OMB will sharpen reviews of agency health IT spending

The Office of Management and Budget wants to coordinate health IT spending in a way similar to other management efforts, such as electronic rulemaking, grants management and software licenses.

For starters, OMB has directed CIOs to describe and justify their health IT investments in their Exhibit 300 budget documents.

Although OMB did not establish new requirements, agencies should detail current plans for putting in place adopted federal health data standards and implementing future standards. The budget submissions are due Sept. 12, said Karen Evans, OMB e-government and IT administrator.

“It underscores the importance for agencies to reflect in sufficient detail, through their exhibit 300 submissions, their activities and leadership in the area of health IT in relationship to implementation of presidential initiatives and the national strategic framework for health IT,” Evans said in a memo to senior IT managers.

OMB isn’t asking for more information as much as putting more governmentwide focus on it, said Health and Human Services Department CIO Charles Havekost.

“This business area is nothing new, although we haven’t had that business area reviewed” in health IT the same way other business areas have been reviewed, he said.

The memo follows a requirement from the administration’s agency 2006 budget pass-back that asked departments to redirect all health IT investments so they are consistent with the president’s health IT framework. OMB estimated that agencies spent about $5 billion on health IT systems in 2005, a government source said.

To supplement its review, OMB will consult with HHS’ Office of the National Coordinator for Health IT, which has planned for health IT investments and health data standards selection through its Federal Health Architecture efforts.

The review and consultation will help OMB determine if proposed health IT investments align with and contribute to the administration’s initiative for a national health IT infrastructure.

OMB already requires agencies involved in health care, such as HHS and the Veterans Affairs Department, to account for their health IT investments as they do other IT investments in their annual budget submissions.

Areas for cooperation

Agency details about health IT investments will be used to fill in and map the Federal Health Architecture. By providing more data, OMB will be able to identify where agencies can cooperate and integrate their health IT infrastructures, a process that will advance administration goals to improve care and efficiency while reducing costs.

“As we move forward, we will evaluate possibilities for further collaboration as appropriate,” Evans said. “Investments within the federal government make up an important segment of the national health IT infrastructure.”

National health IT coordinator David Brailer is leading a public/private effort to develop a national health IT infrastructure to support the exchange of such data as electronic health records.

The national coordinator, under the executive order that established the post last year, also is charged with advancing health IT standards for use by the federal government. That process is under way with electronic drug prescriptions.

“If the federal government is doing a good job [in adopting standards], that can help build momentum that will carry over to states and other organizations,” Havekost said.

OMB’s instructions are in line with the purpose of the national coordinator’s office, a spokeswoman for the office said.

“It ensures that federal monies are coordinated effectively inside the federal government and are being spent most efficiently and effectively, so that the president’s ultimate goal of widespread interoperability is achieved,” she said.

Better care at lower cost

VA, which uses computers, handhelds and clinical applications extensively in its hospitals and other health care facilities, said OMB’s request for more details would enable it and other agencies to take advantage of existing activities in the Consolidated Health Informatics e-government project, which is setting federal standards.

“Both the administration and the Congress recognize that a synergistic health data model and strategy can facilitate better care at lower costs,” said Craig Luigart, VA’s associate deputy assistant secretary for policies, plans and programs.

Under the OMB memo, agencies with systems involved in the delivery of health care services, public-health surveillance, adverse-event reporting or other systems with large health data components may also be asked to submit additional documentation and analysis.

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