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Though it hasn't gotten as much attention, one of the biggest recipients of largesse from President Barack Obama's stimulus package is the health care information technology industry.

The bill requires utilization of electronic health care records for everyone in the U.S. by 2014, when only about 28 percent of health care providers use such systems now. The effort is intended to streamline health care records, reduce test duplication, and reduce errors. (Want to read it for yourself? Start on page 230.)

Health data exchanges, also known as health information exchanges (HIEs) and regional health information organizations (RHIOs), provide a standard way for computer systems used by hospitals, doctors, and insurance providers to exchange information, to help provide more complete information, reduce fraud, and reduce costs. They were called for in 2004 by President George W. Bush as components of a National Health Information Network that is intended to be complete by 2014.

But regions within states such as Indiana offered such services as long ago as 1994, and the state of Delaware said it was the first to offer such a service statewide, in March, 2007. As of a year ago, more than 150 regional efforts were underway, including the Inland Northwest RHIO in Washington and the Quality Health Network in western Colorado.

Obama's proposal, though, goes much further.

It includes:

  • Planning grants of up to 100 percent for entities that apply before 2010, with a stepdown function for later grants that pay a smaller proportion
  • Implementation grants, which can be used for health IT architecture, training for health care professionals, development of best practices methodologies, interoperability between different providers’ systems, and telemedicine
  • Incentive payments for Medicaid and Medicare providers, to encourage them to switch to electronic systems—such as $20,000 a year to buy new equipment and $10,000 a year to administer it (up to a cap) if done in the first five years, but with a disincentive of lower reimbursements after five years
  • A number of secondary effects, such as job creation for implementing all this, and requirements for broadband Internet to support it

Altogether, $19 billion is slated to be spent on such systems -- $20 million alone to the National Institute for Science and Technology to set up standards to make sure systems can exchange data.

However, there are a number of concerns about security and privacy with such a system, said political technology reporter Declan McCullagh. What if people don’t want their records stored electronically? There is the potential for commercialization of confidential medical information. Plus, what happens if someone breaks into to the database or information is lost, as with credit card records? There is now a notification requirement in the case of a data breach if the information is not encrypted--although, according to the definitions used, no notification is necessary is the unintentional disclosure was made “in good faith,” he reported.

It boils down to who owns the records, and on that the bill appears to be silent. Can insurance companies get access to records for marketing policies? Can researchers get access to records for finding pockets of disease? Can attorneys get access to records for lawsuits?

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