The American Recovery and Reinvestment Act of 2009 (ARRA) appropriated $17.2 billion for Medicare and Medicaid providers to adopt certified electronic health record (EHR) technology. Industry estimates of the actual total cost of incentive payments for providers demonstrating meaningful use range from $20 billion to $36.4 billion. As the meaningful use criteria is still being hashed out at the federal level, states are beginning to move forward by partnering with banks and establishing loan programs to provide financial assistance. These loan programs are another way to encourage providers to purchase and implement health information technologies (HIT) and then seek federal incentive payments down the road. Additional government support will be provided through the Regional Extension Centers (REC). Meanwhile, some vendors such as GE Healthcare have opted to offer interest free, deferred payment plans to alleviate concerns over IT costs.

One example is the North Dakota HIT Revolving Loan Fund recently establish via Senate Bill 2332. The state is partnering with the Bank of North Dakota to offer low-interest loans to health care entities looking to make investments in health IT. The process includes submitting an application for review and approval by the HIT Director and the HIT Advisory Committee. Approved applicants are required to complete an on-site readiness assessment then the next step is to complete the Bank's loan application for final approval.

Will states seek vendor support? Yes, it does appear that some states will be seeking vendor assistance, particularly for operations support and quality assurance (QA) services. New York recently completed a HIT Planning Advanced Planning Document (HIT P-APD) which indicated plans to obtain contract services through the New York State Technology Enterprise Corporation (NYSTEC) for planning services. NYSTEC staff will then assist the Department of Health with developing Request for Proposals(s) and procurement(s) to obtain contractors for operational support and program auditing/QA services.

HIT vendors should continue to consider offering financing options to assist providers with purchasing EHR solutions and to streamline purchases with a given states loan program and partnering bank to make the process simple and efficient. In addition, while meaningful use criteria will be the essential guideline for a system, don't forget to be innovative within those confines. Professional services HIT vendors should expect to see more states following New York's lead; as states begin to roll out plans for loan programs over the next couple of months they will have a better idea of where they will be seeking vendor's assistance.