OPTIMIZING THE USE OF THE FISCAL STIMULUS FOR HEALTH IT IN THE U.S.

The fiscal stimulus of 2009 allocated about $19 billion over five years to advance the country’s push for a nationwide health information network. Information sharing among public health agencies and private health care providers has the potential for reducing public health threats and increasing public access to measures of provider quality. It can also help build and disseminate a database of cost-effective best practices in health care delivery. An analysis of existing evidence on enablers and barriers to adoption and effective use of electronic health records suggest that government intervention is justified. The market system will result in low utilization because of scale economies, externalities, network effect, and a need for national standards to ensure interoperability, privacy and data security. However, optimal use of the fiscal stimulus requires that financial and technical assistance be targeted on smaller physician practices and independent hospitals. Such assistance must be made conditional on adoption and effective use of a certified, interoperable system. The public health benefits will also be maximized the more health care providers participate in the national health IT network. Thus, in addition to awarding financial incentives, electronic submission of aggregated or de-identified health information must be mandated of all health care providers, not only those that are participants of Federal health programs.