During the third quarter of 2011, the federal government continued to implement the HITECH Act, which was enacted as part of the American Recovery and Reinvestment Act. This update summarizes key developments and milestones between July 1 and Sept. 30. 

Third-Quarter Health IT Highlights

The third quarter of 2011 saw a number of high-level developments:

• ONC Releases Final Health IT Strategic Plan. On Sept. 12, the Office of the National Coordinator for Health Information Technology released a final version of its Federal Health IT Strategic Plan for 2011 through 2015. The plan focuses on five goals: 1.) achieve adoption and information exchange through meaningful use of health IT; 2.) improve care and population health and reduce health care costs through use of health IT; 3.) inspire confidence and trust in health IT; 4.) empower individuals with health IT to improve their health and the health care system; and 5.) achieve rapid learning and technological achievement.
• HHS Secretary Appoints New OCR Director. On Sept. 13, HHS Secretary Kathleen Sebelius announced the appointment of Leon Rodriguez as director of the Office for Civil Rights. Among other things, OCR is responsible for enforcing the HIPAA privacy and security rules.
• President Obama Proclaims National Health IT Week. President Obama issued a proclamation declaring Sept. 11 through Sept. 16 National Health IT Week. The proclamation urged Americans to learn more about the benefits of health IT, take action to increase adoption and meaningful use of health IT and use the information health IT provides to improve the quality, safety and cost effectiveness of health care.

ONC Policy, Standards Committees

Health IT Policy Committee Submits Meaningful Use Stage 2 Appendix to ONC

The Health IT Policy Committee added an appendix to its Stage 2 meaningful use recommendations, which were approved by the committee on June 8. The appendix included additional meaningful use objectives related to reporting ambulatory clinical quality measures, maintaining a problem list of current and active diagnoses, and maintaining an active medication allergy list, among others.

Other Health IT Policy Committee Recommendations

At its September meeting, the Policy Committee approved the Privacy and Security Tiger Team’s draft recommendations on the use of electronic health records for secondary research. The recommendations will be submitted to HHS in response to the agency’s July 2011 advanced notice of proposed rulemaking regarding changes to the Federal Policy for the Protection of Human Subjects, or “Common Rule,” which governs research on human subjects. 

At its August meeting, the Policy Committee voted to approve with minor amendments the Privacy and Security Tiger Team’s recommendations for best practices for health care providers to warn patients about the privacy risks of viewing and downloading their health information. The panel sent the recommendations to ONC on Aug. 16. 

Also in August, the committee approved the Quality Measures Workgroup’s recommendations on a quality measure framework and quality measures for Stage 2 of meaningful use. The Policy Committee sent the recommendations to ONC on Aug. 5. 

At its July meeting, the Policy Committee approved recommendations from the Privacy and Security Tiger Team regarding amendments and corrections to patient medical information contained in EHR systems. The recommendations state that by Stage 2 of the meaningful use program, certified EHR systems should have the capability to support changes to medical information, particularly to enable a provider’s compliance with HIPAA requirements to respond to patient requests for amendments. By Stage 3 of meaningful use, certified EHR systems should have the ability to transmit revised data to providers to whom the data already have been sent. The Policy Committee sent the recommendations to ONC on July 25.   

Health IT Standards Committee Recommendations

At its September meeting, the Health IT Standards Committee approved recommendations put forward by the Nationwide Health Information Network (NwHIN) Power Team for technical specifications and standards to support the secure transport and exchange of electronic health information on a national scale through NwHIN and the Direct Project. 

At its August meeting, the committee approved the Surveillance Implementation Guide Power Team’s report on standards for health IT-based surveillance systems for population health. 

Also in August, the Standards Committee endorsed the Clinical Quality Measures Workgroup and Vocabulary Task Force joint recommendations on the assignment of code sets to clinical concepts for the purpose of reporting clinical quality measures. 

The recommendations outline the minimum set of vocabulary standards that should apply to each data element included in the 23 categories of clinical concepts defined by the National Quality Forum’s Quality Data Model version 3.0. The committee sent the recommendations to ONC on Sept. 9. 

