Provisions of the HITECH Act hold promise to increase use of health information technology and improve the quality and efficiency of care, but big challenges remain to reach that promise, according to a new report.

The health care division of New York law firm Manatt, Phelps & Phillips interviewed 24 industry experts representing hospitals, group practices, delivery systems, government agencies, employers, community health centers, quality improvement organizations, and consumer and privacy advocates. The resulting report, "HITECH Revisited," looks at the progress and challenges so far to adopt the law's provisions, and mid-course corrections that are needed. Recommendations include:

* The Centers for Medicare and Medicaid Services should revise proposed meaningful use criteria to make them more achievable, particularly for small and rural practices and community health centers.

* CMS should release a full meaningful use roadmap by the end of 2010 and adopt an incremental approach to achievement over a longer time period.

* CMS should directly tie meaningful use to participation in state health information networks.

* Meaningful use criteria should strongly encourage providers to use robust clinical decision support at the point of care.

* CMS should abandon its proposal to deem a hospital that is a meaningful user under the Medicare incentive program to also be eligible for Medicaid incentives. This would enable state-specific, but CMS-approved, meaningful use objectives.

* Congress should make excluded providers, such as long-term care and behavioral health, eligible for meaningful use incentives, or authorize separate funding for excluded providers to adopt and use EHRs.

* The Office of the National Coordinator should closely monitor the effectiveness of regional extension centers and develop alternative approaches if sustainability or operational challenges exist.

* Congress and CMS should implement policies affecting insurers that encourage providers to organize into systems of care that delivery high performance through use of health I.T.

The full, free report is available at

--Joseph Goedert


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