Final Rules for EHRs: Incentives, Certification, Standards –Preliminary Roundup

SECRETARY SEBELIUS ANNOUNCES FINAL RULES TO SUPPORT MEANINGFUL USE OF ELECTRONIC HEALTH RECORDS
July 13, 2010 Press Release from Centers for Medicare and Medicaid Services
Plus PDFs of Final Rules, Joint ONC/CMS Fact Sheet,
ONC and CMS Fact Sheets and FAQs
Blumenthal article from NEJM with Summary Matrix
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KEY LINKS:
Summary of
The “Meaningful Use” Regulation for Electronic Health Records
By David Blumenthal, MD, MPP, National Coordinator for Health IT
and Marilyn Tavenner, RN, MHA, Principal Deputy Administrator of CMS
New England Journal of Medicine, July 13, 2010
Includes matrix with Summary Overview of Meaningful Use Objectives
HTML Version PDF Version

Finding My Way to Electronic Health Records
By Regina Benjamin, MD, MBA, Surgeonn General, US Public Health Service
New England Journal of Medicine, July 13, 2010
HTML Version PDF Version

FINAL RULES
Medicare and Medicaid Programs;
Electronic Health Record Incentive Program [PDF]
http://www.ofr.gov/OFRUpload/OFRData/2010-17207_PI.pdf

Health Information Technology:
Initial Set of Standards, Implementation Specifications,
and Certification Criteria
for Electronic Health Record Technology [PDF]
http://www.ofr.gov/OFRUpload/OFRData/2010-17210_PI.pdf
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July 13, 2010 Press Release from CMS:
WASHINGTON – U.S. Department of Health and Human Services Secretary Kathleen Sebelius today announced final rules to help improve Americans’ health, increase safety and reduce health care costs through expanded use of electronic health records (EHR).

HHS Secretary Kathleen Sebelius

“For years, health policy leaders on both sides of the aisle have urged adoption of electronic health records throughout our health care system to improve quality of care and ultimately lower costs,” Secretary Sebelius said. “Today, with the leadership of the President and the Congress, we are making that goal a reality.”

Under the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009, eligible health care professionals and hospitals can qualify for Medicare and Medicaid incentive payments when they adopt certified EHR technology and use it to achieve specified objectives. One of the two regulations announced today defines the “meaningful use” objectives that providers must meet to qualify for the bonus payments, and the other regulation identifies the technical capabilities required for certified EHR technology.

Announcement of today’s regulations marks the completion of multiple steps laying the groundwork for the incentive payments program. With “meaningful use” definitions in place, EHR system vendors can ensure that their systems deliver the required capabilities, providers can be assured that the system they acquire will support achievement of “meaningful use” objectives, and a concentrated five-year national initiative to adopt and use electronic records in health care can begin.

“This is a turning point for electronic health records in America , and for improved quality and effectiveness in health care,” said David Blumenthal, M.D., National Coordinator for Health Information Technology. “In delivering on the goals that Congress called for, we have sought to provide the leadership and coordination that are essential for a large, technology-based enterprise. At the same time, we have sought and received extensive input from the health care community, and we have drawn on their experience and wisdom to produce objectives that are both ambitious and achievable.”

Two companion final rules were announced today. One regulation, issued by the Centers for Medicare & Medicaid Services (CMS), defines the minimum requirements that providers must meet through their use of certified EHR technology in order to qualify for the payments. The other rule, issued by the Office of the National Coordinator for Health Information Technology (ONC), identifies the standards and certification criteria for the certification of EHR technology, so eligible professionals and hospitals may be assured that the systems they adopt are capable of performing the required functions.

As much as $27 billion may be expended in incentive payments over ten years. Eligible professionals may receive as much as $44,000 under Medicare and $63,750 under Medicaid, and hospitals may receive millions of dollars for implementation and meaningful use of certified EHRs under both Medicare and Medicaid.

The CMS rule announced today makes final a proposed rule issued on Jan, 13, 2010. The final rule includes modifications that address stakeholder concerns while retaining the intent and structure of the incentive programs. In particular, while the proposed rule called on eligible professionals to meet 25 requirements (23 for hospitals) in their use of EHRs, the final rules divides the requirements into a “core” group of requirements that must be met, plus an additional “menu” of procedures from which providers may choose. This “two track” approach ensures that the most basic elements of meaningful EHR use will be met by all providers qualifying for incentive payments, while at the same time allowing latitude in other areas to reflect providers’ needs and their individual path to full EHR use.

“CMS received more than 2,000 comments on our proposed rule,” said Marilyn Tavenner, Principal Deputy Administrator of CMS. “Many comments were from those who will be most immediately affected by EHR technology – health care providers and patients. We carefully considered every comment and the final meaningful use rules incorporate changes that are designed to make the requirements achievable while meeting the goals of the HITECH Act.”

Requirements for meaningful use incentive payments will be implemented over a multi-year period, phasing in additional requirements that will raise the bar for performance on IT and quality objectives in later years. The final CMS rule specifies initial criteria that eligible professionals (EPs) and eligible hospitals, including critical access hospitals (CAHs), must meet. The rule also includes the formula for the calculation of the incentive payment amounts; a schedule for payment adjustments under Medicare for covered professional services and inpatient hospital services provided by EPs, eligible hospitals and CAHs that fail to demonstrate meaningful use of certified EHR technology by 2015; and other program participation requirements.

Key changes in the final CMS rule include:

Greater flexibility with respect to eligible professionals and hospitals in meeting and reporting certain objectives for demonstrating meaningful use. The final rule divides the objectives into a “core” group of required objectives and a “menu set” of procedures from which providers may choose any five to defer in 2011-2012. This gives providers latitude to pick their own path toward full EHR implementation and meaningful use.
An objective of providing condition-specific patient education resources for both EPs and eligible hospitals and the objective of recording advance directives for eligible hospitals, in line with recommendations from the Health Information Technology Policy Committee.
A definition of a hospital-based EP as one who performs substantially all of his or her services in an inpatient hospital setting or emergency room only, which conforms to the Continuing Extension Act of 2010
CAHs within the definition of acute care hospital for the purpose of incentive program eligibility under Medicaid.

CMS’ and ONC’s final rules complement two other recently issued HHS rules. On June 24, 2010, ONC published a final rule establishing a temporary certification program for health information technology. And on July 8, 2010 the Office for Civil Rights announced a proposed rule that would strengthen and expand privacy, security, and enforcement protections under the Health Insurance Portability and Accountability Act of 1996.

As part of this process, HHS is establishing a nationwide network of Regional Extension Centers to assist providers in adopting and using in a meaningful way certified EHR technology.

“Health care is finally making the technology advances that other sectors of our economy began to undertake years ago,” Dr. Blumenthal said. “These changes will be challenging for clinicians and hospitals, but the time has come to act. Adoption and meaningful use of EHRs will help providers deliver better and more effective care, and the benefits for patients and providers alike will grow rapidly over time.”

A CMS/ONC fact sheet on the rules is available at http://www.cms.gov/EHRIncentivePrograms/

Technical fact sheets on CMS’s final rule are available at http://www.cms.gov/EHRIncentivePrograms/

A technical fact sheet on ONC’s standards and certification criteria final rule is available at http://healthit.hhs.gov/standardsandcertification.

RULES:
Medicare and Medicaid Programs; Electronic Health Record Incentive Program [PDF]
http://www.ofr.gov/OFRUpload/OFRData/2010-17207_PI.pdf

Health Information Technology: Initial Set of Standards, Implementation Specifications, and Certification Criteria for Electronic Health Record Technology [PDF]http://www.ofr.gov/OFRUpload/OFRData/2010-17210_PI.pdf

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ONC: Electronic Health Records and Meaningful Use
Information for Providers
Information for Consumers

Information excerpted from ONC pages on July 13, 2010.
Electronic health records can provide many benefits for providers and their patients:

Complete and accurate information. With electronic health records, providers have the information they need to provide the best possible care.Providers will know more about their patients and their health history before they walk into the examination room.

Better access to information. Electronic health records facilitate greater access to the information providers need to diagnose health problems earlier and improve the health outcomes of their patients. Electronic health records also allow information to be shared more easily among doctors’ offices, hospitals, and across health systems, leading to better coordination of care.

Patient empowerment. Electronic health records will help empower patients to take a more active role in their health and in the health of their families. Patients can receive electronic copies of their medical records and share their health information securely over the Internet with their families.

Currently, most health care providers still use medical record systems based on paper. New government incentives and programs are helping health care providers across the country make the switch to electronic health records.

Why Electronic Health Records?
Electronic health records can improve care by enabling functions that paper medical records cannot deliver:

EHRs can make a patient’s health information available when and where it is needed – too often care has to wait because the chart is in one place and needed in another. EHRs enable clinicians secure access to information needed to support high quality and efficient care
EHRs can bring a patient’s total health information together to support better health care decisions, and more coordinated care
EHRs can support better follow-up information for patients – for example, after a clinical visit or hospital stay, instructions and information for the patient can be effortlessly provided; and reminders for other follow-up care can be sent easily or even automatically to the patient.
EHRs can improve patient and provider convenience – patients can have their prescriptions ordered and ready even before they leave the provider’s office, and insurance claims can be filed immediately from the provider’s office.

Background: Legislation and RegulationsThe Health Information Technology for Economic and Clinical Health (HITECH) Act provides HHS with the authority to establish programs to improve health care quality, safety, and efficiency through the promotion of health information technology (HIT), including electronic health records and private and secure electronic health information exchange.Under HITECH, eligible health care professionals and hospitals can qualify for Medicare and Medicaid incentive payments when they adopt certified EHR technology and use it to achieve specified objectives. Two regulations have been released, one of which defines the “meaningful use” objectives that providers must meet to qualify for the bonus payments, and the other which identifies the technical capabilities required for certified EHR technology.

