Stimulus Opps More Ephemeral Than Monetary

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7 PM: A morning session on Economic Stimulus Package Funding Opportunities may have disappointed those looking for hard and fast guidance on how to pay for imaging informatics with some of the $19.2 billion allocated for EMRs. No fault, of course, of presenters Bradley J. Erickson, MD, PhD, Mayo Clinic, Rochester, David S. Mendelson, MD the Mount Sinai Medical Center, and Eliot Siegel, MD, University of Maryland and the VA Maryland Health Care System. The details are still vague.

But the session began to build a scaffold around how radiology may fit into the bigger picture. Meaningful use is a key qualifier to receive stimulus funds, but like a 1950s TV, the picture will take a long time to emerge: the deadline for the definition is December 2009. Now is the time to take that leap of faith, and brainstorm a better, more interoperable future through imaging informatics.

With 83% of the funds unspecified—meaning the field is wide open to anyone who can justify their informatics project—Erickson, who has read the entire bill, believes that CPOE is probably an element of meaningful use, but he could find no mention of RIS, PACS, or CAD in the wording of the bill. “But I don’t know if that means anything,” he said.

He also emphasized that money is a reward, not an incentive. Meaningful use must be demonstrated before any funds are awarded. Buy first, and hope to be paid.

Language in the bill indicates opportunities exist to:

• provide training for IT professionals,
• promote interoperability and data sharing,
• expand use of health IT in public health, and
• participate in comparative effectiveness since imaging plays a role in almost every patient care algorithm
• access USDA and NTIA grants for teleradiology projects

Since no one knows what meaningful use may come to mean, a lot of the focus has turned to patient privacy, Erickson said. The bill expands the HIPAA patient privacy regulations to include business associates. “Any disclosure including disclosures to a third party payor has to be disclosed to patients so that has some people concerned at my institution,” Erickson said.

Mount Sinai Hospital’s EMR vendor invited the institution to participate in a nationwide information exchange among all its client sites. But worries about running afoul of restrictive patient consent portions of New York State patient privacy laws has prevented the hospital from moving forward, Mendelson said.

“The technical piece is almost the trivial piece,” Mendelson said. “It’s the policies and procedures around the exchange of information that will be important.”

If Not Money, Leadership!
All three presenters emphasized the opportunity for radiology to take a leadership role in health IT interoperability, given its pioneering work in health informatics: PACS, DICOM, and IHE.

Mendelson mentioned a a pilot planned by RSNA to export images to some of the personal health record (from Google and Microsoft). “Radiology might be the way to share images and set ground rules to accomplish that,” he said. “If we forego greed—maybe we don’t get the $44,000 for our practice—and look at what we can do to ensure interoperability and secure transmission of information, we can take leadership and show the country how to go. We are ahead of the game: we’ve had PACS and RIS for years and we understand the benefit of interoperability.”

“Were going to get there in increments, and we are not going to get there at once,” Siegel said. “We have to interact with other specialties. Radiologists interested in this are starting to pool their resources.”

One organization that is aggregating information on the stimulus package opportunities is the Academy of Radiology Research, an advocacy lobbying group for research. Siegel recommended bookmarking the site and checking it often: http://www.acadrad.org

Practical Notes
The panel had some practical advice for the many vendors in the audience:

• If you have a product that you think improves health care outcomes and addresses the measures the government wants, find an academic institution or a large private practice to partner with. You’ll need data to justify the claims you are making. You are not going to collect the dollars in the next couple of years, but you will benefit if you have a vision.

• Document effectiveness, think strategically, and add value and intelligence to the health care system. The government has allocated money to do that, so its time to start lining up your ships in that directions.

And