Signed into law on February 17, 2009, the Health Information Technology for Economic and Clinical Health (HITECH) Act represents a historic opportunity to improve American health care delivery and patient care through an unprecedented investment in health information technology (HIT). The Office of the National Coordinator for Health Information Technology (ONC) has undertaken a major effort to successfully implement and oversee HITECH programs. ONC has established eight entirely new major grants programs, issued new regulations, created new Federal Advisory Committee Act (FACA) workgroups, awarded many new contracts to support implementation, and built the federal capacity to manage these efforts. ONC’s efforts have resulted in the implementation of key provisions of the HITECH Act and the obligation of a significant portion of the $2,000,000,000 appropriated for HIT activities. ONC is pleased to have the opportunity to provide the public greater insight on the depth and rapid development of our HIT efforts. Public BenefitsThe HIT initiative is a critical component of health reform as health professionals and health care institutions, both public and private, leverage the full potential of digital technology to prevent and treat illnesses and to improve our nation’s healthcare. The Office of the National Coordinator for Health Information Technology (ONC) is charged with leading and coordinating the efforts to facilitate that nationwide adoption of HIT. HITECH sets an ambitious path to ensure health care transformation through HIT and provides incentives to Medicare and Medicaid providers and hospitals for the meaningful use of certified electronic health record (EHR) technology.
To implement Recovery Act provisions, ONC has implemented swiftly, yet judiciously, a wide array of grant programs; contracts supporting evaluations and studies; privacy and security and communication activities; and published regulations supporting standards and certification, and a certification accreditation program all with the goal of supporting meaningful use. ONC has also contributed greatly to a proposed regulation on the meaningful use of electronic health records (developed by CMS). Each of these initiatives were conducted in a manner that achieved ambitious deadlines while assuring that ONC’s decisions and actions supported the law’s fundamental, long-term purposes: improving health and health care through the application of HIT. Meeting the long-term goals of the Recovery Act will continue to require thorough planning while delivering to the American people quick action and effective investment of committed funds. C. Activities The Office of the National Coordinator for Health Information Technology (ONC), under the authority delegated to it by the Secretary of the Department of Health and Human Services, is implementing the HITECH Act as outlined in the American Recovery and Reinvestment Act of 2009. Current activities are detailed below:Privacy and Security Program – To carry out the Secretary’s statutory responsibilities under Subtitle D of the HITECH Act, $24.3 million has been and will continue to be used to draft regulations, guidance, and reports, and to conduct studies and audits to strengthen privacy protections and security safeguards.
To implement HITECH Act improvements to the Health Insurance Portability and Accountability Act’s (HIPAA’s) privacy and security rules, HHS will use $16.2 million of the $24.3 million for HIPAA enforcement. For example, Section 13411 of the HITECH Act requires the Secretary to conduct periodic audits to ensure compliance with HIPAA. To implement this requirement, HHS has begun to assess, evaluate and develop an appropriate audit program. An audit study has commenced, the results of which are anticipated in July. Findings and recommendations resulting from the study will be evaluated and will serve as the basis for designing an audit program. In addition, the Secretary is required under Section 13410 to formally investigate any complaint where the preliminary facts indicate the possibility of a violation resulting from willful neglect. The Secretary has begun to establish standards for such investigations through the rule making process. Section 13402 of HITECH requires entities that experience a breach in the privacy or security of health information to notify the individual involved as well as the Secretary. In addition to developing rules establishing standards for the breach notification process, the Secretary has also developed and is maintaining a web site list that identifies each covered entity involved in a breach involving the information of more than 500 individuals. The remaining funds will be directed towards studies and the drafting of regulations, guidance, and reports that the HITECH Act requires and will fund studies and the development of best practices for protecting health information in an electronic environment.
State Health Information Exchange Grants – The State HIE Cooperative Agreement Program provides $564 million to fund states’ efforts to rapidly build capacity for exchanging health information across the health care system. Awardees are responsible for enabling increased connectivity for patient-centric information flow to improve the quality and efficiency of care and enable meaningful use of HIT. Key to this is the continual evolution and advancement of necessary governance, policies, technical infrastructure and financing for HIE across each state, territory, and State Designated Entities (SDEs) during a four-year performance period. This program is building on existing efforts to advance regional and state-level health information exchange while moving toward nationwide interoperability.
Health Information Technology Extension Program – The Regional Extension Center (REC)Cooperative Agreements will offer $721 million to fund technical assistance, guidance, and information to support and accelerate health care providers’ efforts to become meaningful users of EHRs. Specifically, the RECs are designed to ensure that primary care clinicians who need help are provided with an array of on-the-ground support to meaningfully use EHRs. Providing training and support services, the RECs will assist doctors and other providers in the adoption and meaningful use of EHR systems.