Incentive Program for Electronic Health Records: Issued by the Centers for Medicare & Medicaid Services (CMS), this final rule defines the minimum requirements that providers must meet through their use of certified EHR technology in order to qualify for the payments.
Standards and Certification Criteria for Electronic Health Records: Issued by the Office of the National Coordinator for Health Information Technology, this rule identifies the standards and certification criteria for the certification of EHR technology, so eligible professionals and hospitals may be assured that the systems they adopt are capable of performing the required functions.

JOINT ONC/CMS FACT SHEET
CMS AND ONC FINAL REGULATIONS DEFINE MEANINGFUL USE AND SET STANDARDS FOR ELECTRONIC HEALTH RECORD INCENTIVE PROGRAM
Excerpted from CMS site on July 13, 2010.
The Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC) today announced two complementary final rules to implement the electronic health records (EHR) incentive program under the Health Information Technology for Economic and Clinical Health (HITECH) Act.

Enacted as part of the American Recovery and Reinvestment Act (ARRA) of 2009, the HITECH Act supports the adoption of electronic health records by providing financial incentives under Medicare and Medicaid to hospitals and eligible professionals who implement and demonstrate “meaningful use” certified EHR technology. The CMS regulations announced today specify the objectives that providers must achieve in payment years 2011 and 2012 to qualify for incentive payments; the ONC regulations specify the technical capabilities that EHR technology must have to be certified and to support providers in achieving the “meaningful use” objectives.

The final CMS rule:

Specifies initial criteria that eligible professionals (EPs), eligible hospitals, and critical access hospitals (CAHs) must meet to demonstrate meaningful use and qualify for incentive payments.
Includes both “core” criteria that all providers must meet to qualify for payments, while also allowing provider choice among a “menu set” of additional criteria.
Outlines a phased approach to implement the requirements for demonstrating meaningful use. This approach initially establishes criteria for meaningful use based on currently available technological capabilities and providers’ practice experience. CMS will establish graduated criteria for demonstrating meaningful use through future rulemaking, consistent with anticipated developments in technology and providers’ capabilities.

The CMS rule finalizes a Notice of Proposed Rulemaking published on Jan 13, 2010.

The final ONC rule:

Sets initial standards, implementation specifications, and certification criteria for EHR technology under the incentive program.
Coordinates the standards required of EHR systems with the meaningful use requirements for eligible professionals and hospitals
With these standards in place, providers can be assured that the certified EHR technology they adopt is capable of performing the required functions to comply with CMS’ meaningful use requirements and other administrative requirements of the Medicare and Medicaid EHR incentive programs.

ONC’s standards and certification criteria final rule completes the adoption of an initial set of standards, implementation specifications and certification criteria that was begun with publication of ONC’s on Jan. 13, 2010.

Timetable for Implementation
The HITECH Act states that payments for Medicare providers may begin no sooner than October 2010 for eligible hospitals and January 2011 for EPs. The final rule aligns the Medicare and Medicaid program start dates. Key steps in the implementation timeline include:

ONC began accepting applications from entities that seek approval as an ONC-Authorized Testing and Certification Body (ONC-ATCB) on July 1, 2010.

ONC projects that certified EHR software will be available for purchase by hospitals and eligible professionals by fall, 2010.

Registration by both EPs and eligible hospitals with CMS for the EHR incentive program will begin in January 2011. Registration for both the Medicare and Medicaid incentive programs will occur at one virtual location, managed by CMS.
For the Medicare program, attestations may be made starting in April 2011 for both EPs and eligible hospitals.
Medicare EHR incentive payments will begin in mid May 2011.
States will be initiating their incentive programs on a rolling basis, subject to CMS approval of the State Medicaid HIT plan, which details how each State will implement and oversee its incentive program.

The “Meaningful Use” Model
By focusing on the effective use of EHRs with certain capabilities, the HITECH Act makes clear that the adoption of records is not a goal in itself: it is the use of EHRs to achieve health and efficiency goals that matters. HITECH’s incentives and assistance programs seek to improve the health of Americans and the performance of their health care system through “meaningful use” of EHRs to achieve five health care goals:

To improve the quality, safety, and efficiency of care while reducing disparities;
To engage patients and families in their care;
To promote public and population health;
To improve care coordination; and
To promote the privacy and security of EHRs.

In the context of the EHR incentive programs, “demonstrating meaningful use” is the key to receiving the incentive payments. It means meeting a series of objectives that make use of EHRs’ potential and related to the improvement of quality, efficiency and patient safety in the healthcare system through the use of certified EHR technology.

Coordinated Approach to Support EHR Adoption
CMS’ and ONC’s final rules complement two other rules that were recently issued. On June 24, 2010, ONC published a final rule to establish a temporary certification program for health information technology. And on July 8, 2010, the Office for Civil Rights announced a proposed rule that would strengthen and expand privacy, security, and enforcement protections under the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

Together the four rules are key components of the regulatory structure needed to administer the EHR incentive program and to meet the goals of the HITECH Act:

The assurance of privacy protections is fundamental to the success of EHR adoption. The refinements and expansions of HIPAA provisions announced July 8 form an important base for EHR acceptance and use.

The temporary certification process published June 24 establishes a process through which organizations can be approved as certifying entities to which vendors may submit their EHR systems for review and certification.
The ONC rule announced today identifies the technical standards which must be met in the certification process, and coordinates those requirements with the meaningful use objectives.
Finally, the CMS rule announced today establishes guidelines and requirements on achieving meaningful use in clinical settings and qualifying for incentive payments based on this meaningful use.

Key Provisions of the Final Rule
CMS’s final meaningful use rule incorporates changes from the proposed rule on meaningful use that are designed to make the requirements more readily achievable while meeting the goals of the HITECH Act. For Stage 1, which begins in 2011, the criteria for meaningful use focus on electronically capturing health information in a coded format, using that information to track key clinical conditions, communicating that information for care coordination purposes, and initiating the reporting of clinical quality measures and public health information.

The final rule reflects significant changes to the proposed rule while retaining the intent and structure of the incentive programs. Key provisions in the final rule include:

For Stage 1, CMS’s proposed rule called on physicians and other eligible professionals to meet 25 objectives (23 for hospitals) in reporting their meaningful use of EHRs. The final rule divides the objectives into a “core” group of required objectives and a “menu set” of procedures from which providers can choose. This “two track” approach ensures that the most basic elements of meaningful EHR use will be met by all providers qualifying for incentive payments, while at the same time allowing latitude in other areas to reflect providers’ varying needs and their individual paths to full EHR use.
In line with recommendations of the Health Information Technology Policy Committee, the final rule includes the objective of providing patient-specific educational resources for both EPs and eligible hospitals and the objective of recording advance directives for eligible hospitals.
With respect to defining hospital-based physicians, the final rule conforms to the Continuing Extension Act of 2010. That law addressed provider concerns about hospital-based providers in ambulatory settings being unable to qualify for incentive payments by defining a hospital-based EP as performing substantially all of his or her services in an inpatient hospital setting or emergency room only.
The rule makes final a proposed rule definition that would make individual payments to eligible hospitals identified by their individual CMS Certification Number. The final rule retains the proposed definition of an eligible hospital because that is most consistent with policy precedents in how Medicare has historically applied the statutory definition of a ”subsection (d)” hospital under other hospital payment regulations.
Under Medicaid, the final rule includes critical access hospitals (CAHs) in the definition of acute care hospital for the purpose of incentive program eligibility.

The final rule’s economic analysis estimates that incentive payments under Medicare and Medicaid EHR programs for 2011 through 2019 will range from $9.7 billion to $27.4 billion.

Development of the Rules
CMS and ONC worked closely to develop the two rules and received input from hundreds of technical subject matters experts, health care providers, consumers, and other key stakeholders. Numerous public meetings to solicit public comment were held by three Federal advisory committees: the National Committee on Vital and Health Statistics (NCVHS), the HIT Policy Committee (HITPC), and the HIT Standards Committee (HITSC). HITSC presented its final recommendations to the National Coordinator in August 2009.

CMS published its proposed rule on Jan. 13, 2010. The agency actively solicited comments on its proposal and received more than 2,000 submissions by the close of the 60-day comment period. These comments, along with the input from advisory groups and outreach activities, were given careful consideration in developing the regulations announced today.
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ELECTRONIC HEALTH RECORDS AT A GLANCE
CMS FACT SHEET With Frequently Asked Questions
Excerpted from CMS site on July 14, 2010.

“Our recovery plan will invest in electronic health records and new technology that will reduce errors, bring down costs, ensure privacy and save lives.”
- President Obama, Address to Joint Session of Congress, February 2009

Background
As promised by the President, the American Recovery and Reinvestment Act of 2009 included under which, according to current estimates, as much as $27 billion over ten years will be expended to support adoption of electronic health records (EHRs). While there has been bipartisan support for EHR adoption for at least half a decade, this is the first substantial commitment of federal resources to support adoption and help providers identify the key functions that will support improved care delivery.

Under the Health Information Technology for Economic and Clinical Health Act (HITECH), federal incentive payments will be available to doctors and hospitals when they adopt EHRs and demonstrate use in ways that can improve quality, safety and effectiveness of care. Eligible professionals can receive as much as $44,000 over a five-year period through Medicare. For Medicaid, eligible professionals can receive as much as $63,750 over six years. Medicaid providers can receive their first year’s incentive payment for adopting, implementing and upgrading certified EHR technology but must demonstrate meaningful use in subsequent years in order to qualify for additional payments.

