The National Broadband Plan (the “Plan”) follows the recent overhaul of the Federal Health IT Strategic Plan in the Health Information Technology for Economic and Clinical Health Act (HITECH) Act. The HITECH Act was part of the American Recovery and Reinvestment Act of 2009, the stimulus law adopted in February of last year. Recommendations in the Plan include new payment incentives, the removal of regulatory barriers to technology use, and ways to make health information more easily available for research and outcome evaluation.
The Federal Health IT Strategic Plan was first formulated in 2004, with the goal of an interoperable electronic health record for everyone in America by 2014. It recognizes the potential of electronic health records (EHRs) to transform health care delivery. EHRs will not just give clinicians access to the patient’s complete history—they will check dosages and allergies, and provide electronic alerts about treatment procedures and guidelines. They will allow patients to manage their own wellness through personal health records. And they will carry broader benefits for population health by improving public health surveillance and response, accelerating research and adoption of best practices, allowing analysis and reporting of quality of care, and delivering health care to rural communities through telemedicine.
The plan has been beset by obstacles. Adoption by clinicians has been particularly slow, mainly because EHRs are expensive and do not show a clear economic return, at least in the short term. There are no federal standards for interoperability, and there are unresolved concerns about health information privacy and security and patient rights in shared electronic health record systems.
The HITECH Act gave the Health IT Strategic Plan a boost by setting up a framework for the development of standards and certification criteria for “qualified” electronic health records. These are EHRs that not only maintain health information, but also have the capacity to provide clinical decision support, to allow electronic physician order entry, to capture quality-related information, and to exchange electronic health information with other sources. The HITECH Act also allocated $19 billion for investment in health care technology, including additional Medicare and Medicaid reimbursement for physicians and hospitals that meet federal standards for the adoption and use of electronic health records.
The Plan observes that three gaps remain: adoption, information utilization and connectivity. The Federal Communications Commission (FCC) recognizes that the first two are largely beyond its purview, and it makes recommendations to Congress and the responsible federal agencies to move the plan forward on these fronts. The recommendations include new payment incentives, the removal of regulatory barriers to technology use, and ways to make health information more easily available for research and outcome evaluation. The FCC also makes the bold recommendation that Congress should consider providing consumers access to and control over their digital health care data. Access they have already, but obtaining it is cumbersome; control they do not have under current law.
The Plan makes several recommendations for filling the third gap, connectivity. First, the Plan recommends the FCC should replace the underutilized Internet Access Fund with a Health Care Broadband Access Fund, which would support bundled telecommunications and broadband services for health care providers. Participation would be based on need, with subsidy levels greater than those presently in place under the FCC’s Internet Access Fund.
The Plan recommends that the FCC establish a Health Care Broadband Infrastructure Fund to subsidize network deployment to health care delivery locations where existing networks are insufficient. This program would have features in common with the FCC’s Rural Health Care Pilot Program, in which the FCC says it experienced overwhelming interest. Funding would be based on demonstrated need, and participants would be required to pay a minimum percentage of project costs, such as the 15 percent payable under the Pilot Program.
The Plan would expand participation in the access and infrastructure funds by allowing funding for nursing homes, hospices, long-term care facilities, off-site administrative offices and data centers, and even some for-profit providers. These are not currently eligible for the Internet Access Fund. The Plan also calls for additional funding for Indian Health Service, because tribal lands have particularly low broadband penetration.
The Plan recommends that the FCC work with other agencies to align its health care program with other federal criteria for the use of health care information technology, such as the criteria being developed by the Department of Health & Human Services under the HITECH Act. Federal investment should be focused away from process and toward outcomes, to ensure that the program funds “not just wires, but health.”
Finally, the Plan recommends that the FCC play a more prominent and sustained role in supporting the nation’s health information, and should publish a Health Care Broadband Status Report every two years as part of a continuing effort to evaluate the impact of its programs and change direction when they do not meet expectations.
The FCC will be releasing a series of notices to launch each of its future proceedings.