Milestones Mark ARRA, HITECH First Quarter

The first quarter of 2011 brought a couple of notable milestones in the federal government’s implementation of the American Recovery and Reinvestment Act of 2009 — the arrival of a new national coordinator for health information technology and an invitation to the public to help define the country’s health IT strategy. This update summarizes key first-quarter ARRA developments — including those involving the Health Information Technology for Economic and Clinical Health Act.

David Blumenthal, former national coordinator for health IT, announced in February his intention to leave the Office of the National Coordinator for Health IT to return to Harvard University, where he was a practicing physician, tenured professor and researcher before President Obama named him to head ONC in March 2009. In April, he was replaced by Farzad Mostashari, ONC’s former deputy national coordinator.

ONC invited public comment on the Federal Health IT Strategic Plan for the next five years. The plan reflects ONC’s strategy, developed in collaboration with other federal partners, for realizing the federal government’s health IT agenda over the next five years. The comment period closed on May 6, 2011.

ONC Policy, Standards Committees Move Forward

At its February meeting, the Health IT Policy Committee approved the Privacy and Security Tiger Team’s recommendations for accurately matching patients with their data during health information exchange. The Tiger Team’s recommendations addressed the following areas: standardized formats for demographic data fields; internally evaluating matching accuracy; accountability; developing, promoting and disseminating best practices; and supporting the role of the individual/patient.

At the committee’s meeting in March, committee members endorsed the Quality Measures work group’s approach to developing recommendations for Stage 2 meaningful use clinical quality measures.

The Health IT Policy Committee’s Information Exchange work group’s Provider Directory Task Force worked on recommendations regarding individual-level provider directories that could facilitate health information exchange. The recommendations address the directory’s content, functional capabilities, operational requirements and use cases.

The Health IT Policy Committee’s newly created PCAST Report work group held its first meetings. The work group’s charge is to address issues raised in the President’s Council of Advisors on Science and Technology’s report on health IT, titled, “Realizing the Full Potential of Health Information Technology To Improve Healthcare for Americans: The Path Forward.” The work group is chaired by Paul Egerman and vice-chaired by William Stead.

In February, the Health IT Policy and Standards committees hosted a stakeholder meeting in Washington, D.C., to hear feedback on the PCAST Report. In March, the PCAST Report work group determined that integrating the report’s recommendations for a new exchange architecture into meaningful use criteria would not be feasible by the time Stage 2 criteria are required in 2013. Instead, the work group established a new Alternative Concepts Task Force to develop alternative pathways that would allow for implementation of the report’s exchange architecture recommendations in a series of incremental steps.

The Health IT Policy Committee’s Enrollment work group explored ways to establish a “verification hub,” or a central federal database to verify whether individuals are eligible for federal and state health and human services programs. The work group evaluated several “hub” models.

EHR Certification Final Rule Published

ONC published a final rule establishing the permanent program for ONC to authorize organizations to certify electronic health record technology. The permanent certification program will replace the existing temporary program by 2012. In contrast with the temporary program, the permanent program separates the testing and certifying of health IT products. The rule also expands the scope of the permanent certification program so that it may cover “other types” of health IT. According to the final rule, ONC will select one organization, called the ONC-Approved Accreditor, to accredit authorized certification bodies. In the near term, the National Institute of Standards and Technology, through its National Voluntary Laboratory Accreditation Program, will be responsible for accrediting groups to test health IT under the permanent certification program.

The Certification Commission for Health IT announced the launch of EHR Alternative Certification for Hospitals, an alternative certification program for hospitals’ existing and customized EHR systems. The EACH program is ONC-authorized to test and certify EHRs in 2011 and 2012 as part of ONC’s temporary EHR certification program.  Testing and certification would cost hospitals between approximately $7,600 and $32,000.

Outreach Grants for Regional Extension Centers

ONC announced an additional $32 million for regional extension centers in January. The funding is to encourage registration in the EHR Incentive Programs and to support additional technical assistance.

ONC awarded an additional $12 million to RECs in February for technical support assistance to help critical access hospitals and rural hospitals adopt and meaningfully use certified EHR technology. This funding follows the $20 million awarded to RECs in September 2010 to provide technical assistance to CAHs and rural hospitals.

As part of its Meaningful Use Vanguard program, ONC began recruiting “physician champions” who are well on their way to achieving meaningful use of EHRs. MUV participants will work with their REC to assist other providers to adopt and meaningfully use EHRs.

Medicare and Medicaid EHR Incentive Programs

As of April 15, 2011, the following states had opened registration for the Medicaid EHR Incentive Program during the first quarter of 2011: Alaska, Iowa, Kentucky, Louisiana, Michigan, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee and Texas.