EHR Certification

ANSI Solicits Applications for ONC-ACBs Under Permanent Certification Program

On Aug. 25, the American National Standards Institute announced it is accepting applications from entities seeking accreditation to certify EHRs under ONC’s permanent certification program. ANSI — which was selected by ONC as the permanent certification program’s ONC-Approved Accreditor — accepted applications through Oct. 7.  

CCHIT Certifies Five Additional EHR Systems Through Alternative Certification Program

On July 13, the Certification Commission for Health Information Technology announced that five health care systems joined Beth Israel Deaconess Medical Center in certifying complete or modular EHRs under CCHIT’s EHR Alternative Certification for Healthcare Providers program, which certifies legacy software, customized commercial products or self-developed EHR systems. The following hospital systems received certification:

• Health Management Associates in Naples, Fla.;
• New York University Langone Medical Center in New York City;
• Northwestern University in Chicago;
• Tenet Healthsystem Medical, Inc., in Dallas; and
• University of North Carolina Health Care in Chapel Hill, N.C.

Medicare and Medicaid EHR Incentive Programs

Update on Provider Registration and Incentive Payments

As of September, more than 110,000 health care providers had registered for the meaningful use incentive programs, and Medicare and Medicaid together had paid more than $872 million in incentive payments. Meanwhile, 27 states had operational Medicaid EHR Incentive Programs as of September. 

OIG Report Finds States Lack Data for Complete Meaningful Use Eligibility Review

On July 15, the HHS Office of Inspector General issued a report describing 13 states’ plans for verifying that health care providers meet program eligibility requirements for Medicaid EHR Incentive Program payments and outlining states’ possible oversight limitations. The report states that a lack of data limits both the number of eligibility requirements that states plan to verify prior to payment and the completeness of those verifications.

CMS Proposes Pilot Program To Allow Hospitals To Report Quality Measures Online

In the Hospital Inpatient Prospective Payment System proposed rule for calendar year 2012, CMS proposed to allow eligible hospitals and critical access hospitals participating in the Medicare EHR Incentive Program to electronically report clinical quality measures by participating in CMS’ Physician Quality Reporting System-Medicare EHR Incentive Pilot. Providers who participate in the pilot must also participate in the PQRS incentive program. Participants would be required to submit data on nine quality measures from the meaningful use program that also fulfill PQRS requirements. Comments on the proposed rule were due Aug. 30.

Health Information Exchange

ONC Launches Two Metadata Initiatives

In September, ONC launched two initiatives to test health information exchange metadata standards under its Standards & Interoperability Framework:

ONC soft launched the Data Segmentation Initiative, which builds on the President’s Council of Advisors on Science and Technology recommendation that metadata tags be developed and used for health information exchange. The goal of the initiative is to enable health providers to segment and withhold certain data from exchange. The initiative formally launched Oct. 5.

ONC launched its Query Health Initiative, a public-private collaboration that will establish standards and services for distributed population queries of data in EHRs. ONC is seeking participants for three Query Health Workgroups: the Business Workgroup, the Clinical Workgroup and the Technical Workgroup. 

ONC Issues Notice of Proposed Rulemaking on Metadata Standards

On Aug. 5, ONC issued an advance notice of proposed rulemaking soliciting public comments on metadata standards to support health information exchange. The ANPRM outlines standards for patient identity metadata (i.e., data required to uniquely select a patient from a population), provenance metadata (i.e., data that provide information on a dataset’s history, origin and modifications) and privacy metadata (i.e., data to convey and communicate patient preferences regarding the sharing of his or her health information). Comments were due Sept. 23.

ONC Releases NwHIN Transport Specifications

On Aug. 12, the ONC Office of Standards and Interoperability announced that NwHIN transport and security specifications were available for public review and comment. ONC held two public calls to discuss the specifications in August. Comments were accepted until Sept. 16.

Privacy and Security

HHS Issues Proposed Rule on Patient Access to Laboratory Results

On Sept. 12, HHS issued a proposed rule that would give patients direct access to their laboratory test results. The proposed rule would amend the Clinical Laboratory Improvement Amendments of 1988 regulations and the HIPAA Privacy Rule. Comments on the proposed rule are due Nov. 14.

