This blog post comes to us from ACC Informatics Committee Co-Chair Michael Mirro, M.D., F.A.C.C. Dr. Mirro is medical director of the Clinical Research Center at Parkview Hospital in Fort Wayne, Ind., and is a clinical professor of medicine at Indiana University School of Medicine. As co-chair of the Informatics Committee, Dr. Mirro leads the way in coordinating the health information technology activities and policies of the College.

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The year 2009 will potentially bring a significant movement in the implementation of health information technology (health IT) into clinical practices. The Obama administration has indicated the intent to invest $50 billion in health IT over five years. Meanwhile, the CMS e-prescribing initiative that started Jan. 1 represents the first tangible incentive program for health IT use.  

The adoption of health IT to improve the U.S. health care system is central; health IT can improve safety and convenience, and save valuable time and money.  Substantial bipartisan support has built over the past two years to support a national agenda to accelerate integration of health IT into physician practices.  The role of the federal government in health IT is significant, and currently includes the following:

1. Development of health IT standards
2. Assisting in EHR vendor certification
3. Developing financial incentives for health IT adoption
4. Developing pilot programs in data storage and data exchange

Of the recent activities to accelerate health IT adoption, the CMS e-prescribing initiative will likely have the greatest impact. The current adoption of health IT has been slow (13% of practices) due to the lack of clear return on investment; fear of lack of functionality that slows the patient encounter process; uncertain security standards; and doubt that EHR systems will interface for proper information exchange (interoperability). 

The development of e-prescribing incentives by CMS will clearly move the needle for health IT.  Currently, as of 2007, only 2% of the 1.5 billion eligible prescriptions are electronically prescribed.  The current incentives that are in place include a 2 percent payment bonus for 2009-2010 if physician practices use a qualified e-prescribing system., which is then reduced to 1 percent in 2011 and 2012, and 0.5 percent in 2013. A 2.0 percent penalty will occur in 2014. The goal of this program has been to utilize the Medicare payment system as an initial model of introducing health IT in a limited fashion into clinical practices.

The ACC will be carefully monitoring member experiences with the program. Numerous potential administrative issues may arise, just as was observed with the Physician Quality Reporting Initiative program. This modest investment by the federal government will help -- but will not support long-term -- health IT system implementation. Robust health IT requires an investment up to $25,000 to $45,000 per physician just to "plug into the system" and annual maintenance costs of about 12 to 20 percent of initial costs, according to CBO. Meanwhile, physicians are under increasing reimbursement cuts from Congress and others and must deal with more administrative burden than ever.

The ACC supports the federal agenda and has attempted to prepare its members for health system transformation. As part of this, the ACC has established a health informatics committee with participation by members in many activities related to health IT interoperability, standards harmonization and the development of electronic health record adoption tools.

In addition, the ACC has been aggressively supporting other physician payment incentive programs. One example of this is the ACC outpatient quality improvement program, IC3, which if implemented electronically could ultimately provide robust in-office quality improvement with measureable reductions in health expenditures.

More about ACC’s commitment to health IT can be found at http://www.acc.org/healthIT. 

My question to readers: Do you want to leave money on the table from Medicare Part B by not participating in the program? If you participate in the e-Prescribing program, then give the ACC feedback on implementation and Vendor use by commenting below.

- By Michael Mirro, M.D., F.A.C.C., Co-Chair of the ACC Informatics Committee

* Dr. Mirro's post is the third in a new monthly series of guest posts by ACC leadership. Check back next month to see which ACC leader is sharing his or her thoughts on health care reform!