Overburdened Health IT Agency Adds Another Big Project: Enrollment in Insurance Exchanges

Last Updated May 3, 2010 6:00 AM EDT

The Office of the National Coordinator for Health Information Technology, better known as ONC, is the agency responsible for implementing the electronic health record (EHR) adoption program authorized by last year's economic stimulus law. ONC has done an incredible job on a tight deadline, but it's still far from completing its work in that area. Now ONC chief David Blumenthal has announced that his agency will begin work on another project that is nearly as big and ambitious as the EHR initiative: to develop electronic standards for enrolling people in the insurance programs created by the Affordable Care Act. That includes a vast expansion of Medicaid eligibility as well as 50 state health insurance exchanges.

Naturally, this effort, which recalls the Manhattan Project in its complexity, must be completed within five months (180 days from the signing of the bill). What were the legislators thinking when they set that deadline?

They surely were not thinking about the fact that state Medicaid programs alone use a bewildering variety of mostly outdated information systems. They were also probably not thinking that whatever enrollment systems are devised for the state insurance exchanges will have to be linked with existing state systems that contain various kinds of eligibility data.

But ONC officials and the members of the Health IT Standards Committee, an advisory body, are aware that much of the eligibility data is scattered across government systems, including those of the Departments of Treasury, Agriculture and Housing and Urban Development. They also know that some of the data is in social service and agency databases, such as those of the food stamp program, the school lunch program, and state tax departments. So the government must not only develop standards but must also locate the data and link it together so it's easy for people to find out what they're eligible for and enroll in those programs.

Good luck.

Let's not forget that ONC spent nearly a year putting together the "meaningful use" criteria for providers to obtain government EHR subsidies. Those requirements -- and the standards to support them -- have received voluminous public comments that ONC is still sifting through. By the time the agency publishes its final rules, probably close to the June 30 deadline, there will not be much time left to help doctors and hospitals figure out how to adapt to those criteria so they can get the 2011 subsidies. And then ONC will have to prepare the next round of meaningful use requirements, scheduled to take effect in 2013.

At the same time, the agency is supervising the development of regional HIT extension centers to train physicians; disbursing grants to community colleges to train the trainers; and helping states get health information exchanges up and running. Put it all together, and ONC already had a full plate before it took on enrollment in government-sponsored insurance programs.

In Blumenthal's remarks to the Standards Committee, he said of the online shopping site that people will use in the health insurance exchanges, "The point is to make it as easy to buy health insurance as it is to buy from Amazon."

That's great, but maybe what ONC needs is an Amazon or a Google to figure out the myriad details involved in setting up this enormous database. I don't believe that private enterprise is always the answer, but this might be a case where properly incentivized entrepreneurs could get the job done faster, better, and more easily.

Image supplied courtesy of reich-chemistry wikispaces.

  • Ken Terry

    Ken Terry, a former senior editor at Medical Economics Magazine, is the author of the book Rx For Health Care Reform.