Health information technology: successes, challenges, next steps | AccountingWEB

Health information technology: successes, challenges, next steps

Massachusetts Governor Patrick's conference on health information technology, entitled "Improving Health Care and the Economy", began yesterday in Worcester, MA.  Dr. Blumenthal kicked off the conference citing achievements at the federal level and congratulating Massachusetts for being the first state to attain provider targets.

A down payment on health care reform

Quoting President Obama, Dr. Blumenthal told an audience of several hundred that health information technology, while important, is just the down payment on health care reform.  More important, he said are the aspirations of change we plan to achieve as a country.

HITECH anticipates and addresses barriers to reform

In his talk, Dr. Blumenthal noted that in addition to seeking change, the law also anticipates and addresses barriers to reform including financial and market barriers to technology adoption.   These hurdles  include the current absence of incentives to improve the quality of health care, the lack of incentives to adopt technology, and concerns about what technology to adopt and how to deal with productivity losses during the transition.

During the question and answer period, Dr. Blumenthal said that the standards that were developed in 2010 lay a strong foundation for the future.  Nevertheless, we will need to do more in the next round.  He also said that HITECH didn't cover the continuum of care because there was so much to address relative to acute care.

MA leads the way

Next up was Governor Patrick.  He announced that Massachusetts had succeeded in covering 98% of the population with just a 1% increase in state spending.  He then spoke about the importance of the health care sector to the Massachusetts economy, the prominence of Massachusetts organizations in various segments of the health care industry, and the extent to which Massachusetts institutions were leading the way in health information technology adoption.

He noted that cost remains a significant challenge-and one we must address to maintain universal coverage.  He advocated for doing so through better integration of programs and data.

Innovation Center will change the world

The next speaker, Dr. Sachin Jain, focused on the administration's commitment to health care innovation.  He said that the stimulus money leveled the HIT playing field, the Affordable Care Act improved access to care, and that the new Medicare and Medicaid Innovation Center will change the world.  Funded with $10 billion every ten years, it's goal is to identify new models for payment and care-and then diffuse them through the system.

The 7 doors of innovation

Dr. Jain then outlined the "7 doors of innovation."  These include RFPs, fast track pilots to modernize Medicare and remove policies that harm patients, requests for citizen input in problem identification and priority setting, sole source contracting, prizes and challenges, fast track for ideas that are already supported by evidence, rapid testing of new models of cares.

He said that one of the goals of the Innovation Center is to find models that work.  They will test various models since "one size will not fit all".

Dr. Jain invited the audience to submit their ideas.  In response to an audience question, he said that while priority may be given to coalitions that propose testing across multiple geographies, that doesn't preclude smaller tests for more targeted innovations.

Through the eyes of various stakeholders

The last session, yesterday, featured a panel that addressed the impact of health information on clinicians, patients, and the economy.  In his introductory remarks, Dr. John Halamka discussed some of the challenges associated with creating a health information exchange.  Examples ranged from the difficulties of uniquely identifying patients, to mismatches in vocabulary across the care continuum, to the problems with building quality measures by consensus.

Dr. Halamka also speculated that the deadlines for meaningful use will be extended to allow more time for vendors to develop software and providers to install and test it.  He predicted, that in the meantime, there would be an intermediary step where the government would require providers to achieve more aggressive goals for the technology executed in the first stage of meaningful use.

Physician perspective

Three of the four panelists were physicians.  Dr. Alice Coombs, representing physicians, discussed the steep costs associated with technology adoption in terms of finances, time, and reputation (until we get risk-adjustment right).

Vendor perspective

Dr. Bell, representing the vendors pointed out that the current EHR systems provide basic federal compliance saying that "everything else" is yet to come.  Her talk focused on some of the shortcomings of the current systems, the implications of these gaps, and the order in which vendors were addressing them.  Examples of shortcomings include the dearth of clinical decision support, the lack of assurances that multiple providers could simultaneously access systems, the absence of guarantees that functions would work together, data portability in the event of a bankrupt vendor, and the bias toward primary care physicians (rather than specialists or the rest of the clinical team).

Hospital perspective

Lynn Nicholas, representing hospitals, also talked about some of the cost considerations-both financial and in terms of eventual job loss.  She said Massachusetts hospitals face unique financial challenges because their facilities are older and therefore their net capital falls below the national average.

Consumer perspective

Dr. Charlotte Yeh, now Chief Medical Officer at AARP, said that her current role has given her a new appreciation of the consumer perspective.  She noted that professionals and patients have very different ideas of health care quality.  Whereas the professionals look at clinical measures, patients are more concerned with the quality of their lives.

Day 2: Workshops

Today, conference attendees, had the option of attending four workshops such as the ones I attended on Payment Reform, Secondary Uses of Data, and Telemedicine.  Each of these included a 15 minute talk by an expert followed by a half hour discussion.

Payment reform

Sarah Iselin of the Blue Cross and Blue Shield Foundation described some of the thinking behind Payment Reform, how it will differ  from capitation (e.g. providers don't take on actuarial risk, pay for adherence to quality measures, longer transition period), and the extent to which various factors drive cost.  Her talk was followed by a spirited discussion that examined payment reform from the perspective of each of the major stakeholders.

Secondary uses of data

Jo Porter, Deputy Director, NH Institute for Health Policy and Practice, provided examples of reports that New Hampshire, Vermont, and Maine have used their "all payer" databases to report.  The ensuing discussion included concerns about the privacy of patient data and a deeper dive into the relative strengths and weaknesses of data from various sources (all payer, discharge, government).


