User Fees for Electronic Health Records

President Obama has released his 2014 budget proposal, which includes $80.1 billion in spending for the Department of Health and Human Services (HHS), an increase of  $3.9 billion. The proposed budget for The Office of the National Coordinator for Health IT (ONC) would increase its $61 million budget to $78 million, a 28% increase. The plan also includes a $1 million fee for electronic health record vendors that would almost certainly be passed along to users of the systems.

“In addition to the expanding marketplace and corresponding increase in workload for ONC, much of the work to date has been funded using Recovery Act funds scheduled to expire at the end of FY 2013. Consequently, a new revenue source is necessary to ensure that ONC can continue to fully administer the Certification Program as well as invest resources to improve its efficiency," the ONC explains in the budget proposal appendix.

In particular, the fee could be used to fund:

• Development of implementation guides and other forms of technical assistance for incorporating standards and specifications into products
• Development of health IT testing tools that are used by developers, testing laboratories and certification bodies
• Development of consensus standards, specifications and policy documents related to health IT certification criteria
• Administration of the ONC Health IT Certification Program and maintenance of the Certified Health IT Product List
• Post-market surveillance, field testing and monitoring of certified products to ensure they are meeting applicable performance metrics in the clinical environment

If approved the collections will likely begin late in fiscal year 2014 and would be gradually phased in. According to the proposal "user fees would be collected from Health IT vendors," and then "would be collected on ONC’s behalf by ONC-Authorized Certification Bodies (ONCACBs)" which already certify EHR systems as part of the meaningful use program. A fee structure would be established by the Secretary and published in the Federal Register, but a tiered system is being proposed where EHR modules would likely be assessed at a lower rate than a complete EHR system.

The HIMSS EHR Association opposes ONC's proposal. "EHR developers are already devoting extensive resources to successful implementation of the EHR Meaningful Use Incentive Program and other healthcare delivery reform efforts, including the significant fees associated with EHR product certification," the group said in a statement. I'm not automatically opposed to fees, however it is not the vendors that would ultimately bear the cost. My biggest issue with the EHR Incentive Program is that it should be more accurately called the EHR Vendor Incentive Program since these companies are making record profits and any payments to providers are simply a pass through to the vendors.

I would like to see steeper requirements for certification as future stages of meaningful use are developed. There are WAY too many products on the Certified Health IT Products List (CHPL) for small practices, community and critical access hospitals to make sense of and choose an appropriate vendor. When this program first launched a software developer friend reviewed the standards and certification criteria and claimed that she could design a product that would meet all of the certification requirements and yet be completely unusable in actual practice. I told her not to waste her time since it appeared that some companies had already done that...