Government Making Progress on Federal Stimulus Provisions

The federal government continues to move ahead with implementing various provisions of the American Recovery and Reinvestment Act of 2009.  This update summarizes certain significant developments since early March.

Health IT

On April 6, HHS announced more than $267 million in awards to 28 additional not-for-profit organizations to establish Health Information Technology Regional Extension Centers. This latest round of awards brings the total number of RECs to sixty. Additionally, all REC awardees now have an opportunity to apply for a $25 million two-year supplemental expansion award to provide health IT support services to more than 2,000 critical access hospitals and rural hospitals having 50 beds or fewer. RECs are eligible for $12,000 for each critical access and rural hospital that they assist.

On April 2, ONC announced $60 million in awards for four institutions under the Strategic Health IT Advanced Research Projects program. The SHARP program funds institutional research on barriers to health IT adoption to inform solutions to achieving nationwide “meaningful use” of health IT, with a focus on:  

  • Health IT security;
  • Patient-centered cognitive support;
  • Health care application and network platform architectures; and
  • Secondary use of electronic health record data.

Also on April 2, HHS announced awards totaling $84 million to 16 universities and junior colleges to support training and development of more than 50,000 new health IT professionals. 

On April 1, the Agency for Healthcare Research and Quality awarded nearly $40 million in contracts to help establish the Health IT Research Center, a national organization designed to support the recently funded RECs.  AHRQ previously announced its intent to solicit contracts to develop the HITRC on Jan. 28. Awardees include:

  • Booz Allen Hamilton and Function 1 to develop a public Web site and private collaborative; portal for REC staff and physicians to interact with the research center electronically;
  • Abt Associates, Westat and RTI International to provide educational tools and resources;
  • Westat to establish the knowledge-sharing network; and
  • RTI International to develop a practice transformation model for use in primary care settings.

On March 24, ONC released a white paper detailing consumer consent options for electronic health information exchange. The paper was discussed during the March 25 Health IT Policy Committee’s Privacy and Security work group meeting. Most of the initiatives examined in the paper are state-based exchanges. 

ONC also has commissioned at least two additional papers that will address:

  • Data segmentation issues (e.g. the ability of EHRs to tag and treat distinct pieces of health information); and
  • Other technological capabilities for protecting the privacy and security of health information in HIE.  These papers are due in two to three months.

On March 24, the Department of Justice’s Drug Enforcement Administration released an Interim Final Rule with Request for Comments that provides guidance to health care providers for electronically prescribing controlled substances. Pharmacies may also receive, dispense and archive these electronic prescriptions. The IFC is published in the March 31 Federal Register.  Written comments are due by June 1.

Meanwhile, the National Institute of Standards and Technology released draft test protocols that can be used by health IT vendors, certification bodies and others to test whether health IT systems are capable of assisting eligible professionals and eligible hospitals in achieving meaningful use under the Medicaid and Medicare incentive programs. The draft test methods were developed in accordance with the ONC Notice of Proposed Rulemaking on the Medicaid and Medicare EHR Incentive Program.

NIST also has released a bid for contractors to provide technical expertise around the development of a Web-based HIPAA Security Rule Self-Assessment Toolkit with supporting training material. Submissions are due by April 29. 

In a March 19 Federal Register notice, ONC described its plans to conduct a nationwide survey of approximately 2,500 households to determine the general attitude toward electronic HIE and associated privacy and security concerns.  ONC will prepare a draft report and use webinars to deliver the findings to the general public. A final report will be posted on the ONC Web site. 

On March 17, the Congressional Research Service released a report titled “Selected Health Funding in the American Recovery and Reinvestment Act of 2009.”  The report reviews funding allocation and spending by HHS agency and by sub-topic area (e.g. health IT, disease prevention, comparative effectiveness research).

On March 15, HHS announced the remaining awards for State Health Information Exchange Cooperative Agreements. The awards provide $162 million to 16 states and state-designated entities, adding to the $385 million awarded in February.

On March 9, ONC released a draft of its health IT strategic framework, which highlights the strategic themes, principles, objectives and strategies the agency plans to address in its 2010 strategic plan. A Health IT Policy Committee’s Strategic Plan work group will be chartered to inform the Strategic Plan development. The strategic plan will be finalized in May.

On March 8, ONC released a notice of proposed rulemaking on establishing certification programs for health IT. ONC proposes two separate certification processes — a temporary certification process and a permanent one — with two related comment periods. Comments on the temporary process were due on April 9, 2010, with the final rule expected in June, simultaneous with the CMS final rule on the EHR Incentive Programs and the ONC final rule on standards for certified EHR technology. ONC will accept comments on the permanent process until May 10 and expects to issue a final rule in “early fall” 2010.

On March 1, CMS, in collaboration with ONC, released guidance clarifying that the Clinical Laboratory Improvement Amendments permit labs to electronically exchange lab data.  The guidance is intended to address confusion regarding laboratory data and health IT.

Privacy and Security

The HHS Office for Civil Rights launched a Web site listing HIPAA-covered entities that have reported breaches of unsecured protected health information affecting more than 500 individuals as required under HITECH.

OCR is working on an “omnibus package” of 2010 regulations that will clarify a number of privacy and security provisions enacted under the ARRA, including more enforcement rule changes.  HHS will also finalize its interim final rule on breach notification that was released Aug. 24, 2009.

Work Force Development

The Health Resources and Services Administration released $50 million in funding to support work force training for health care professionals. This funding is available under the Equipment to Enhance Training for Health Professionals Program and encompasses 21 health professional training initiatives authorized under Titles III, VII, and VIII of the Public Health Service Act.

Community Health and Preventive Care

On March 19, HHS announced awards of $372 million to 44 awardees as part of the CDC-administered Communities Putting Prevention to Work program to reduce obesity and smoking rates, increase physical activity and improve nutrition.

Of the 44 communities receiving grants:

  • 23 communities received funding for obesity prevention;
  • 14 communities received funding for tobacco cessation; and
  • Seven others receive funding for both obesity and tobacco cessation efforts. 

On March 5, CDC released $10 million in funding related to the Communities Putting Prevention to Work program for national organizations to provide expert guidance to communities, help sustain prevention efforts when recovery act funding ends and foster a national movement toward prevention by implementing key practices across their networks and systems. CDC also released several notices for contractors to provide related communications, monitoring and evaluation services.

Broadband

On March 16, the Federal Communications Commission delivered the National Broadband Plan to Congress. The Plan outlines FCC’s agenda to ensure all residents of the U.S. have access to broadband by 2020.

On March 4, the Department of Commerce released a quarterly status report on the Broadband Technology Opportunities Program to Congress. The report focuses on:

  • The first round of grant awards and the second round notice of funding availability;
  • Steps taken to ensure sufficient oversight and compliance; and
  • Efforts to ensure sufficient staffing and resources. 

Throughout March, Commerce and the Department of Agriculture continued to announce awards under the BTOP and USDA’s programs for broadband infrastructure development in rural areas. 

Comparative Effectiveness Research

On March 10, HHS announced two comparative effectiveness research projects. Project A will examine methods to create efficient reimbursement incentives for improving health care quality in FQHCs, rural health clinics and free clinics.

Project B will investigate the impact of health IT, including EHRs, in communities with health disparities and in areas with high proportions of uninsured, underinsured and medically underserved individuals.

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