ONC announced the release of results from two ONC-commissioned surveys conducted by the American Hospital Association and the National Center for Health Statistics regarding the number of providers who plan to earn meaningful use incentive payments. The AHA survey found that 81% of hospitals plan to participate in the Medicare and Medicaid EHR Incentive Programs, with about 65% of hospitals indicating that they would enroll during Stage 1. The NCHS survey found that 41% of office-based physicians are currently planning to participate; 32% of these intend to enroll during Stage 1.

In February, CMS’ Office of Public Affairs announced that over 21,000 providers registered for the Medicare and Medicaid EHR Incentive Programs in January and four states reported initial Medicaid incentive payments totaling almost $20.5 million.

Also in February, the Government Accountability Office released a report recommending that CMS expedite efforts to remove inconsistencies in requirements for physicians eligible for incentive payments or subject to penalties under its electronic prescribing and EHR programs. 

The National Committee for Quality Assurance released new standards for patient-centered medical homes. The standards emphasize federal health IT requirements, including those in the federal Medicare and Medicaid EHR Incentive Program regulation.

Health Information Exchange Grants Announced

ONC announced the award of $16 million in new Health Information Exchange “Challenge Grants” to eight State HIE Cooperative Agreement Program grantees. Grants will fund the development of innovative approaches to health information exchange that will be implemented in pilot sites and then shared, reused and leveraged by other states and communities to increase nationwide interoperability. Organizations in the following states received awards: Colorado, Georgia, Indiana, Maryland, Massachusetts, Montana, North Carolina and Oklahoma.

In February, ONC announced that providers and public health agencies in Minnesota and Rhode Island have begun exchanging health information using Direct Project specifications. The Direct Project is a collaborative effort to develop technical standards and services necessary to securely push content from a sender to a receiver. According to ONC, other Direct Project pilots are planned for California, New York, Connecticut, Tennessee, Texas and Oklahoma.

ONC awarded Surescripts a $1.4 million contract for the “measurement of clinical transactions through EHRs.” Under the contract, Surescripts will collect, report and analyze ongoing evidence of nationwide electronic exchange of clinical information, such as electronic prescribing, and submit reports to ONC at least quarterly. Surescripts is required to report its findings to ONC from September 2011 through December 2014.

Privacy, Security and Other Health IT Developments

The HHS Office for Civil Rights submitted to the Office of Management and Budget a proposed rule that would implement EHR accounting of disclosure provisions called for in HITECH. The proposed rule is expected to outline health care providers’ responsibilities when patients request information on disclosures involving their EHRs. OMB review is one of the final steps before the proposed rule is published in the Federal Register.

Other health IT developments during the first quarter include:

• The HHS Office of Inspector General released its FY 2011 work plan for assessing the appropriate use of funds provided to HHS under ARRA. OIG intends to investigate several projects related to health IT adoption, including the Medicare and Medicaid EHR Incentive Programs;
• The U.S. Department of Agriculture in January announced it awarded more than $34.7 million in grant funding to 106 projects in 38 states and one territory through its Distance Learning and Telemedicine Program. The grants will fund educational projects and expand access to health care services in rural areas;
• The National Quality Forum, at the request of HHS, converted 113 NQF-endorsed measures from a paper-based format to an electronic “eMeasure” format. The conversion will allow the measures to be more easily read by EHR systems;
• HHS launched the “Health Indicators Warehouse,” an online portal to enable health IT application developers’ access to de-identified, aggregated health data. The warehouse includes pre-tabulated national, state and local health indicators, reflecting multiple dimensions of population health, health care and health determinants;
• The Health Resources and Services Administration’s Maternal and Child Health Bureau announced the availability of two-year grants to expand technical infrastructure to allow the exchange of maternal and child immunization information, as well as projects to develop electronic birth records. Grant proposals were due March 28 for a projected Sept. 30, 2011 award date;
• CMS released “Electronic Health Records Demonstration Evaluation: Implementation Report 2010,” a report on its two-year Medicare EHR demonstration projects in the District of Columbia, Louisiana, Maryland, Pennsylvania and South Dakota;
• HHS Secretary Kathleen Sebelius announced winners of the second round of the HHSinnovates program, which launched in 2010 to recognize innovation efforts throughout HHS.  This round’s winners included a new public health reporting tool from the Indian Health Service in partnership with CDC, FDA, and a National Institutes of Health National Library of Medicine project adapting its widely used MedLinePlus information service to make it directly linkable to EHRs and PHRs; and
• CMS announced the renaming of the Advisory Panel on Medicare Education to the Advisory Panel on Outreach and Education. 

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