New directions for federal and state health IT funding, health IT workforce needs, and the difficulties that states face with the economy, were addressed during the Institute for e-Health Policy Congressional Luncheon Seminar held on February 25th.
Neal Neuberger, Executive Director for the Institute for e-Health Policy, told the attendees that in the last 18 years, approximately 140 individual lunch briefings and yearly demonstrations were held on Capitol Hill. These informative sessions throughout the years have brought healthcare leaders together to discuss not only the importance of telemedicine, eHealth, and health information technology, but the speakers have also presented possible solutions to help resolve critical issues in the health technology field.
The first speaker, Representative Tim Murphy (R-PA) not only serves in Congress, but he is also a clinical psychologist. He mentioned that with the number of Senators and Representatives working in Congress with healthcare backgrounds, he is surprised that they weren’t sitting at the table during the Health Care Summit held at the Blair House on the 25th to give their valuable insight and thoughts concerning healthcare and medicine.
He also said that while trillions of dollars are being spent on healthcare, dollars are still wasted. This results not so much from fraud but from the fact that doctors are paid for procedures which may or may not be necessary and adds to treatment costs.
To summarize HHS activities to help in the adoption of EMRs, David Hunt, M.D, Medical Officer, HHS Office of the National Coordinator for HIT, reported that only 43.9 percent of office-based physicians use an EMR/EHR system. He feels that this percentage using the systems is nothing to celebrate.
Dr. Hunt discussed the steps needed to implement HIT. The foundation is based on policies, principles, procedures, and enforcement. Next, the system needs to be usable, functional, reliable, and interoperable, with the next stage requiring financial and non financial incentives. At this point, physicians need to adopt and implement the system, and lastly, the system needs to help the public by delivering information through HIEs.
Several HHS programs are now ongoing to help strengthen HIT infrastructure and assist physicians and others adopt EMRs. Adoption by physicians is going to be made easier by having access to the resources of the Regional Extension Centers underway. Several other programs include the Beacon Community Cooperative Agreement Program to provide grants for communities to use to strengthen the HIT infrastructure, the Strategic Health IT (SHARP) Program to fund research and address the problems that have impeded the adoption of HIT, and the State Health Information Exchange Cooperative Agreements to advance secure HIEs across the healthcare system.
Labor Secretary Hilda Solis recently announced that $227 million will be used to train 15,000 people in the job skills needed in the healthcare IT and other high growth fields. Gerri Fiala, Deputy Assistant Secretary for Employment and Training, at the Department of Labor (DOL), discussed the future and programs coming or now in place that affect the present day health technology workforce.
The Bureau of Labor Statistics predicts that the Health Information Management workforce will continue to grow and that by 2016 there will be a need for 200,000 medical records technicians, and for the decade ending in 2016, 76,000 new technician jobs will open up.
She explained that the Public Workforce System is working with DOL to provide administrative oversight along with demonstration grants, research, and policy guidance. In addition, state and local workforce investment boards are developing strategic plans and setting funding priorities, while the local one-stop career centers are delivering services to workers and employers.
One of the most important goals is to provide critically needed training. She explained that DOL has an effective grant program called the “Community-Based Job Training Initiative (CBJT)”. This program provides competitive grant awards to community colleges and community-based organizations and so far, 108 healthcare grants have been awarded through CBJT. In other programs, another eleven grants totaling more than $46 million will be used train additional workers for careers in HIT.
In addition to training programs, the DOL Office of Apprenticeship is working with employers to develop apprenticeship programs for 40 healthcare occupations to include such positions as Information Assurance Specialist, IT Project Manager, and IT Generalist.
Since there will be a tremendous need for nurses, allied health professionals, and health IT professionals, DOL would like to see a Health Care Training Initiative that could potentially make $100 million available for competitive grants.
Ree Sailors, Program Director for Health IT, Center for Best Practices, National Governors Association, wants to see more collaboration among states and the federal government. She was very pleased that at the recent Governors meeting held this winter, one session was on healthcare and many of the governors expressed hope for quality improvement, transparency, avoidance of unnecessary testing, and better coordination for the chronically ill.
Right now, the states are preparing or updating their state roadmaps, engaging stakeholders to develop new ideas, establishing leadership offices, and determining the state HIE business model.
According to Sailors, what really worries the states today is that state revenues are down by 17 percent from this time last year during the present budget cycle. There are estimates that the deficit in the next three years will be $250 plus billion dollars.
Sailors went on to explain that usually recovery at the state level lags behind the country as a whole by an additional year or more and this means that Medicaid expenditures continue to go up. Also, concerns about the economy are forcing, some states to cut educational expenses, release prisoners early, and cut back on optional services. Many states are operating during this critical and stressful time with a reduction in the workforce but unfortunately, at the same time, the state’s work load increases.
As Sailors emphasized, coordination across state agencies and with the private sector is vital, but now the states need to coordinate their activities with the federal programs resulting from the influx of funding. This means that coordination is not just a state level challenge in terms of HIEs, but also means that the states need to work with federal agencies on state grants, NHIN, Medicaid assistance, and on state and regional demonstration programs.
To add to state priorities, there is the need to build up broadband and continue to develop workforce educational efforts. As she recapped, states are excellent partners and have specialized insight, but today it is really a difficult and changing environment for the states to have to operate in.
There is an enormous need for education not only today but also down the road, according to Dan Rode, Vice President of Policy and Government Relations, American Health Information Management Association. The stimulus funding will last a few years, but the need for a more educated workforce will go on for years.
“The new six month education and training programs in health IT are not always ideal. The country and the deans of colleges and universities need to look at longer and deeper educational programs. It is difficult to convince the deans in these financially difficult times to enhance their health IT programs, so part of the answer is to build professional educational programs and provide for more educational partnerships”, said Rode.
He pointed out that AHIMA and AMIA have worked on several projects together and have developed core competencies needed for the health workforce. These projects will help the workforce implement and support health technology tools and move the industry toward an electronic future.
Other grant programs include the “Curriculum Development Centers Program” to provide grants to institutions of higher education to support HIT curriculum development, and the “Community College Consortia to Educate HIT Professionals” program promises to rapidly expand existing HIT academic programs at Community Colleges.
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