Since enactment of HITECH in February 2009, the Office of the National Coordinator for Health Information Technology (ONC), the Centers for Medicare & Medicaid Services (CMS) and other HHS agencies have been laying the groundwork for the massive national investment in EHRs:

Creation of Regional Extension Centers (RECs) to support providers in adopting EHRs
Developing workforce training programs
Identifying “Beacon Communities” that lead the way in adoption and use of EHRs
Developing capabilities for information exchange, including building toward a Nationwide Health Information Network
Improving privacy and security provisions of federal law, to bolster protection for electronic records
Creating a process to certify EHR technology, so providers can be assured that the EHR technology they acquire will perform as needed
Identifying standards for certification of products, tied to “meaningful use” of EHRs
Identifying the “meaningful use” objectives that providers must demonstrate to qualify for incentive payments.
Supporting State Medicaid Agencies in the planning and development of their Medicaid EHR Incentive programs with 90/10 matching funds.

Why EHRs?
Electronic health records improve care by enabling functions that paper records cannot deliver:

EHRs can make a patient’s health information available when and where it is needed – it is not locked away in one office or another.
EHRs can bring a patient’s total health information together in one place, and always be current – clinicians need not worry about not knowing the drugs or treatments prescribed by another provider, so care is better coordinated.
EHRs can support better follow-up information for patients – for example, after a clinical visit or hospital stay, instructions and information for the patient can be effortlessly provided; and reminders for other follow-up care can be sent easily or even automatically to the patient.
EHRs can improve patient and provider convenience – patients can have their prescriptions ordered and ready even before they leave the provider’s office, and insurance claims can be filed immediately from the provider’s office.
EHRs can link information with patient computers to point to additional resources – patients can be more informed and involved as EHRs are used to help identify additional web resources.
EHRs don’t just “contain” or transmit information, they also compute with it – for example, a qualified EHR will not merely contain a record of a patient’s medications or allergies, it will also automatically check for problems whenever a new medication is prescribed and alert the clinician to potential conflicts.
EHRs can improve safety through their capacity to bring all of a patient’s information together and automatically identify potential safety issues — providing “decision support” capability to assist clinicians.
EHRs can deliver more information in more directions, while reducing “paperwork” time for providers –for example, EHRs can be programmed for easy or automatic delivery of information that needs to be shared with public health agencies or quality measurement, saving clinician time.
EHRs can improve privacy and security – with proper training and effective policies, electronic records can be more secure than paper.
EHRs can reduce costs through reduced paperwork, improved safety, reduced duplication of testing, and most of all improved health through the delivery of more effective health care.

Why “meaningful use” requirements?
EHRs do not achieve these benefits merely by transferring information from paper form into digital form. EHRs can only deliver their benefits when the information and the EHR are standardized and “structured” in uniform ways, just as ATMs depend on uniformly structured data. Therefore, the “meaningful use” approach requires identification of standards for EHR systems. These are contained in the ONC Standards and Certification regulation announced on July 13, 2010.

Similarly, EHRs cannot achieve their full potential if providers don’t use the functions that deliver the most benefit – for example, exchanging information, and entering orders through the computer so that the “decision support” functions and other automated processes are activated. Therefore, the “meaningful use” approach requires that providers meet specified objectives in the use of EHRs, in order to qualify for the incentive payments. For example: basic information needs to be entered into the qualified EHR so that it exists in the “structured” format; information exchange needs to begin; security checks need to be routinely made; and medical orders need to be made using Computerized Provider Order Entry (CPOE). These requirements begin at lower levels in the first stage of meaningful use, and are expected to be phased in over five years. Some requirements are “core” needs, but providers are also given some choice in meeting additional criteria from a “menu set.”

Identification of the “meaningful use” goals and standards is the keystone to successful national adoption of EHRs. The announcement of final “meaningful use” regulations on July 13, 2010, marks the launch of the Nation’s push for EHR adoption and use.

Looking ahead
What is the timetable for approving the organizations that will certify EHR systems as qualifying for “meaningful use?”

ONC anticipates that the first entities will be authorized as ONC-ATCBs before the end of summer.

How soon can we expect certified EHR systems to be available?

We anticipate that certified EHR systems will be available later in the fall.

How will be the CMS EHR incentive program registration process work?

Medicare: Hospitals and eligible professionals can register for the program starting in January 2011. Once the programs begin, a link on the Registration web page on http://cms.gov/EHRIncentivePrograms/ will be available. Providers can use this central website to get information about the program and link to the programs’ online registration system.
Medicaid: The registration process will be the same for the Medicaid Incentive Program as for Medicare. A link on the Registration web page on http://cms.gov/EHrIncentivePrograms/ will be available when the program begins. Eligible Providers under the Medicaid Incentive Program can register at this site whether or not their state has initiated their program yet and CMS will pass their information on the state once the state initiates their program.

How will providers demonstrate that they have achieved the “meaningful use” objectives required by the regulation?

For 2011, CMS will accept provider attestations for demonstration of all the meaningful use measures, including clinical quality measures. Starting in 2012, CMS will continue attestation for most of the meaningful use objectives but plans to initiate the electronic submission of the clinical quality measures. States will also support attestation initially and then subsequent electronic submission of clinical quality measures for Medicaid providers’ demonstration of meaningful use.

How and when will incentive payments be made?

CMS expects to initiate Medicare incentive payments nine months after the publication of the final rule. For Medicaid, States are determining their own deadlines for launching their Medicaid EHR Incentive programs but are required to make timely payments, per the CMS final rule. CMS expects that the majority of States will have launched their programs by the summer of 2011.

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Standards and Certification Criteria Final Rule:
Fact Sheet
Excerpted from ONC site on July 14, 2010

The Health Information Technology for Economic and Clinical Health (HITECH) Act provides HHS with the authority to establish programs to improve health care quality, safety, and efficiency through the promotion of health information technology (HIT), including electronic health records (EHRs) and private and secure electronic health information exchange.

The HITECH Act directs the Office of the National Coordinator for Health Information Technology (ONC) to support and promote meaningful use of certified EHR technology nationwide through the adoption of standards, implementation specifications, and certification criteria as well as the establishment of certification programs for HIT.

About the Standards and Certification Criteria Final Rule
Two companion regulations were announced today. ONC’s final rule complements a final rule announced by the Centers for Medicare & Medicaid Services (CMS) that defines the minimum requirements that providers must meet through their use of EHRs in order to qualify for payments under the Medicare and Medicaid EHR incentive programs. The ONC rule establishes the required capabilities and related standards and implementation specifications that Certified EHR Technology will need to include to, at a minimum, support the achievement of meaningful use Stage 1 by eligible health care providers under the Medicare and Medicaid EHR Incentive Program regulations.

What Standards and Certification Criteria Mean for Health Care Providers
Both the Medicare and Medicaid EHR incentive programs include a requirement related to certified EHR technology. Under the Medicare EHR incentive program, eligible health care providers may receive incentive payments if they adopt and meaningfully use certified EHR technology (Complete EHR or EHR Modules that have been certified by an Office of the National Coordinator for Health Information Technology-Authorized Testing and Certification Body (ONC-ATCB)). Under the Medicaid EHR incentive program, eligible health care providers may first adopt, implement, or upgrade to certified EHR technology in their first year of the program and receive an incentive payment before having to meaningfully use certified EHR technology. The standards and certification criteria final rule specifies the necessary technological capabilities EHR technology will need to include, for the EHR technology to be certified by an ONC-ATCB. Additionally, it specifies how eligible health care providers will need to use the certified EHR technology to meet applicable meaningful use requirements.

What Standards and Certification Criteria Mean for Developers of EHR Technology
Developers of EHR technology who design their EHR technology in accordance with this final rule and subsequently get their EHR technology tested and certified by an ONC authorized testing and/or certified entity are assured that their EHR technology can be adopted by eligible health care providers who seek to achieve meaningful use Stage 1.For other questions related to the standards and certification criteria, please email onc.request@hhs.gov

Standards and Certification Criteria, visit http://healthit.hhs.gov/standardsandcertification
Medicare and Medicaid EHR incentive programs, visit http://www.cms.gov/EHRIncentivePrograms/

Standards and Certifications Criteria Final Rule:
Frequently Asked Questions
Excerpted from ONC site on July 14, 2010.

A. Background/GeneralKey Messages

Health Care Providers: Key Points
Both the Medicare and Medicaid electronic health record (EHR) incentive programs include a requirement related to certified EHR technology. Under the Medicare EHR incentive program, eligible health care providers must adopt and meaningfully use certified EHR technology (Complete EHR or EHR Modules that have been certified by an Office of the National Coordinator for Health Information Technology-Authorized Testing and Certification Body (ONC-ATCB)). Under the Medicaid EHR incentive program, eligible health care providers may first adopt, implement, or upgrade to certified EHR technology in their first year of the program and receive an incentive payment before having to meaningfully use certified EHR technology. The standards and certification criteria final rule specifies the necessary technological capabilities EHR technology will need to include in order be certified by an ONC-ATCB and subsequently used by eligible health care providers to meet applicable meaningful use requirements.

Developers of EHR Technology: Key Points
Developers of EHR technology who design their EHR technology in accordance with this final rule and subsequently get their EHR technology tested and certified by an ONC-ATCB are assured that their EHR technology can be adopted by eligible health care providers who seek to achieve meaningful use Stage 1.

B. Standards and Certification

B1. What is the standards and certification criteria final rule?
The final rule establishes the required capabilities and related standards and implementation specifications that Certified EHR Technology will need to include to, at a minimum, support the achievement of meaningful use Stage 1 by eligible health care providers under the Medicare and Medicaid EHR Incentive Programs.

