There are numerous federal and state regulations concerning health information technology (HIT). This introduction provides background on several HIT topics with links to more information.
HITECH Act
Part of the American Recovery and Reinvestment Act of 2009 (ARRA), the Health Information Technology for Economic and Clinical Health Act (HITECH Act) provides a framework for health information technology development and usage. All provisions of the act are overseen by the Office of the National Coordinator for Health Information Technology (ONC), including:
- A Health Information Technology (HIT) Policy Committee
- A HIT Standards Committee
- Processes for adoption of policy and standards recommended by the committees
- Workforce investments
- Funding to provide technical assistance on best practices and assist health care providers to adopt, implement and effectively use certified electronic health records (EHRs)
Funding for technical assistance and provider assistance is distributed through Health Information Exchanges, HIT Research and HIT Regional Extension Centers (HIT RECs).
Part IV of HITECH details Medicare and Medicaid incentives for HIT adoption by health care professionals, prospective payment system (PPS) hospitals and critical access hospitals (CAHs). A financial incentive is available for eligible health care professionals and hospitals who can demonstrate the meaningful use of certified EHR technology.
Meaningful Use
Meaningful use is defined as using certified EHRs:
- In a meaningful manner, such as e-prescribing
- For electronic exchange of health information to improve health care quality
- To submit clinical quality and other measures
Criteria for meaningful use is set for three stages:
- Stage 1, which sets the baseline for electronic data capture and information sharing, was implemented in 2011
- Stage 2, which expands on the baseline, is expected to be implemented in 2012
- Stage 3, which also expands on the baseline, is expected to be implemented in 2015
According to the act, Stages 2 and 3 are to be developed through future rule making.
Incentives are awarded by both Medicare and Medicaid to eligible professionals and hospitals who attest to achievement of the set stages of meaningful use with a certified EHR technology based on set formulas for the costs incurred to adopt and implement such technology.
Standards and Certification
EHR technology standards and certification requirements have been issued by ONC to ensure that systems they adopt perform required functions in the manner they are to be delivered. These rules will increase interoperability, functionality, utility and security of HIT and support meaningful use. ONC created a certification program for testing and certifying HIT and identified an Approved Accreditor (AA) to accredit organizations for certifying EHR technology. To receive incentive payments under the Medicare and Medicaid EHR Incentive Program, eligible professionals and hospitals are required to use certified EHR technology.
Privacy and Security
To ensure health information exchanges are private and secure, the Health Insurance Portability and Accountability Act (HIPAA) Privacy & Security Rules have been modified. These rules extend the Office for Civil Rights’ enforcement to business associates and covered entities, strengthen individual rights to request and receive medical information electronically, and set new limits on the use and sale of individuals’ information. ONC evaluates potential privacy and security protections for health information exchange. It has awarded George Washington University a grant to conduct research analyzing legal and policy questions as they relate to privacy and security for electronic health records and health information.
Anti-fraud and Medical Identity Theft
ONC is also funding efforts to evaluate the scope of medical identify theft and to prevent and detect fraud in electronic medical records.
Training and Support
The HIT REC program supplies training, support, information, guidance and technical assistance for health care providers seeking to achieve meaningful use of EHRs. The goal is to provide outreach and support services to at least 100,000 priority primary care providers within two years. Sixty-two RECs have been established nationally and supplemental funding was awarded to 46 existing RECs to help eligible CAHs and rural hospitals adopt certified EHR technology.
A national HIT Research Center (HITRC) gathers information on effective practices and to help RECs work together to identify and share best practices in EHR adoption, meaningful use and provider support. Several programs are working to expand the availability of HIT professionals to support the movement to EHRs, as well as to support innovation and research on HIT adoption.
- Community College Consortia to Educate HIT Professionals Program
Established to help address the growing demand for highly skilled HIT specialists, and seeks to develop or improve non-degree HIT training programs students can complete in six months or less. Five regional groups of more than 70 member community colleges are participating in the program, which is expected to train 10,500 new HIT professionals annually by 2012.
- Program of Assistance for University-Based Training
Helps address growing demand for highly-skilled HIT specialists. It is designed to rapidly and sustainably increase the availability of role-specific HIT professionals requiring university-level training. Will establish new and/or expanded training programs while assuring graduates are prepared to fulfill their chosen HIT professional role. Nine colleges and universities were awarded grants to participate in the program.
- Beacon Community Program
Provides funding for communities to develop and enhance HIT infrastructure and exchange capabilities. These communities are to share and demonstrate a vision where hospitals, clinicians and patients collaborate as meaningful users of HIT. Funding was provided to 17 communities focusing on health system improvements in the areas of quality, cost-efficiency and population health within the local system of care.
- Strategic Health Information Technology Advanced Research Projects (SHARP) Program
Provides funds for research focused on achieving breakthrough advances to address well-documented problems impeding HIT adoption. Knowledge generated and innovations created from this program will accelerate progress toward meaningful use of HIT and a high-performing and adaptive health care system.
