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The government's financial incentive is probably enough to convince providers who would have adopted HIT in three to five years to start adopting now, Mueller says, but it's not enough to bring those most reluctant providers. "You have to put a huge pile of cash on the table to get someone to dramatically change behavior," he says. "A modest amount can get someone who was thinking about it to do it."

Most providers are probably hoping to be deemed meaningful users prior to getting dinged by penalties rather than in time for reimbursement, says Overhage. "A lot of people will be in jeopardy of being penalized, because this is hard stuff to do." The healthcare industry should keep its eye on the ultimate goal of the legislation, which according to many industry experts is to reduce costs and improve efficiency, safety, and quality of care, not simply to put technology in place. Providers have to be committed to fulfilling the intent and not just the letter of the law, says Overhage.

Long-term gain
The stimulus package has the potential to improve quality of care by giving providers access to patient data at the right time and place with health information exchanges. It can also help drive efficiency by eliminating duplicative diagnostic or lab tests and offering providers access to decision support software.

But there is a real concern that the money will not be used in the most effective way. "We don't have the cookbook yet," says Overhage, adding that there are going to be thousands of hospitals and doctors trying to do the right thing quickly and still secure their share of the funds. "I don't know if we are as good at spending the government's money as effectively as our own money," he says.

The Health Information Technology for Economic and Clinical Health Act can be incredibly daunting—especially if you are a small isolated facility, says Mueller.

The Congressional Budget Office estimates that only 50% of the nation's nearly 1,300 critical-access hospitals will reach the "meaningful user" designation by 2019—four years after providers start incurring penalties. Roughly 2,000 of the nation's 5,700 hospitals are rural community hospitals and approximately 25% of the nation's population lives in rural areas. That is why it is critical for regional and state organizations to help engage rural community providers and close the gaps for things like statewide health information exchanges, says Mueller. "If we target the funds, state by state, with that kind of priority in mind, we should actually close the gap rather than widen it."

Publicly supported technical assistance centers should be targeted at the providers that are cash poor and unable to buy consultants, as well. Rural hospitals and clinics do not have extensive IT departments; they are going to need high levels of technical assistance. Yet rural healthcare was not mentioned as a target group and critical access hospitals and rural health clinics were not mentioned specifically in the request for proposal for HIT regional extension centers, says Morgan. "This is not an oversight; this is a path forward without rural."

Carrie Vaughan

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