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The HIT Realist Column

States to Obama: Give Us That HITECH Grant Money!

July, 2009

On 2/16/09 the HITECH Act became law, providing $19.2 billion for the purpose of stimulating the uptake and use of health information technology (HIT). Approximately $2 billion will be spent on states to allow them to invest in an HIT infrastructure, and in particular, for the development of Regional Health Information Organizations (RHIOs) and health information exchanges (HIEs) both of which in the past have resulted in failure. Now many states are seeing the HITECH money as an opportunity to aggressively promote HIT to improve the future of healthcare through the use of certified electronic health records (c-EHR) and through these exchanges.1

            The 6 states discussed below have vastly different plans for promoting HIT, from the aggressive to the sublime.

Massachusetts (MA)

Since 2004, MA has become a national leader in implementing HIT. On 8/10/2008 SB 2863 set the groundwork for further state led HIT initiatives, including the establishment of the e-Health Institute to oversee state HIT activities and adoption, including the deployment of c-EHR systems networked through a statewide HIE.

A recent 6/2008 survey to test how much HIT uptake has been impacted after 4 years of massive HIT funding questioned 18,282 physicians. Roughly 36% use all “basic” c-EHR capabilities, which is about twice what is seen nationally. In MA 20% of prescriptions are sent electronically (eRx), which is the highest level of eRx use in the country. 2 Unfortunately only 5% of MA physicians “significant use” advanced capabilities, which is just 1% higher than what is found nationally. 3,4,5

Arizona (AZ)

            The uptake of EMR technology throughout Arizona has been credited to a 2005 executive order by then-Gov. Janet Napolitano that all healthcare providers install EMRs by 2010. A recent report has stated that there is a marked increase in physicians who are canceling their EMR contracts and deinstalling their expensive c-EHR software systems. This is especially prevalent among smaller physician groups. 6 Deinstallations and failed installations will be among the biggest factors which will keep a national HIE from becoming a reality.

New Jersey (NJ)

On 1/8/2008 NJ passed the A. 4044 bill that made it the first state to mandate a move toward c-EHR. On 5/11/2009 another bill was proposed which would make it illegal to sell or otherwise distribute a non-CCHIT c-EMR in the state of NJ, applying penalties of up to $5,000.

It seems that its main sponsor, Dr. Conaway, has numerous financial ties with several lobbying groups, including HIMSS, as documented in his financial disclosures. The idea of manipulating competition as a quid pro quo by making the sale of a non-c-EHR system illegal is bad policy. 7,8

Maryland (MD)

On 5/19/09 HB 706 was signed into law, mandating that all commercial state-regulated health insurance payers (not just Medicare/Medicaid) need to provide monetary incentives to health care providers to adopt and use an c-EHR. This law is meant to bolster the state's efforts to create a HIE by 10/2009.

With this bill the state is trying to cut off all physician choice concerning HIT by making a practitioner subject to a host of penalties from all insurers if he doesn’t use a c-EHR. 9,10,11

Louisiana (LA)

On 8/2007 the Health Resources and Services Administration (HRSA) announced $31.4 million in grants to promote the growth of HIT in 4 communities, including LA. Unfortunately by 12/2008 only half the applications for the 100 available $58,000 grants had been submitted.

The failure of this program may be the forerunner of what will occur with the HITECH Act and indicates that physicians just can’t afford HIT, don’t want the extra electronic paperwork, don’t want the disruption in workflow caused by eRx and CPOE, and don’t want to learn and use complex c-EHRs. 12,13,14,15

New Mexico (NM)

            On 3/23/2009 SB 278 (the “EMR Act”) was signed into law, encourageing more EMR use as well as to provide for patient confidentiality. It established an EMR as the legal equivalent of an existing paper record.

            The NM Department of Health also has helped 122 providers in 36 communities set up an EMR system in their practice. The program remains optional for providers and does not set any penalties for nonparticipation. 16 Thumbs up to NM for writing appropriate, prudent HIT law!


            Several states are trying to aggressively promote HIT, even though c-EHR systems have only been adopted by 17% of physicians, with only 4% of physicians “significantly using” them. Those legislators rushing HIT bills need to slow down, they need to show due diligence in learning the nature and history of EMR, and they should consider the overall impact of HIT within the fiscal constraints of a recession. They should stay clear of improper lobbyist influence and associations with companies that will ultimately benefit from HIT legislation. The growth of HIT will evolve slowly; it can’t be rushed with poorly written laws.

Al Borges MD


  1. http://www.state.nj.us/recovery/infrastructure/hit.html
  2. http://www.histalkpractice.com/2009/06/24/news-062509/ 
  3. http://www.masstech.org/ehealth/news/clip_01_20_05.html
  4. http://www.himss.org/advocacy/d/MassInclusion_HIT.pdf
  5. http://tiny.cc/D4PY4
  6. http://tiny.cc/DPs6z
  7. http://www.emrupdate.com/forums/t/19877.aspx
  8. http://ehrdecisions.com/  
  9. http://www.emrupdate.com/forums/p/20045/98969.aspx
  10. http://tiny.cc/PFZW9
  11. http://www.kaisernetwork.org/daily_reports/rep_index.cfm?hint=3&DR_ID=58573
  12. http://www.dhh.louisiana.gov/offices/?ID=156
  13. http://www.emrupdate.com/forums/p/17697/92147.aspx#92147
  14. http://histalk2.com/2008/12/10/readers-write-121108/ 
  15. http://ehrdecisions.com/incentive-programs/louisiana/ 
  16. http://tiny.cc/DExt2

 Alberto Borges, MD
Alberto Borges, MD, is in private practice and is an assistant clinical professor of medicine at The George Washington University School of Medicine and Health Sciences in Washington, DC. Check out his website at http://msofficeemrproject.com. The opinions expressed in this blog do not necessarily reflect those of HCPLive. If you like what Dr. Borges has to say, make sure to read his print column of The HIT Realist published in MDNG.



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