The federal government continues to implement various provisions of the American Recovery and Reinvestment Act, which included the Health Information Technology for Economic and Clinical Health Act. This update summarizes key developments during the second quarter of 2011.

ONC Leadership Changes, Committees March Onward

Farzad Mostashari replaced David Blumenthal as national coordinator for health information technology.  Mostashari, formerly deputy national coordinator at the Office of the National Coordinator for Health IT, took over the top job in April.

At its June meeting, the Health IT Policy Committee approved the Meaningful Use work group’s revised Stage 2 objectives and criteria and the recommendation to delay the transition from Stage 1 to Stage 2 by one year for providers who qualify for meaningful use incentives in 2011. The committee passed on its recommendations to ONC.

The Policy Committee also endorsed the Adoption and Certification work group’s letter summarizing feedback from an April hearing on improving electronic health record usability. The letter discusses the definition of usability, how it is measured and why it is important. It also summarizes findings from the hearing, which focused on the lack of consistent standards across EHR systems.

The Policy Committee also approved:

• The Privacy and Security Tiger Team’s amended recommendation related to digital certificates.  The amended recommendation requires that certificate authorities be cross-certified with the Federal Bridge certificate authority;
• The Information Exchange work group’s recommendations related to individual-level provider directories;
• The PCAST Report work group’s analysis and recommendations regarding the President’s Council of Advisors on Science and Technology report on health IT published in December 2010. The workgroup identified major policy and operational feasibility concerns with the technology vision put forward by the PCAST report, and suggested an incremental test-bed approach to achieving the health IT capabilities called for by the report; and
• The Privacy & Security Tiger Team’s recommendations on EHR user authentication, patient portals, and security assessments.

At its June meeting, the Health IT Standards Committee approved the Metadata Analysis Power Team’s recommendations on the necessary metadata elements and technology standards to enable, among other things, the unique identification of a patient and the privacy of the data.

At its meeting in April, the Standards Committee endorsed the Privacy and Security Standards work group’s recommendations on requirements and evaluation criteria for digital certificates to identify Nw-HIN and Direct Project participants. The Standards Committee sent the recommendations to ONC in April.

Meaningful Use Work Group Focuses on Specialists

The Meaningful Use work group hosted a public hearing in May to gather input from stakeholders about the needs of specialty providers who are currently implementing Stage 1 meaningful use requirements to further inform the group’s deliberations on Stage 2 and Stage 3 meaningful use criteria. At its meeting on June 1, the Meaningful Use work group decided it would seek to integrate specialists into Meaningful Use criteria by beginning to differentiate between criteria that are pertinent to specialty care and criteria that should be required only of primary care physicians.

The Health IT Policy Committee’s Privacy and Security Tiger Team collected comments on a privacy and security policy framework for electronic health information exchange in April and May. The group published a brief summary of relevant Health Insurance Portability and Accountability Act requirements and Tiger Team recommendations to date and requested comments from the public regarding any gaps in the framework that still need to be addressed.

The Health IT Standards Committee Implementation Workgroup collected public comments in May and June on the progress of the EHR temporary certification program.

Accreditor named for EHR Certification

In June, ONC announced the selection of the American National Standards Institute as the ONC-approved accreditor for the Permanent Certification Program for Health Information Technology.  ANSI will be responsible for accrediting organizations to certify EHR technology under the Permanent Certification Program, which is expected to replace the temporary program in 2012.

In May, the Certification Commission for Health Information Technology announced new EHR certification programs focusing on women’s health, oncology and clinical research. Existing CCHIT EHR certification programs cover cardiovascular medicine, children’s health, emergency departments, behavioral health, dermatology, and long-term and post-acute care. CCHIT began accepting certification applications for the new programs on June 2.

According to a June Federal Register notice, ONC intends to conduct online user experience surveys of regional extension center staff to evaluate the usefulness and usability of the National Health Information Technology Research Center, which provides assistance and support to RECs.