Joe Kvedar, MD, Director, Center for Connected Health at Partners Healthcare described how telemedicine could help bridge the gap between supply and demand for health care providers.   He then provided compelling examples of how telemedicine had improved health care access, quality, and efficiency for various conditions.  A lot of the discussion centered on barriers to use.  One of the topics was the difficulty of motivating patients to care for their own health.

All in all, it was an informative two day session.  One of the major conclusions that I drew after hearing all the speakers is that the devil will be in the details.

Read about how BB Marketing Plus has helped clients with the detail of their health care projects.

This blog

by Barbara Bix - In tough economic times, more and more clients are looking to their accountants to help them improve the bottom line. Often, the best way to do that is to start with the top line-since one can only decrease expenses so far. This blog discusses concrete actions you and your business-to-business clients can use to accelerate revenues.

More from this blog

Bloggers crew

Steve Knowles has spent 25 years in business and practice in the UK, but he also worked in the states and the years haven't dulled his way of seeing an alternative view to everyone else, and every day is a new adventure.


Joel M. Ungar, CPA is a lifelong resident of the Detroit area and a graduate of The University of Michigan. He is a principal with Silberstein Ungar, PLLC, a Top 15 auditor of SEC public reporting companies.


Allan Boress, CPA, with over 25 years as a practitioner and consultant to the accounting profession. Mr. Boress is the author of 12 published books in 6 different languages, including a best-seller, The "I-Hate-Selling" Book.


Larry Perry, CPA, CPA Firm Support Services, LLC, is the author of accounting and auditing manuals, author and presenter of live staff training seminars, and author of webcast and self-study CPE programs. He blogs about small audits, reviews, and compilations.

Sandra Wiley, COO and Shareholder, is ranked by Accounting Today as one of the 100 Most Influential People in Accounting as a result of her prominent role as an industry expert on HR and training as well as influence as a management and planning consultant. She is also a founding member of The CPA Consultant's Alliance. Sandra is a certified Kolbe™ trainer who advises firms on building balanced teams, managing employee conflict and hiring staff.

Maria Calabrese, CIR, Human Resources manager for Fazio, Mannuzza, Roche, Tankel, LaPilusa, LLC in Cranford, New Jersey, Maria's topics revolve around the world of: Mentoring, Performance management, and The "Y Generation," a.k.a. "The whY generation".


William Brighenti is a CPA, Certified QuickBooks ProAdvisor, and Certified [Business] Valuation Analyst, operating an accounting, tax, and QuickBooks consulting firm in Hartford, Connecticut, Accountants CPA Hartford.


Ken Garen, CPA, is the co-founder and President of Universal Business Computing Company (, a software development firm of high-volume, high-productivity accounting and payroll technology.


Eva Rosenberg, MBA, EA, is the publisher of, and author of the weekly syndicated Ask TaxMama column. She provides answers to tax questions from taxpayers and tax professionals worldwide.


Amy Vetter, CPA, CITP is the CPA Programs Leader for Intacct Corporation responsible for leading the CPA/BPO Partners nationally.

Brian Strahle is the owner of LEVERAGE SALT, LLC where he provides state and local tax technical services to accounting firms, law firms and tax research organizations across the United States. He also writes a weekly column in Tax Analysts State tax Notes entitled, "The SALT Effect." For more info, visit his website:
Scott H. Cytron, ABC, is president of Cytron and Company, known for helping companies and organizations improve their bottom line through a hybrid of strategic public relations, communications, marketing programs and top-notch client service. An accredited consultant, Scott works with companies, organizations and individuals in professional services (accounting, finance, medical, legal, engineering), high-tech and B2B/B2C product/service sales.

Rita Keller is a nationally known CPA firm management consultant, speaker, author, mentor and blogger. She has over 30 years hands-on experience in CPA firm management, marketing, technology and administrative operations.

Stacy Kildal is the mom of two fantastic kids, an Advanced Certified QuickBooks ProAdvisor, Certified Enterprise Solutions ProAdvisor, Sleeter Group Certified Consultant, a nationally recognized member of the Intuit Trainer and Writer Network, and co-host of RadioFree QuickBooks.
Michael Alter's blog specializes in providing practical advice to those who seek greater profitability and practice management tactics that enhance deeper client relationships.

Sally Glick, CMO, Principal, Marketer of the Year in 2003 and AAM Hall of Famer in 2007, leads a lively discussion of the constantly expanding roles of marketing and the professional marketers that drive this initiative in accounting firms of all sizes.


The IMA Young Professionals Blog features the insights of IMA’s Young Professionals Committee. Committee members share advice and experiences on careers, continuing education, work/life balance, and other issues affecting young accounting and finance professionals.


FEI Financial Reporting Blog provides highlights from SEC, PCAOB, FASB, IASB, and other regulatory news, including reporting under Sarbanes-Oxley Sect 404. It is written by Edith Orenstein, Director of Technical Policy Analysis at FEI.


Sue Anderson has 30 years of experience in continuing education for accountants. Currently she is the program director for online CPE provider CPE Link.


Jim Fahey is COO of Apple Growth Partners, a regional CPA firm in Ohio. His focus is on the effective and efficient use of technology within the firm by all team members.

Caleb Newquist is the Editor-in-Chief of Sift Media US, overseeing content for both AccountingWEB and Going Concern.

Leita Hart-Fanta, CPA, CGFM, and CGAP is the author of "The Yellow Book Interpreted" and owner of a website devoted to training for governmental auditors.


AccountingWEB is more than just a U.S. team of journalists and financial and technology experts - we have an international side, too! Members of our British team who publish share their ideas, insights, and perspectives from across the pond.