B2. What are the major differences between the standards and certification interim final rule and the final rule?
In large part, the final rule is very similar to the interim final rule. However, in response to public comments, the final rule clarifies or revises certain standards and certification criteria. As noted in the final rule, some of the adopted certification criteria were revised to realign with changes to the Medicare and Medicaid EHR Incentive Programs final rule.

B3. What is the difference between a Complete EHR and an EHR Module?
Complete EHR refers to EHR technology that has been developed to meet, at a minimum, all applicable certification criteria adopted by the Secretary. For Complete EHRs designed for an ambulatory setting this means all of the certification criteria adopted at 45 CFR 170.302 and 45 CFR 170.304. For Complete EHRs designed for an inpatient setting this means all of the certification criteria adopted at 45 CFR 170.302 and 45 CFR 170.306. These certification criteria represent the minimum capabilities EHR technology needs to include and have properly implemented in order to achieve certification. They do not preclude Complete EHR developers from including additional capabilities that are not required for the purposes of certification.

EHR Module refers to any service, component, or combination thereof that meets at least one certification criterion adopted by the Secretary. EHR Modules, by definition, must provide a capability that can be tested and certified in accordance with at least one certification criterion adopted by the Secretary. Therefore, if an EHR Module does not provide a capability that can be tested and certified at the present time, it is not HIT that would meet the definition of EHR Module. We stress “at the present time,” because as new certification criteria are adopted by the Secretary, other HIT could be developed and then tested and certified in accordance with the new certification criteria as EHR Modules. An EHR Module could provide a single capability required by one certification criterion or it could provide all capabilities but one, required by the certification criteria for a Complete EHR. In other words, we would call HIT tested and certified to one certification criterion an “EHR Module” and HIT tested and certified to nine certification criteria an “EHR Module,” where ten certification criteria are required for a Complete EHR.

B4. CMS has specified a number of clinical quality measures for meaningful use. What clinical quality measures must EHR technology include in order to be certified?
In order to be certified, a Complete EHR or EHR Module designed for an ambulatory setting must be tested and certified as including at least nine clinical quality measures specified by CMS – all six of the core (three core and three alternate core) clinical quality measures specified, and at least three of the additional measures. Complete EHR and EHR Module developers may include as many clinical quality measures above that requirement as they see fit.A Complete EHR or EHR Module designed for an inpatient setting must include and will be required to be tested and certified to all of the clinical quality measures specified by CMS.

B5. Does EHR technology need to include administrative transactions capabilities?
No, we have removed these capabilities as conditions of certification for EHR technology in support of meaningful use Stage 1, but intend to revisit their inclusion for Stage 2.

C. Certification Process

C1. Where can I find out about the certification process?
For more information on the temporary certification program and the certification process, visit http://healthit.hhs.gov/tempcert.

D. Comments on the Interim Final Rule

D1. Where can I learn about how my comments on the interim final rule on standards and certification criteria, issued in January, were addressed in the final rule?
ONC staff carefully reviewed and considered each of the approximately 400 timely comments received on the standards and certification criteria interim final rule. Section III of the standards and certification criteria final rule discusses how the comments were addressed and incorporated into the final rule.

E. Related Rules

E1. How is this final rule related to the Medicare and Medicaid EHR Incentive Programs final rule?This final rule completes the adoption of an initial set of standards, implementation specifications, and certification criteria, and more closely aligns such standards, implementation specifications, and certification criteria with final meaningful use Stage 1 objectives and measures. Adopted certification criteria establish the required capabilities and specify the related standards and implementation specifications that certified EHR technology will need to include to, at a minimum, support the achievement of meaningful use Stage 1 by eligible professionals, eligible hospitals, and/or critical access hospitals.

HHS Press Briefing Webcast: Meaningful Use, Standards, Certification: July 13 10:00 AM ET

Posted on July 13, 2010 by Mike Squires

July 13, 2010 10:00 AM Live Webcast
“CMS and ONC will host a press briefing (on Tuesday, July 13, 2010 at 10:00 a.m. EDT) to announce the final rules on Meaningful Use and Standards and Certification under the HITECH Act’s Electronic Health Records (EHR) incentive program.”

See the e-Healthcare Marketing post published after the press briefing, with CMS Press Release, Joint ONC/CMS Fact Sheet; andtwo PDFs of new rules covering Meaningful Use, Incentives, Certification, and Standards. The Press briefing is below.

Presenters will include
Kathleen Sebelius
          Secretary, U.S. Department of Health and Human Services
Donald Berwick, M.D
          Administrator, Center for Medicare & Medicaid Services
David Blumenthal, M.D., M.P.P.
          National Coordinator for Health Information Technology
Regina Benjamin, M.D., M.B.A.
          Surgeon General

This video Webcast is also available on YouTube.

Related Links which we expect will be updated later today, July 13, 2010.
ONC Section on Meaningful Use
ONC Section on Standards & Certification
CMS Section on EHR Incentives
CMS Section on Meaningful Use
CMS Section on Certification

PwC CIO Survey: ‘Ready or not: On the road to meaningful use of EHRs and health IT’

Posted on July 3, 2010 by Mike Squires

Survey: eight in ten hospital CIO members of CHIME concerned they won’t meet standards in time
Pricewaterhouse Press Release of June 29, 2010 in full below.
NEW YORK, June 29, 2010 – A year and a half after the American Recovery and Reinvestment Act allocated billions of dollars to help hospitals and doctors purchase equipment to computerize patient medical records, even the most sophisticated hospitals in the country are struggling to qualify for the payments. Eight in 10 hospital chief information officers (CIOs) surveyed by PricewaterhouseCoopers LLP said they are concerned or very concerned they will not be able to demonstrate “meaningful use” of electronic health records (EHR) within the federally established deadline of 2015, according to a report entitled Ready or not: On the road to the meaningful use of EHRs and health IT, published today by PricewaterhouseCoopers’ Health Research Institute (HRI).

PricewaterhouseCoopers’ survey of 120 hospital CIOs who are members of the College of Healthcare Information Management Executives (CHIME) found:

Only half of the hospitals and health system CIOs surveyed say they will be prepared to meet the first set of meaningful use requirements and apply for incentive bonuses in 2011, the first year they are available.
CIOs interviewed for the report said they also were concerned about meeting later-stage requirements within the specified time frames. These requirements include (1) advancing care processes through decision support; (2) providing and populating patients’ personal health records; and (3) improving health outcomes through data-sharing outside their own organizations, such as with insurers, patients and other providers.

The promise of stimulus funding has accelerated EHR adoption and the collection of massive amounts of electronic health data as hospitals and physicians across the country race to meet eligibility requirements. But the existing infrastructure to support meaningful use of EHRs on a national health information superhighway is insufficient, according to the CIOs interviewed by PricewaterhouseCoopers.

“Healthcare organizations are building high-performance race cars to travel back country roads,” said Daniel Garrett, leader of the health information technology practice, PricewaterhouseCoopers. “Furthermore, we found many healthcare providers are mired in the complexity of incentive-rule criteria and may not be working toward longer-term goals for meaningful EHR usage. The bottom line is improved quality of care and patient safety, delivered more efficiently. Government leaders and health organizations need to give consideration to the ultimate goal as they work to finalize and meet guidelines for meaningful use.”

According to PricewaterhouseCoopers’ report, many hospitals are behind the curve on the path to meaningful use. The biggest barriers include:

Lack of clarity and a final ruling hinder meaningful use implementation. Guidelines for system certification were issued by the US Department of Health and Human Services on June 7, but final guidelines for meaningful use criteria are not expected until fall of 2010, leaving many CIOs and their vendors at an impasse. CIOs surveyed by PricewaterhouseCoopers are most concerned about reporting requirements. Ninety-four percent of CIOs said they are concerned they can’t meet government requirements about how to report meaningful use, and 92% are concerned about remaining lack of clarity in meaningful use criteria.
Shortage of skilled staff. There is a shortage of professionals in the labor market with the appropriate mix of skills to help integrate information technology usage into clinical, operational and administrative practices. The government predicts a shortfall of about 50,000 qualified health IT workers over the next five years. According to the report, hospitals are scrambling to hire additional staff, including clinicians with IT expertise and business skills.
Vendor readiness and fallout from consolidation are unclear. More than one-third of CIOs surveyed by PricewaterhouseCoopers said they are concerned or very concerned about vendor readiness overall. In particular, 44% of CIOs said they are concerned that the external vendors they rely on in health information exchanges (HIEs) are not prepared for meaningful use implementation. Recent merger and acquisition activity among EHR and IT vendors reflects serious efforts by technology suppliers to better position themselves for rapid deployment of systems and integration support.
Existing infrastructure capabilities are being questioned. Complex networking capabilities and increased bandwidth are needed to reliably handle the massive influx of data that needs to flow 24X7, and hospital CIOs are concerned about the unknown cost of maintaining back-up plans should the system go down and they have to revert to paper records.

Collaboration characterizes early adopters

According to PricewaterhouseCoopers, one of the keys to successful meaningful use of EHRs is getting buy-in early on from physicians and increasing the involvement of physicians and other clinicians in quality initiatives.

“Nowhere would the meaningful use of EHRs be more valuable than in a hospital emergency department, where it could mean life or death for a patient,” added Garrett. “Emergency department physicians aren’t eligible for stimulus incentives but their meaningful use of EHRs is crucial to the hospital and its patients. Hospitals that do not see the path to meaningful use of EHRs as part of a bigger transformational opportunity to improve healthcare quality could be on a long path toward meaningless use.”