The REC program has coverage in virtually every geographic region of the United States, which ensures sufficient community-based support. The goal of the program is to provide outreach and support services to at least 100,000 priority primary care providers within two years. Priority primarycare providers are individuals and small group practices (fewer than 10 physicians and/or other health care professionals with prescriptive privileges) primarily focused on primary care as well as physicians, physician assistants, or nurse practitioners who provide primary care services in public and critical access hospitals, community health centers, rural health clinics, and in other settings that predominantly serve uninsured, underinsured, and medically underserved populations.
The Health Information Technology Research Center (HITRC), funded at $53 million, will be responsible for gathering relevant information on effective practices and helping the RECs collaborate with one another and with relevant stakeholders to identify and share best practices in EHR adoption, effective use, and provider support.Health IT Workforce Cooperative Agreements – Awards totaling $84 million to 16 universities and 70 junior colleges will support training and development of more than 50,000 new health IT professionals. An additional $34 million is available for two year funding under the Community College Consortia program after successful completion of a mid-project evaluation. The institutions receiving awards will help health care providers and hospitals implement and effectively use electronic health records. Specific Health IT workforce cooperative agreement programs are identified as follows:• Community College Consortia – Provide assistance to institutions of higher education, or consortia thereof, to establish or expand health information technology education programs. Training is designed to be completed within six months or less. The programs offer flexibility to provide each trainee with skills and competencies that he/she does not already possess – either health care or information technology.
• Curriculum Development Centers Program – Provides funding to institutions of higher education, or consortia thereof, to support health information technology curriculum development. The materials developed under this program will be used by the member colleges of the regional Community College Consortia and will also be available to institutions of higher education across the country.
• University-Based Training Program – Produce trained professionals for vital, highly specialized health IT roles. Most trainees in these programs will complete intensive courses of study in 12-months or less and receive a university-issued certificate of advanced training. Other trainees supported by these grants will study toward masters’ degrees.
• Competency Examination Program – Supports the development and initial administration of a set of health IT competency examinations. The program will create an objective measure to assess basic competency for individuals trained in short-term, non degree health IT programs and for members of the workforce seeking to demonstrate their competency in certain health IT workforce roles.
Beacon Communities – Cooperative Agreements totaling an estimated $250 million will provide fundingto create demonstration communities in which clinicians, hospitals, and consumers show how the meaningful use of EHRs can achieve measurable improvements in health care quality, safety, efficiency, and population health in a given geographic area. An additional $5M will be funded to provide technical assistance to cooperative agreement award recipients.National Institute of Standards and Technology (NIST) – The Recovery Act mandated the transfer of $20 million from ONC to NIST, a component within the Department of Commerce, to continue health care information enterprise integration. Specific efforts include accelerating the development and harmonization of standards through collaboration with ANSI (American National Standards Institute), Healthcare Information Technology Standards Panel (HITSP), Standards Developing Organizations, Federal agencies, professional societies, and industry; creating a healthcare information technology testing infrastructure to ensure that standards are implemented consistently as part of certification,; engaging NIST experts to plan and lead technical and programmatic activities which includes developing the architecture for testing infrastructure; developing advanced security technologies and guidance; prioritizing standards harmonization (in collaboration with industry); accelerating implementation specifications; engaging in research and development on usability; consulting on conformity assessment; and implementation assistance.
Other Initiatives include the Strategic Health IT Advanced Research Projects (SHARP) Cooperative Agreements. This program, funded at $60M, will support research projects focused on specific areas where breakthrough improvements can greatly enhance the transformational effects of health IT and address well-documented problems that have impeded adoption and the pathway to meaningful use. Each awardee will implement a collaborative, interdisciplinary program of research addressing a specific focus area. The four focus areas for the SHARP awardees are security of health information technology, patient-centered cognitive support, healthcare application and network platform architectures; and secondary use of EHR data. Another large key initiative will advance standards development and interoperability. These activities, estimated to total $64M, are designed to develop the standards, tools, policies, governance, interoperability framework, and technical infrastructure to support the Nationwide Health Information Network and create standards-based interoperability for health information exchange. Public Health – These programs, funded at an estimated $30.5 million, will advance the capability of public health agencies to receive electronic reporting information from eligible professionals and hospitals, which will prepare eligible professionals and hospitals in becoming meaningful users of EHR technology. Funding supports interoperability of EHRs and immunization registries and electronic laboratory reporting between public health agencies and clinical care settings. These projects are critical to building the capacity of public health agencies to receive the electronic information from eligible professionals and hospitals that are working towards becoming meaningful users of EHRs.