NPRM and IFR have been generally positive. For instance, David C Kibbe of the Health Care Blog expresses his belief that the suggested blueprints for EHR technology from the IFR are what will revolutionize the marketplace. Kibbe welcomes the fact that the IFR creates a new software core for “EHR technology”, a core founded on support and quality rather than charge maximization. Further, he welcomes the introduction of EHR Modules, which are thought to ensure a sort of plug-and-play implementation of components from different vendors.
All in all, the IFR offers manufacturers a certain degree of innovational freedom, even if some main boundaries are drawn. It should also be noted that the HHS recognizes the need for standardization to be iterative and open for adoption of new standards when the need of such arises.
Hopefully the NPRM and IFR can provide clear guidelines for the future development of eHealth standards and speed up the implementation of EHR technology. Economic incentives such as those specified in the HITECH Act are usually a way good way to set the most grinding wheels in motion. But this is an ongoing process and subsequent rules and guidelines in coming years will need to continue to actively support eHealth standardization and implementation.