PricewaterhouseCoopers’ CIO survey found distinct patterns of collaboration among hospitals and health systems furthest ahead in achieving meaningful use. The survey found:

Health systems that have connected with physicians, patients and health insurers around meaningful use are more likely to be ready to apply in 2011 for incentives. They are three times more likely to incorporate patient input, 87% more likely to work with health insurers and 63% more likely to assist physicians with regard to meaningful use than are those planning to apply for the first time after 2011.
Health systems that include patients in the planning for EHRs are more confident about meeting meaningful use requirements. Seventy-four percent of CIOs who had involved patients responded that they would be among those applying for stimulus incentives in 2011, compared with 50% of all hospitals and health systems surveyed. Yet, fewer than 20% of CIOs surveyed said their organizations are incorporating patient input into meaningful use initiatives.
Sixty-three percent of CIOs said their organizations are either already working with physicians around meaningful use issues or plan to do so within the next six months. Moreover, an overwhelming 88% responded that meaningful use is somewhat or very likely to increase the involvement of non-administrative physicians in quality initiatives.
Most health systems are missing out on opportunities to connect with health insurers around meaningful use. Only 6% of CIOs said meaningful use would improve alignment with health insurers over the next two years, and only 24% said it would improve alignment long-term. Academic medical centers appear most unclear about how they will work with health insurers around meaningful use; 81% of their CIOs said their organizations either do not plan to work with health insurers at all or do not know whether they will do so, compared with 47% among all hospitals.

“Success in achieving meaningful use standards hinges on closer integration with key constituents – physicians, health insurers and patients,” said Kelly Barnes, US leader, health industries, PricewaterhouseCoopers. “Meaningful use of EHRs is an ambitious goal that requires significant clinical, operational and cultural changes, and patients need to be at the center of all planning. Healthcare organizations have an opportunity to be listening much more closely to what patients are telling them they want and need, and through meaningful use of EHRs, they can deliver care in a more personalized, coordinated way.”

The PricewaterhouseCoopers report outlines five milestones that hospitals will have to meet to achieve meaningful use. These include: Governance and tone set by the top of the organization; a balance among competing priorities; forging new public-private and community partnerships; a decision to make patients the purpose; and collaborating with physicians and payers.

A full copy of the report Ready or not: On the road to meaningful use of EHRs and health IT is available at http://www.pwc.com/us/meaningfuluse.

Methodology

PricewaterhouseCoopers’ Health Research Institute surveyed 120 CIOs and health IT executives, who are members of the College of Healthcare Information Management Executives (CHIME) during the second quarter of 2010. In addition, HRI conducted in-depth interviews with 14 CIOs and health leaders from health systems, health information exchanges, health insurers and regional extension centers.

About PricewaterhouseCoopers’ Health Research Institute (HRI)

PricewaterhouseCoopers’ Health Research Institute (http://www.pwc.com/hri) is an leading resource for health industry expertise. By providing cutting-edge intelligence, perspective and analysis on issues impacting the health industry, HRI assists executive decision-makers and stakeholders worldwide in navigating their most pressing business challenges. PricewaterhouseCoopers is one of the only firms with a dedicated global healthcare research unit, capitalizing on fact-based research and collaborative exchange among our network of professionals with day-to-day experience in the health industries.

About PricewaterhouseCoopers’ Health Industries Group

PricewaterhouseCoopers’ Health Industries Group (http://www.pwc.com/healthindustries) is a leading advisor to public and private organizations across the health industry, including payers, providers, academic institutions, health sciences, biotech/medical devices, pharmaceutical companies, employers and new non-traditional market participants in the dynamic healthcare space. PricewaterhouseCoopers has a network of more than 4,000 professionals worldwide and 1,200 professionals in the US dedicated to the health industries.

PricewaterhouseCoopers’ Health Industries’ clients include 40 of the top 100 hospitals in the US and 16 of the 18 best hospitals as ranked by US News & World Report; all 20 of the world’s major pharmaceutical companies; all of the top 20 commercial payers in the US; municipal, state and federal government agencies and many of the world’s preeminent medical foundations and associations. Follow PwC Health Industries at http://twitter.com/PwCHealth.

About PricewaterhouseCoopers
PricewaterhouseCoopers (www.pwc.com) provides industry-focused assurance, tax and advisory services to build public trust and enhance value for its clients and their stakeholders. More than 163,000 people in 151 countries across our network share their thinking, experience and solutions to develop fresh perspectives and practical advice.

“PricewaterhouseCoopers” refers to PricewaterhouseCoopers LLP or, as the context requires, the PricewaterhouseCoopers global network or other member firms of the network, each of which is a separate and independent legal entity. © 2010 PricewaterhouseCoopers LLP. All rights reserved.

Toward Enhanced Information Capacities for Health: Achieving the Promise: NCVHS

Posted on June 26, 2010 by Mike Squires

NCVHS Concept Paper Looks How to Achieve the
Promise of Health Reform and Electronic Health Records
The National Committee on Vital and Health Statistics (NCVHS) met June 16-17, 2010 in Washington, DC, and used the NCVHS concept paper “Toward Enhanced Information Capacities for Health” as the basis of discussions for their 6oth Anniversary Symposium of the committee. The paper, issued May 26, 2010, focuses on policies HHS could establish to maximize the benefits that could be acheived through the appropriate use of the tremendous amount of health data that will be generated with Electronic Health Records.

The committee advises the Secretary of HHS on policies toward health data, statistics, privacy, national health information policy, and Administrative Simplication of HIPAA.

NCVHS Concept Paper
“Toward Enhanced Information Capabilities for Health”
PDF FORMAT
The text of the 11-page paper is reproduced in whole below.

EXECUTIVE SUMMARYHealth care reform and federal stimulus legislation have created an unprecedented opportunity to improve health and health care in the United States. The nation’s ability to seize this opportunity will depend greatly on the existence of robust health information capacities. The National Committee on Vital and Health Statistics (NCVHS) is the statutory advisory body on health information policy to the Department of Health and Human Services. On the occasion of the Committee’s 60th anniversary, this concept paper outlines its current thinking about the necessary information capacities and how NCVHS can help the Department guide their development.

We are entering a new chapter in the health and health care of Americans. The expansion of health care coverage, the infusion of new funds and adoption of standards for electronic health records (EHRs), and increased administrative simplification offer us the potential to use the enriched data generated to better address our country’s health and health care challenges. Having better information with which to measure and understand the processes, episodes, and outcomes of care as well as the determinants of health can bring considerable health benefits, not only to individuals but also to the population as a whole.

To be able to achieve the promise of these new developments, we need to be attentive to the underpinnings of the data, ensuring that they are easy to generate and use at the front lines as well as easy to reuse, manipulate, link, and learn from within a mantle of privacy and security. It is important to remember that the new data sources are not necessarily a replacement for traditional sources such as administrative and survey data, which play a key role in our infrastructure. Rather, the new sources present an opportunity to augment and enrich traditional sources. While efficiency may be gained by replacing some survey and administrative data with newer EHR data, we must continue to nourish and sustain the traditional data sources that offer unique and irreplaceable information for both clinical and population health purposes.

National health information capacities must enable not just better clinical care but also population health and the many synergies between the two. More specifically, health information policy should foster improved access to affordable, efficient, quality health care; enhanced clinical care delivery; greater patient safety; empowered and engaged patients and consumers; patient trust in the protection of their health information; continuous improvement in population health and the elimination of health disparities; and support of clinical and health services research. A major priority of health information policy should be to enable the multiple uses of data, drawn from the full range of sources, while minimizing burden. Most sources have primary uses for which they were designed; however, with adequate standardization, privacy protections, and technology, the data from many sources can be used for multiple purposes. Realizing the collective potential of all information sources is what will allow the U.S. to maximize the return on its investments in system reform and health IT for the benefit of all Americans.

As information capacities expand, it is critical that the information be comprehensive, timely, efficiently retrievable, and usable, with full individual privacy protections in place. “Comprehensive” refers to the inclusion not just of traditional health-related data, but also of data on the full array of determinants of health, including community attributes and cultural context. Usability of the data—whether for initial use or reuse―requires a well-coordinated effort to assure the accessibility and availability of information as well as its standardization.

NCVHS will continue to use its consultative and deliberative processes, working collaboratively with other HHS advisory committees, to help the Department meet these opportunities and challenges. Given the rapidity of the changes now under way, we cannot over-emphasize the urgency of this endeavor and the need to move ahead with deliberate speed.

INTRODUCTION

Health care reform and federal stimulus legislation have created an unprecedented opportunity to improve health and health care in the United States. The nation’s ability to seize this opportunity will depend greatly on the existence of robust health information capacities. 1 To maximize the return on these enormous investments and make it possible to evaluate their impact, health information capacities must be carefully developed with an eye to their uses for improving health care and health for all Americans. New investments in EHRs and health information exchanges are important contributors, especially for clinical care, but the benefits from these investments will be limited unless the synergies with other types of health information are recognized and used. Population-level data from vital statistics systems, surveys, and public health surveillance and health care administrative data are equally important information sources. Assuring that all these sources are adequately developed and supported and can be integrated appropriately is essential to developing the information capacities the nation needs.

The National Committee on Vital and Health Statistics, the Department’s statutory advisory body on health information policy, has long assisted the Department in the development of national health information policy, providing thought leadership and expert advice in the areas of population health, privacy, standards, the NHII/NHIN, health care quality, and more. Nearly ten years ago, NCVHS put forward a vision for a national health information infrastructure in its 2001 report, Information for Health,2 followed in 2002 by a vision for 21st century health statistics.3 Today, as data and communication capacities explode and health care coverage expands, new thinking and visioning are needed to clarify the information capacities that will make it possible to meet our national goals for better health and health care for all Americans. On the occasion of the Committee’s 60th anniversary, this concept paper outlines its current thinking about the required capacities and their development.

