Governance Considerations from HIT for the Board and Other Hospital Stakeholders [Installment 1]

May 18, 2009 HIPAA, HITECH and Health Information Technology Blog

The pressure on healthcare providers to convert to electronic medical records (EMR) as part of the overall HIT movement has increased dramatically in recent months. Promulgations from HHS and FTC, the federal stimulus package and HITECH, which recently heavily-amended HIPAA, create new challenges for healthcare providers.

Over the next several months, my blog entries will discuss some of the threshold issues that face the manifold stakeholders in the hospital industry as they struggle to cope with the new and somewhat uneven landscape of HIT. The earlier entries will deal with the Boards and their responsibilities to their hospitals and other stakeholders with respect to HIT.

Boards of Directors and Trustees of profit and non-profit hospitals have been dealing for years with the ever-increasing costs of HIT for hospitals. Annually they are presented with a menu of costly budget items for investment in HIT. They have dutifully authorized and seen the inexorable growth of IT departments within their hospitals and have become almost inured and resigned to the inevitability of continued spiraling costs, often without any tangible results in the eyes of the Boards. Now they will be confronted by new and different costly demands respecting HIT in the face of an active controversy as to what will and should be the shape of future HIT initiatives.

The May 11, 2009 edition of The Boston Globe carried an article by Carolyn Y. Johnson, entitled "Digital Medical Records Push Exposes Potential Side Effects." Its thrust was that, even with $19 billion to be spent by the stimulus package to support EMR investment and a real urgency for comprehensive HIT to cut costs and save lives, "a growing body of research illustrates the potential challenges - from getting doctors to use the safety enhancing features the systems offer, to the patchwork of privacy regulations in different states."

I would like to add to the challenges identified in Ms. Johnson's article the need of each hospital to educate and to get the Board "on board" with the importance of HIT and undertaking pro-active initiatives in the institution. This Board effort is likely to be threatened by multiple complexities, including declining patient population, reduced reimbursement, heavy regulation, intense competition, dwindling donor contributions and heavy endowment losses for non-profit hospitals, a history of unclear returns from past substantial investments in HIT, competitive demands for capital dollars that promise quick tangible returns and many other factors.

[To be continued in Installment 2]