With one day to spare, the federal government made its deadline for issuing long-awaited rules that will govern the distribution of more than $44 billion in Medicare and Medicaid incentives to hospitals and health care professionals demonstrating “meaningful use” of certified electronic health records. 

Due by the end of 2009 as stipulated by the federal stimulus package, the meaningful use rules released Dec. 30 might have been the most anticipated development of year’s end, but it wasn’t the only one. The government continues to move ahead with the implementation of various provisions of the American Recovery and Reinvestment Act of 2009.  This update summarizes significant developments over the past two months.

‘Meaningful Use’ Comment Period Under Way

The joint announcement by CMS and the Office of the National Coordinator for Health IT included an interim final regulation issued by ONC that sets initial standards, implementation specifications and certification criteria for EHR technology. 

For a 60-day period that started Jan. 13, the public can comment on the government’s proposed meaningful use regulations, as well as ONC’s interim final rules on certification. ONC expects the final rule on EHR standards and certification to be released this spring. In early 2010, ONC plans to issue a notice of proposed rulemaking related to the certification of EHRs.

Health IT Planning Grants for States

Since late November, CMS has approved funding for eight states and the Virgin Islands to support planning activities for implementation of the Medicaid EHR incentive program and the development of their state Medicaid health IT plans. The grants were awarded to:

• California ($2.48 million);
• Georgia ($3.17 million);
• Idaho ($142,000);
• Iowa ($1.16 million);
• Montana ($239,000);
• New York ($5.91 million);
• Tennessee ($2.7 million);
• Texas ($3.86 million); and
• The U.S Virgin Islands ($232,000).

Health IT Committees Meet, ONC Reorganizes

The Health IT Policy Committee met in mid-December and discussed three new work groups — the Nationwide Health Information Network, Privacy and Security and ONC’s Strategic Plan.

Meanwhile, the Health IT Standards Committee met in November and focused on lessons learned from the Standards Committee’s Implementation Work Group. The committee also discussed activities and testimony from multiple industry experts on security considerations in four areas:

• Stability/reliability;
• Cybersecurity;
• Data theft/loss/misuse; and
• Building trust.

In addition, ONC underwent an agency reorganization aimed at improving its ability to advance the health IT goals outlined by ARRA. The reorganization replaced the four existing agency offices (Office of Health IT Adoption, Office of Interoperability and Standards, Office of Programs and Coordination and Office of Policy and Research) with five new offices that have refined functions and report directly to the national coordinator for health IT.

Health IT Research and Development

Last month, ONC issued three funding announcements for health IT research and work force development:

• $60 million for the Strategic Health IT Advanced Research Projects, or SHARP, program to research health IT adoption barriers and inform solutions on nationwide meaningful use. 
• $32 million for university-based training programs for health IT professionals in at least one of the following roles: clinician/public health leader, health information management and exchange specialist, health information privacy and security specialist, research and development scientist, programs and software engineer and health IT subspecialist. 
• $6 million for higher education institutions to develop and administer health IT competency exams.

Applications for each program are due Jan. 25, 2010.

Money for Research, Clinics

Last month, the federal Agency for Healthcare Research and Quality announced plans to spend $2 million to develop a center of excellence to support community-based participatory research on the use of health IT for elderly patients.

Eligible applicants are state and local governments and higher education institutions. Letters of intent are due Feb. 25, 2010, and applications are due March 25, 2010.

AHRQ also announced it will issue a bid for contractors to develop an operations plan for the Health Information Technology Research Center.

Meanwhile, HHS announced nearly $600 million for initiatives to advance construction and renovation projects and to facilitate EHR adoption at federally qualified health centers nationwide.

Nearly $509 million is available for renovations or new construction. A request for proposals will be released in spring 2010. Three-year demonstration projects are expected to begin in January 2011.

In addition, $88 million is available for Health Center Controlled Networks. Of that, approximately $78 million will fund EHR implementation at up to 26 HCCNs, with each award capped at $3 million. The remaining $10 million will fund up to 10 HCCNs to implement innovative health IT projects other than EHRs, with an award ceiling of $1 million. Awards will be for two-year projects. The deadline for applications is Feb. 5. 

ONC announced a $235 million funding opportunity to develop health IT “beacon communities.” A total of $220 million in cooperative agreements is available for 15 “beacon communities” to leverage their existing EHRs, health information exchange capabilities and expertise to achieve measurable improvements in health care quality, safety, efficiency, and population health. The remaining $15 million will go toward providing technical assistance to the beacon communities and evaluating the success of the program. Award announcements are expected in March 2010, with programs slated to begin in April 2010.

Meanwhile, ONC announced two significant changes to the funding for the Health Information Technology Regional Extension Center Program. Funding for the program was consolidated from three cycles into two, and the available amount of funding was increased from $598 million to $640 million. Available funding in the first round has increased from $189 million to $350 million and in the second round from $225 million to $290 million. ONC also accelerated the deadline for full applications in the second round from March 2 to Jan. 29th, with award announcements expected by the end of March.

Work Force Development

ONC announced $80 million in funding for health IT work force development, including $70 million for community college training programs and $10 million for developing educational materials to support these programs. In addition, one awardee will receive funding to become the National Training and Dissemination Center through which these curricula will be distributed and refined as necessary.

Eligible applicants include any U.S. not-for-profit institution of higher learning currently engaged in providing training in health IT. 

Full applications for the $10 million program were due Jan. 14, and applications for the $70 million program are due Jan. 22. Awards are expected to be announced by March 15.

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