In 2009, as course-altering legislation was unfolding, NCVHS began to consider how it could assist the Department’s development of the necessary information capacities.4 All four NCVHS subcommittees have contributed to the early thinking on this subject, and all plan further work

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1 We use the term capacities in the sense of the ability to perform or produce. That is, information capacities are understood in relation to specific needs, purposes, and functions of information.
2 NCVHS, Information for Health: A Strategy for Building the National Health Information Infrastructure, November 2001.
3 NCVHS, Shaping a Health Statistics Vision for the 21st Century, November 2002.
4 As part of this process, NCVHS in 2009 commissioned two authors of the 2002 health statistics vision report to help the Committee consolidate and update its recommendations. Their report to the Committee is posted on the NCVHS website. < http://www.ncvhs.hhs.gov/090922p3.pdf >
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in their respective domains, as described below. 5 The Committee has crafted a highly effective process for bringing multiple points of view and areas of expertise to bear as it develops recommendations to the Secretary, and this process is well suited to the work that lies ahead. NCVHS will continue to use its consultative process to create venues for dialog, eliciting input and perspectives from stakeholders and experts regarding critical challenges, potential opportunities, and next steps. It will use this external input and its own broad expertise to help the Department develop health information policies that are commensurate with new opportunities and needs. Given the rapidity of the changes now under way, we cannot over- emphasize the urgency of this endeavor and the need to move ahead with deliberate speed.

INFORMATION CAPACITIES FOR HEALTH AND HEALTH CAREPublic sector involvement in health information has a long history. State, local, and federal agencies have gathered information through vital records, hospital and ambulatory data sets, public health surveillance, population surveys, and other sources to monitor health trends, identify threats, and guide interventions to protect and promote health. Congress initiated a new type of government involvement in 1996 when the Health Information Portability and Accountability Act (HIPAA) recognized the importance of protecting individuals’ health care information while improving the efficiency of health care delivery through standardized electronic administrative transactions. Most recently, the American Recovery and Reinvestment Act of 2009 (ARRA) began another type of intervention, providing financial incentives for health IT adoption in the nation’s hospitals and physician offices as well as funding for infrastructure support.

While much current attention is focused on the ARRA funding of health IT and critical associated tasks such as defining and implementing “meaningful use” of EHRs, a broader perspective is required to take full advantage of evolving opportunities. Widespread use of optimally configured, standardized EHRs will greatly expand the information available on health care services, users, and providers. However, promoting the health and wellness of the population also requires information about those who have not received health care services, among other things, as well as information on other determinants of health beyond traditional health care, including environmental, social, and economic factors.6

In short, national health information capacities must support a broad array of uses and purposes that include improving access to affordable and efficient quality health care, supporting clinicians in delivering care, empowering and engaging patients and consumers in their care,
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5 At present, NCVHS has subcommittees on population health, standards, quality, and privacy/confidentiality/security.
6 See the NCVHS-developed graphic of the determinants of health on page 9 of its report on a vision for 21st century health statistics (see note 3).
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ensuring patient safety, promoting patient trust, eliminating health disparities, monitoring and improving population health, and supporting health services and clinical research. As these capacities are developed, it is critical that the information being collected be comprehensive, timely, efficiently retrievable, and usable, and that individual privacy be protected.

In the Committee’s view, this requires a well-coordinated effort that assures the following:

1. Accessibility and availability of information. The availability of sufficient, timely information from relevant sources must be assured to meet the priority needs of diverse users (including clinicians, consumers, purchasers, payors, researchers, public health officials, regulators, and policymakers) for taking action and evaluating outcomes. To minimize burden, wherever possible data should be collected once, for multiple appropriate uses by authorized users. Where appropriate, the capacity to connect data from multiple sources should be provided.

2. Standardization. Standardization is necessary to enable interoperability for the efficient collection and timely sharing of information among all types of users. Robust standards should be assured through the definition, application, and adoption of terminologies, codes, and messaging in the areas of reimbursement, public health, regulation, statistical use, clinical use, e-prescribing, and clinical documents.

3. Privacy, confidentiality, and security protections. With the increasing adoption of interoperable electronic health records technology, along with the move toward global access to health data and emerging new uses of data, methods of access and information availability raise significant new and unique privacy and security concerns. Appropriate privacy, confidentiality, and security protections; data stewardship; governance; and an understanding of shared responsibility for the proper collection, management, sharing, and use of health data are critical to addressing these concerns.

Each is briefly discussed below.

1. ACCESSIBILITY AND AVAILABILITY OF INFORMATION

In today’s world, the boundaries between health care, population health, and even individual personal health management are permeable, and information exchange is increasingly multi- directional. The domains traditionally called “public health” and “health care” are increasingly intertwined, often sharing broad, common information sources and capacities. For example, promoting the health and wellness of individuals and the population requires attention to health determinants including not only the treatment and prevention of disease and the nature of community health resources but also environmental, housing, educational, nutritional, economic, and other influences. Continuously improving the quality, value, and safety of health care involves, among other things, research and knowledge management, meaningful performance measurement, education and workforce development, and support for personal and family health management. Finally, improving health and health care on a national scale requires monitoring and eliminating health disparities and assessing the health status of all Americans, including vulnerable sub-populations.

A major priority of health information policy should be to facilitate these interconnections and enable the multiple uses of information for current and emerging data needs. With health IT, complemented by the necessary privacy protections and data stewardship and facilitated by well designed standards, data can be combined to create richer information and used to address a broad array of current and emerging health and health care issues. Realizing the collective potential of all information sources is what will allow the U.S. to maximize the return on its investments in system reform and health IT for the benefit of all Americans.

At present, the major sources of data on health are:

       Surveys (interview and examination) and Censuses    Public health surveillance data (e.g., notifiable disease reporting, medical device reporting)        Health care data (EHRs, HIEs, registries, and other such as prescription history, labs, imaging)
      Administrative data (claims, hospital discharge data, vital records)
      Research data (community-based studies, clinical trials, research data repositories)

Another essential set of sources for understanding health is the information on influences on health (including transportation, housing, air and water quality, land use, education, and economic factors) managed by various public and private sector agencies. In addition to all these well-established sources, new ones such as personal health records and computerized personal health monitoring devices are emerging with the potential to contribute to understanding health at individual and population levels. Social networking content has the potential to provide yet another new and novel resource.

Most data sources have primary uses for which they were designed. However, given adequate standardization, privacy protections, and informatics technology, these sources have great potential to be used for multiple purposes. For example, EHR data elements are collected to document and manage clinical care, but also can be used for public health reporting (such as communicable diseases and medication safety) and to evaluate population health and conduct health services research. Surveys are principally for population-level analysis, but survey information also contributes to clinical care. Vital records not only provide information about births and deaths, but also serve as the “bookends” of population health data. Administrative data (ICD-9-CM disease codes and CPT-4/HCPS procedure codes) were initially used for management and reimbursement, but today play a critical role in quality assessment and public health monitoring (e.g., quality and safety indicators and disease prevalence evaluation). As we look to the future, the goal is to leverage all these sources, when appropriate, and expand their utility for understanding personal and population health and their determinants while carefully protecting the confidentiality of the data they contain.

To bring about the needed improvements and efficiencies and draw all possible benefit from the large and growing investment in health IT, the emerging information capacities must enable both more effective and cost-effective clinical services and population health promotion, and their many synergies. This can be facilitated through multi-directional data sharing and linkages to generate information that is comprehensive and broadly representative. It will be critical to break down the silos that now make it difficult to share and connect data. This requires addressing the policy, institutional, technical, and other barriers that contribute to the existing silos. A workforce trained to take advantage of the broader data and informatics capacities is also essential. Detailed local data are needed to enable understanding of health and health care at local neighborhood, community, sub-population, and other levels of aggregation. Key decisions about health and health care are made at the local level, and we envision the potential to meet these needs in ways not previously possible. Finally, a critical use of population health data, especially with the advent of health care reform, is to assess the effectiveness, comparative effectiveness, and equity of health care.

Because resources are limited and burden must be minimized, information policy must set priorities regarding which data are most important in order to target investments in data collection. As noted, burden can be minimized by collecting data once for multiple uses. At least in the near term, provided that data can be put in the hands of trusted stewards, enhanced administrative data may be a powerful component that reduces the burden of multiple collections. As new capacities come on line, it may be possible to curtail or redirect some current collection activities.

An important criterion is that information, whatever its source, must be meaningful to users. Experience has demonstrated that having relevant data and information available does not ensure that it is accessible in a timely manner and useful form to the full range of potential users. Delays may be created by approval processes or regulatory requirements, as well as by the lack of data handling and analysis capacities that could enable a user to pose a question, indentify relevant data sources, and request a report that is understandable and protects the privacy of data sources. Ensuring access to useful information is a critical part of the challenge. An overarching goal of all these endeavors is to assure that data can be converted into information and ultimately into knowledge that can answer the priority questions about personal and population health in the U.S. and enable effective decisions and actions to improve them.

2. STANDARDS FOR INTEROPERABILITY, USABILITY, QUALITY, SAFETY, AND EFFICIENCY

The purposes of health information standards are to ensure the efficient, secure, safe, and effective delivery of high quality health care and population health services; to support the information exchange needs of health care, public health, and research; and to empower consumers to improve their health.