Medicare and Medicaid EHR Incentive Programs

CMS in May issued the first round of EHR incentive payments, totaling more than $75 million, to providers who signed up in the first two weeks of the Medicare EHR Incentive Program and who have successfully demonstrated meaningful use. Payments will continue to be made on a monthly basis to qualifying providers.

Alabama, Missouri, Pennsylvania and Washington opened registration for the Medicaid EHR Incentive Program during the second quarter of 2011, bringing the total number of states with operational programs to 17 as of June 30, 2011. According to CMS, additional states will launch their programs during the summer and fall this year (So far in Q3, four more states — Arizona, Connecticut, Rhode Island and West Virginia – have gone live with their Medicaid EHR incentive programs).

In May, CMS issued further guidance to state Medicaid programs on the use of administrative funds to support health information exchange as part of the Medicaid EHR Incentive Program.

The Department of Veterans Affairs announced plans for a rural health pilot project to launch this summer that will share veterans’ health records between VA facilities and private health care providers in southeastern Utah. The information exchange pilot will be among 11 other pilot projects that use the VA’s Virtual Lifetime Electronic Record to share information with participating local health practitioners, but it will be the first pilot to focus on rural health.

Privacy, HIPAA Rules Revisited

In May, HHS issued a notice of proposed rulemaking to modify the “accounting of disclosures” provision of the HIPAA Privacy Rule. The NPRM also implements and expands a provision of the HITECH Act that requires HIPAA-covered entities and their business associates to account for disclosures of protected health information to carry out treatment, payment, and health care operations if such disclosures are made through an EHR.

HHS released its plan for a departmentwide retrospective review of existing regulations in May. The plan is designed to eliminate or modify outdated, costly requirements, as called for in an executive order issued by President Obama in January. The department’s plan includes the review of certain rules pertaining to health IT privacy and security, including the HIPAA Privacy and Security Rules. Modifications to the Privacy and Security Rules will be incorporated in a broad final omnibus HIPAA rule expected to be released later this year.

The HHS Office of the Inspector General released a report evaluating ONC’s adoption of technology standards to protect the security of health information in health IT tools. The report found that ONC standards lack general IT security procedures, such as encrypting protected health care data on portable devices.

Health IT Work Force Program Graduates 3,000 Workers

The Health IT Work Force Development Program, created under Section 3016 of ARRA, was launched in 2010 with $36 million and received an additional $32 million in 2011 to fund university-based training of health IT professionals. In April, more than 3,000 individuals graduated from 82 Community College Consortia health IT training programs.

According to a Federal Register notice in April, ONC will conduct an evaluation of the Work Force Program consisting of focus groups and interviews with student participants.

ONC in May released a set of “HIT Pro” exams designed to evaluate the health IT competencies of individuals who have completed an ONC Work Force Development nondegree training program or professionals with relevant experience or other training.

Other Health IT Developments

• The American Diabetes Association announced a partnership with ONC and CDC to launch a nationwide program that will leverage health IT to prevent and manage diabetes. This fall, two ONC Beacon Community grantees, Southeast Michigan Beacon Community in Detroit and the Crescent City Beacon Community in New Orleans will launch new public health campaigns that rely on mobile health technology to help individuals assess their risk of type 2 diabetes and provide them with information and access to local resources. 
• In June, the Government Accountability Office released “HHS Research Awards: Use of Recovery Act and Patient Protection and Affordable Care Act Funds for Comparative Effectiveness Research,” a report on the use of ARRA and Affordable Care Act funds for comparative effectiveness research.
• The Human Resources Services Administration’s Office of Rural Health Policy solicited grant proposals under its Rural Health Information Technology Grant Program to assist rural providers who work in formal networks, alliances, coalitions or partnerships in their effort to effectively achieve meaningful use requirements. Grants will fund networks’ completion of strategic and business planning process, as well as their development of sound strategies for sustaining operations.

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