The governor is poised to sign a Maryland bill into law this week on health information systems. Click here to see the Baltimore Sun article. The bill was known as HB706 on Electronic Health Records – Regulation and Reimbursement, was adopted by the House and State Senate by April 10, 2009. The Act empowers the Maryland Health Care Commission to establish a health information exchange in the State, and to develop regulations that incentivize providers that use an electronic health record. The incentives are required to have monetary value, and may include such things as increased reimbursement for specific services, lump sum payments, gain-sharing arrangements, and rewards for quality. Click here for the full text of the enrolled House Bill. By 2015, the bill also anticipates that health care providers will be using an electronic health record that is nationally certified and capable of sharing information with the State’s health information exchange.
I think this is an interesting development for health care providers. Most estimates that I have seen show that a majority of health care providers do not use computerized records for keeping track of patient care. The records systems are relatively expensive (at least in the short term for software licensing, equipment, and the like), most providers are not techno-geeks, there are serious technical security issues that have to be managed (such as those promulgated under the HIPAA security regulations), and in the short term providers are not likely to become more productive or see a substantial increase in revenue from the investment. This bill, once signed into law, will start to pile on incentives for providers to move to an EHR, particularly if a provider can begin to demonstrate improvements in the quality of care delivered to patients.
The bill also presumes that there is value in a standard health information exchange, which I imagine would act as a clearinghouse for authorized users to access or analyze health information on Maryland residents. Beyond the obvious privacy concerns (employers firing or not hiring employees with expensive health conditions), having such sensitive information in one place will require a substantial investment in protecting that data from unauthorized access or theft. I think it is interesting that the State is not just letting the free market address the need for these kinds of information exchanges – Google and Microsoft have both put products in the marketplace for individual consumers to manage health information. Arguably, such a large scale effort to place all Maryland patient information into a single repository may exceed the resources of private investors or companies expecting to profit from the repository’s development. The open question is what value such a repository will actually have to individual patients whose data is “on deposit.” Stay tuned!