The impending implementation of the next generation of HIPAA standards, the enactment of The Health Information Technology for Economic and Clinical Health (HITECH) Act in 2009, and the recent signing of health reform into law are creating an unprecedented convergence of driving forces, foundational components, technology advances and capabilities, and regulatory requirements. Together, these assets can help create a common national pathway toward achieving the vision and policy priorities of a 21st century health system that relies on a strong health information and health information technology foundation. The past five years have seen a remarkable transformation in the adoption and use of standards for electronic exchange of health information. The transformation encompasses privacy and security standards, standards for administrative and financial transactions, the establishment of unique identifiers, and more recently the adoption of standards for codifying, packaging, and transmitting clinical information between and across health care organizations. This rapidly evolving transformation is moving us closer to the ideal of a fully interoperable electronic health information collection and exchange environment that supports all functions and needs of the country’s health and health care ecosystem, as discussed in the previous pages.

Data standards provide a key architectural building block that supports the collection, use, and exchange of health information. Health information standards have been developed and are being adopted and implemented in many different areas. Capturing information in codified format through standard representations such as clinical vocabularies and terminologies, code sets, classification systems, and definitions is a key strategy for achieving semantic interoperability. The inclusion of standardized metadata, which describe characteristics of the data such as provenance, increases the potential for assessing the reliability and validity of the data for aggregation, research, and other uses. Organizing and packaging data through defined electronic message and document standards to be accessed and exchanged via standardized electronic transport mechanisms and protocols achieves access and exchange of health information. The availability and integrity of health information is protected and ensured through the deployment of security standards, thus guaranteeing confidentiality and privacy of protected health information. Finally, the certification of health information technology for Meaningful Use depends on the wise deployment and use of health information standards.

3. PRIVACY, CONFIDENTIALITY, SECURITY

With the move toward the management of health data in electronic form, there is a significant opportunity to enhance health data access, utility in patient care, and important secondary uses. The opportunity is further enhanced through the emergence of new methods to exchange health data, both on a regional and national basis. However, the ability to realize the potential of electronic health data depends greatly on ensuring that uses are appropriate and individuals’ reasonable privacy, confidentiality, and security expectations are met.

Individuals should have the right to understand how their health data may be used, and to provide consent where appropriate. Often, consent is difficult, as not all uses are known at the time the health data are collected. Further, standards do not yet exist to track an individual’s consent as data are exchanged. Although many of the population health uses described in this concept paper involve aggregated or de-identified health data, legitimate concerns exist about group harms and possible re-identification. In addition, the possibility of using health data from emerging information sources, such as personal health record systems, raises unique privacy concerns.

NCVHS has discussed many of these privacy challenges in numerous reports and letters to the Secretary. Most notably, NCVHS published two reports, a Primer on health data stewardship 7 and Recommendations on Privacy and Confidentiality, 2006-2008. Both are available on the NVCHS website.8

Further work is necessary to develop the privacy, confidentiality, and security standards that should apply as these data uses continue to evolve. In addition, work is needed to establish governance structures to provide the proper oversight of entities that exchange and use health data. In essence, governance is the accountability for ensuring that proper data stewardship (as described in the NCVHS Primer cited above) is practiced. To differentiate between governance and data stewardship, data stewardship is focused on the internal practices of the entity that uses health data, whereas governance is focused on the oversight of such entities to ensure that their data stewardship practices are adequate. Such oversight includes initially approving entities that have access to data, ensuring that such entities appropriately use and protect data, and ensuring that entities that misuse data are appropriately sanctioned.

THE WAY FORWARDTaken together, today’s emerging policy opportunities and the nation’s longstanding health challenges create a situation of considerable urgency for the United States. The openness to bold new approaches offered by recent legislation will disappear quickly. Given that the U.S. lags behind most other industrialized countries in the health status of its citizens, we must seize the opportunities to maximize the health benefits and begin to assess whether the huge investments are indeed having the desired impact.

This paper has noted the critical federal role in devising health information policy to support national health goals. Federal leadership is more needed than ever to create the comprehensive approaches that will guide the development of information capacities and coordinate efforts by actors in the public and private sectors. Whatever progress is made in the critical transition to electronic health records, clinical data alone will not suffice; broad information capacities that

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7 An NCVHS Primer: Health Data Stewardship―What, Why, Who, How, December 2009.
8 http://www.ncvhs.hhs.gov
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draw on all the sources and serve all the purposes discussed in this paper will be necessary. This will require shoring up the data resources for public functions such as surveys, safety surveillance, and vital records, along with strategic thinking to determine what capacities will be needed in the future and how to guide their development. Many issues require research and demonstration as part of a prioritized, adequately funded research agenda. In addition, further investments in a trained workforce are needed, to ensure the availability of professionals and leaders who can properly use information resources for analysis and decision-making.

As it develops policies and strategies, the Department has always invited input from experts and stakeholders; and NCVHS has long helped to facilitate this dialogue and distill the key messages and lessons. NCVHS will continue to use its consultative and deliberative processes, working collaboratively with other HHS advisory committees, to help the Department meet the current opportunities and challenges. As noted, all NCVHS subcommittees plan to be involved in this effort; this report is an early installment on subcommittee and full Committee work plans for the coming 18 months or more. NCVHS expects to develop recommendations on a research agenda, which may be the focus of one or more hearings. Each of the subcommittees is identifying the key issues in its domain, to be pursued through workshops, hearings, and internal deliberations as NCVHS develops recommendations for the Secretary. The subcommittees’ preliminary thinking is outlined below.

SUBCOMMITTEE ON QUALITY

Over the next two years, the NCVHS Subcommittee on Quality will focus on supporting the development of meaningful measures, leveraging both existing and emerging data sources (e.g., patient-generated data, remote monitoring, personal health records), and in particular identifying significant opportunities and gaps. Critical to meaningful measurement is the availability of relevant data elements that could be easily captured using certified EHR technology and functionality, among other tools. The Subcommittee on Quality will identify emerging health data needs for a health system where the individual engages in his or her health and health care. As a near-term priority, the Subcommittee will address the data needs of person-centered health and health care, emphasizing coordination and continuity of care across a continuum of services. A longer term goal is to develop a national strategy to leverage clinically rich health data to address important national questions about determinants of health and disease.

SUBCOMMITTEE ON PRIVACY, CONFIDENTIALITY AND SECURITY

The NCVHS Subcommittee on Privacy, Confidentiality and Security will focus its efforts on providing recommendations that support national priorities, in coordination with such groups as the ONC HIT Policy Committee’s Privacy and Security Workgroup. In the next year, the Subcommittee plans to develop recommendations regarding governance as well as a framework for the identification and appropriate management of sensitive data. The Subcommittee will also consider transparency and the role of patient consent. In addition, it will continue to review and make recommendations regarding new privacy, confidentiality, and security regulations; compliance with these regulations; and strategies for effective enforcement.

SUBCOMMITTEE ON STANDARDS

Health care reform legislation now provides a new opportunity to continue the administrative simplification that began under HIPAA―a process in which NCVHS will remain heavily involved. The NCVHS Subcommittee on Standards will continue to meet its responsibilities related to HIPAA; will implement the many administrative simplification responsibilities assigned by the Health Reform Act of 2010; and will meet new requests for recommendations on the use of standards to enhance interoperability of the transmission and semantics of health data as they arise. As we look to the future, several goals stand out with respect to standards. The Subcommittee will seek to ensure a comprehensive framework and roadmap for health information standards that support the national health IT strategic framework, vision and policy priorities; the public health policy agenda; the NCVHS proposed data stewardship framework; a national research agenda that includes comparative effectiveness; and the needs of all data users.

SUBCOMMITTEE ON POPULATION HEALTH

Understanding the population’s health and its determinants relies on multiple data sources, including population surveys, clinical data, administrative data (notably, birth and death records and billing data on use of health services), and public health and environmental reporting systems. At the national level, Federal agencies such as the National Center for Health Statistics are charged with developing methods, assessing validity, and reporting national population health information. As we envision building a comparable capacity for communities and states across America, the quality of information and its timeliness will be central to success. The Subcommittee on Population Health will focus on facilitators and barriers to data linkage at state and local levels as a critical part of health information infrastructure, specifically linking EHR data with existing administrative and local survey data. Fundamental to understanding population health is describing the underlying population, which also comprises those who have not seen a doctor recently or have refused to respond to a survey. The work of the Subcommittee will focus on methods to ensure that linked data sources provide valid health information, including methods to adjust for missing data and methods to protect privacy.

AHRQ Webinar: Quality Measures to Improve Patient Care: June 23

Posted on June 20, 2010 by Mike Squires

Impact of Health IT on Quality Assessment:
Innovations in Measurement and Reporting
Excerpted from AHRQ on June 20, 2010
This free 90-minute teleconference will explore the use of quality measures to improve patient care.

Date: June 23
Time: 2:00 – 3:30 p.m., ET
Sponsored by the Agency for Healthcare Research and Quality’s (AHRQ) National Resource Center for Health IT

To register, click here.

Presenters:

•   Denni McColm, M.B.A., is Chief Information Officer for Citizens Memorial Healthcare. She has been at Citizens Memorial since 1988, serving as Director of Human Resources and Director of Finance before moving into the CIO role in June, 2003. Ms. McColm served on the Certification Commission for Health Information Technology as a Commissioner from 2006-2008. She also served on the Davies Awards of Excellence Organizational Selection Committee from 2006 -2008 and again in 2010. She is a member of the Editorial Board for Healthcare IT News, published in partnership with HIMSS. Ms. McColm holds a Master of Business Administration degree from the University of Missouri-Columbia.
•   Karen Kmetik, Ph.D., is Vice President of Performance Improvement at the American Medical Association (AMA), where she provides strategic leadership for AMA initiatives in health care quality measurement and improvement. She also leads the activities of the AMA-convened Physician Consortium for Performance Improvement® (PCPI) through continued development and effectiveness testing of performance measures, advancement of the   integration of the measures into health IT, and implementation in a variety of programs. Dr. Kmetik is a founding member of the Collaborative for Performance Measure Integration with EHR Systems, co-sponsored by the AMA, the National Committee for Quality Assurance (NCQA), and the HIMSS Electronic Health Record Association (EHRA).
•   Henry Fischer, M.D., is an Assistant Professor at the University of Colorado Health Sciences Center and a practicing internist at Denver Health Medical Center (DH). He is director of the diabetes collaborative at Denver Health, which serves over 7000 primarily indigent adult patients with diabetes. He was the PI on an AHRQ funded study of, i) the automated distribution of individualized diabetic performance report cards to patients by mail and at the point of care, and, ii) the electronic distribution of provider performance report cards on diabetes measures with patient-level data. He is currently studying the use of text messaging to help manage diabetes outside of clinic visits in a primarily low-income population.