ONC Releases PHR Model Privacy Notice

Also on Sept. 12, ONC released a Personal Health Record Model Privacy Notice, a standardized template that a Web-based PHR company can use to inform consumers about its privacy and security policies. According to ONC, the PHR Model Privacy Notice was designed to be similar to existing consumer labels, such as nutrition facts labels. Use of the PHR Model Privacy Notice is voluntary. 

HHS Submits Reports on Breach Notification and Privacy and Security Rules Compliance

On Sept. 1, OCR released two annual reports required under the HITECH Act. The first report provides an overview of HITECH’s breach notification requirements and describes the breach reports submitted to HHS under the law. The second report summarizes complaints of alleged violations of the HIPAA privacy and security rules.

Rural Health IT

HHS Awards $11.9 Million to Rural Health Networks for Health IT

On Sept. 2, HHS announced the award of more than $11.9 million to 40 rural health networks across the nation to support their adoption of health IT. The funding also is intended to help the networks’ providers qualify for meaningful use incentive payments.

Other Health IT Developments

ONC Launches Consumer Engagement Campaign

In September, ONC launched an outreach campaign to encourage consumers to become more involved in their health care through the use of health IT tools. The campaign is designed to highlight the benefits of EHRs, PHRs and mobile health applications. As part of the campaign, ONC launched a new Healthit.gov website.

HHS Solicits Public Comment on Comparative Effectiveness Research Database

On Sept. 23, HHS published a notice requesting public comments on the Multi-Payor Claims Database project, one of a number of comparative effectiveness research initiatives funded by ARRA. The project seeks to consolidate access to longitudinal data on health services financed by both public and private payers.

HHS Awards $8.5 Million to Beacon Communities for Health IT Adoption

On Sept. 12, HHS announced the award of $8.5 million to 85 community health center programs, located in 15 of ONC’s 17 Beacon Communities throughout the nation. The funding, made available under the Affordable Care Act, will aid health centers in the adoption of health IT to support long-term improvements in quality of care, health outcomes and cost efficiencies.

ONC, AcademyHealth and Commonwealth Fund Launch Beacon Evidence and Innovation Network

In July, ONC partnered with AcademyHealth and the Commonwealth Fund to launch the Beacon Evidence and Innovation Network, a project to systematically identify and share best practices across 17 selected Beacon Community Cooperative Agreement Program participants. BEIN will provide technical assistance to the Beacon Communities, convene experts and leaders on topics of interest to the network and disseminate lessons learned through the development of issue briefs, white papers and case studies.

Comments Sought on Plan To Reduce Health IT Disparities

On Aug. 24, the HHS Health IT Disparities Workgroup issued a request for comments to inform the development of a federal plan to reduce health IT disparities. The workgroup published a draft set of strategies and tactics that include: ensuring all patient populations have equal access to health IT opportunities; using health information exchanges to identify disparities; leveraging health IT to identify quality of care trends among different racial and ethnic populations; and including underserved populations in future ONC and health IT projects. The workgroup is seeking feedback on the draft strategies and tactics, as well as on specific activities to reduce health IT disparities.

VA Holds Competition To Develop Blue Button PHR

On July 19, the Department of Veterans Affairs announced the Blue Button Prize Competition to build a PHR using VA’s Blue Button download format. The Blue Button is a tool that enables veterans to download their personal health information from their HealtheVet account into a simple file that can be read, printed or saved on any computer. Qualifying PHRs must be easily installable by physicians and other clinical professionals, be readily available to all of the physicians’ patients and allow patients to download their data using VA’s Blue Button simple text-based format. The PHRs must also meet data security requirements. VA will install the winning PHR on the websites of 25,000 physicians across the country. The contest closed Oct. 18, and a winner will be announced Nov. 15. 

ONC, National Cancer Institute Launch Competition for Health IT Cancer Prevention Apps

In July, ONC and the National Cancer Institute launched the “Using Public Data for Cancer Prevention and Control: From Innovation to Impact Developer Challenge” as part of ONC’s Investing in Innovation program. The challenge supports cancer prevention and treatment through the demonstration of new methods for the dissemination of information to the public. Participants must develop innovative consumer health applications that leverage existing NCI and other federal health-related data. Submissions were due Aug. 26.

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