Ms. McColm will begin the teleconference by providing an overview of the three year quality measurement project at Citizens Memorial Healthcare. She will discuss the challenges involved with applying quality measurement in ambulatory care and describe how they were able to achieve their goals. Dr. Kmetik will describe the Cardio-HIT project, whereby different practice sites with different EHRs exported data to a warehouse for the calculation of national performance measures. She also will describe current efforts to design measure specifications to enable integration of measures into EHRs. Dr. Fischer will conclude the event by presenting on the use of an integrated diabetes registry to improve the quality of care for adult diabetic patients in a safety net system. He will describe the effects of providing both patients and providers information via report cards and the benefits and challenges of this process.

Live Webcast Information

Start Time:

June 23, 2010 2:00 PM Eastern

1:00 PM Central, 12:00 PM Mountain, 11:00 AM Pacific

Estimated Length:

1 hour, 30 minutes

Registration Fee:

Free
To register, click here.

CMS: Final HIT rules moving from late spring to early summer?

Posted on June 10, 2010 by Mike Squires

NYTimes: Doctors and Hospitals Say Goals on Computerized Records Are Unrealistic; “Early summer” is the real story
“Final rules will be out in early summer,” according to Jonathan D. Blum, deputy administrator of the Centers for Medicare and Medicaid Services, as quoted in Robert Pear’s June 8, 2010 story in the New York Times, “Doctors and Hospitals Say Goals on Computerized Records Are Unrealistic.”

For several months, National Coordinator for Healthcare IT David Blumenthal has been saying that the final rules for certification of EHR systems (from ONC) and the final EHR incentives (from CMS) would come out in “late spring” 2010, which means prior to June 21. ONC and CMS have been working closely together on these two rules.

The quote by the deputy administrator of CMS appears to be setting the stage for finalization of rules to come June 21 (first day of summer) or later. Perhaps this New York Times story is actually setting the stage for some more flexibility in the final definitions and timing of “meaningful use” requirements. Folks from Intermountain, Kaiser, and Partners Healthcare System in Boston, are quoted as saying too much change is expected in too short a time, and these are people who are way ahead of the curve.

Beacon Community Program: Technical Call – June 1, 1pm EDT

Posted on June 1, 2010 by Mike Squires

Office of Nat’l Coordinator for Health IT Technical Assistance Call:
Tuesday 6/1/10, 1:00 – 2:00 PM EDT (Link to slides below)
Excerpted from Office of National Coordinator for Health IT Web site and email on 6/1/10:
“An additional $30.3 million is currently available to fund two additional Beacon Community cooperative agreement awards. Please note that the Office of the National Coordinator for Health Information Technology is accepting Letters of Intent from potential applicants until 11:59 PM EDT June 9, 2010.”

“In addition, as was announced last week, ONC will be hosting a Technical Assistance call for potential applicants today, Tuesday, June 1 at 1:00 PM EDT. This call will be a presentation on preparing proposals for this cooperative agreement. The purpose of this note is to pass on the specific dial-in information for today’s call.”

Technical Assistance Call (for round 2 Beacon applicants): 6/1/2010

Slides [PDF - 420 KB]

Previous Technical Assistance Calls

Technical Assistance Call: 12/14/09

Technical Assistance Call: 1/20/2010

Learn more about the Beacon Community Cooperative Agreement Program:

Additional $30.3 Million is available to fund 2 Beacon communities, see Funding Opportunities Announcement [MS Word doc - 822 KB]
- Letter of intent due Wednesday, June 9, 2010
- Application due Monday, June 28, 2010
To see the full announcement, go to http://www.grants.gov/search/basic.do and search for CFDA# 93.727
Facts-At-A-Glance [PDF – 388 KB]

Frequently Asked Questions
Please note: This section is updated frequently. Please check back often for updates.
Technical Assistance Webinar Announcement: ONC is hosting a technical assistance call about the Beacon Communities program on June 1, 2010 from 1:00– 2:00 PM EDT. This call will be a presentation on preparing proposals for this cooperative agreement. Additional details about the call are now available. (Shown above.)
ONC hosted technical assistance calls for first round applicants to answer questions related to the Beacon Community Program on December 14, 2009, and January 20, 2010. View the slides and transcripts from the calls. (Shown above.)

For questions relating to the Beacon Community Cooperative Agreement Program, email BeaconCommunityGrants@hhs.gov.For previous posts about Beacon Communities on e-Healthcare Marketing, click here.

Teachable Moment — EHR Implementation Video

Posted on May 23, 2010 by Mike Squires

Pittsburgh Regional Health Initiative (PRHI) Presents
EHR Implementation in A Teachable Moment Video
Frank Civitarese, DO, President of Preferred Primary Care (PPC) and a Board Member of Pittsburgh Regional Health Initiative (PRHI) is featured in a brief video about his practice’s EHR implemenation, along with comments by Rick Schaeffer, VP & CIO, ST. Clair Hospital, and Charity Dean, Office Manager in Dr. Civitarese’s practice.

PRHI is a Pittsburgh, PA area “regional consortium of medical, business and civic leaders to address healthcare safety and quality improvement as a social and business imperative” using its commmunity as a “demonstration lab.” PHRI “is a nonprofit operating arm of the Jewish Healthcare Foundation.”

“Preferred Primary Care Physicians consists of 34 board-certified physicians specializing in internal medicine and family practice. PPCP has 15 practice locations in the South Hills and two locations in Uniontown in Fayette County. In addition, PPCP offers state-of-the-art outpatient centers for cardiac testing, sleep disorders, and physical therapy.”

PRHI: EHR Implementation: A Teachable Moment Video
PRHI Teachable Moments Videos
PRHI Champions of Work Redesign
http://prhi.org

ONC Blog: Beacon Communities Lead Charge to Improve Health Outcomes

Posted on May 5, 2010 by Mike Squires

Blumenthal Blogs on Health IT Buzz Blog plus add’l Links
Beacon Communities Lead the Charge to Improve Health Outcomes
Wednesday, May 5th, 2010 | Posted orginally by Dr. David Blumenthal on Health IT Buzz Blog.
Excerpted directly from ONC Health IT Buzz Blog.
Across the nation, in communities large and small, health information technology (health IT) innovators are boldly leading the way toward the adoption and meaningful use of electronic health records (EHRs). Yesterday, we awarded $220 million in Beacon Community cooperative agreements to 15 trailblazing community consortiums that will demonstrate how the meaningful use of electronic health records can serve as a critical foundation for achieving measurable improvement in the quality and efficiency of health care in the United States.

Health care providers often suggest that health IT is challenging to implement, and that certain types of communities are better prepared (and funded) to reap its benefits.

The 15 Beacon Communities named today, however, demonstrate the significant diversity among those who have been successful in implementing and using health IT. The areas of diversity represented in the consortiums receiving grants include:

Geographic – Beacon Communities are located from coast to coast and beyond to Hawaii
Population Density – Beacon Communities serve both urban and rural populations
Populations – Beacon programs address health disparities among minority populations, including Native American, African American, and Hispanic, among others

Equally important, these communities are committed to demonstrating tangible outcomes:

Individual Health Outcomes – Beacon Communities’ outcomes encompass a variety of disease states and treatment approaches, including diabetes, cardiovascular disease, asthma, and chronic obstructive pulmonary disease
Population Health outcomes – Beacon Communities target varying dimensions of population and public health, from improved immunization and cancer screening rates, to innovations for public health surveillance

Additionally, the Beacon Community Program demonstrates robust collaboration among Federal agencies. Two of the grantees seek to improve Veterans’ care by leveraging the Department of Defense’s and Department of Veteran Affairs’ Virtual Lifetime Electronic Record (VLER) program for active duty, Guard and Reserve, retired military personnel, and eligible separated Veterans.

These diverse partners will provide unique insights into best practices that can be applied to similar communities nationwide, as they strive to build a health IT infrastructure as a critical foundation for health system improvement. In doing so, the Beacon Community program will support the nationwide adoption of health IT by 2015.

I congratulate the Beacon Community awardees and am confident the Beacon Communities will succeed in demonstrating the promise of health IT and facilitating other communities’ adoption and meaningful use of technology.

–David Blumenthal, M.D., M.P.P. – National Coordinator for Health Information Technology
For the original post, comments and the complete Health IT Buzz Blog.
# # #

White House Video of VP Biden and Sec’y HHS Sebelius Announcement

Additional e-Healthcare Marketing posts with info on Beacon Communities
–Blumenthal Letter #14 on Beacon Communities
–White House Announcement on $220 Million Awards with Communities Listed
–ONC Named for Beacon Communities Program
–ONC Roles and Posts–Includes Overall Director, Ofc of State and Community Programs

e-Healthcare Marketing

Health Information Exchange, Electronic Health Records and Personal Health Records

Category Archives: Hospitals