Health Information Technology for Economic and Clinical Health Act

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The Health Information Technology for Economic and Clinical Health Act, abbreviated HITECH Act, was enacted under Title XIII of the American Recovery and Reinvestment Act of 2009. Under the HITECH Act, the United States Department of Health and Human Services planned on spending $25.9 billion to promote and expand the adoption of health information technology.[1] The Washington Post reported the inclusion of "as much as $36.5 billion in spending to create a nationwide network of electronic health records."[2] At the time it was enacted, it was considered "the most important piece of health care legislation to be passed in the last 20 to 30 years"[3] and the "foundation for health care reform."[3][4]

Subtitle A--Promotion of Health Information Technology

Part 1--Improving Health Care Quality, Safety, and Efficiency

Electronic health records (EHR)

The HITECH Act set meaningful use of interoperable EHR adoption in the health care system as a critical national goal and incentivized EHR adoption.[5][6] The "goal is not adoption alone but 'meaningful use' of EHRs — that is, their use by providers to achieve significant improvements in care."[7]

Title IV of the act promised maximum incentive payments for Medicaid to those who adopt and use "certified EHRs" of $63,750 over six years beginning in 2011. Eligible professionals had to begin receiving payments by 2016 to qualify for the program. For Medicare, the maximum payments were $44,000 over five years. Doctors who did not adopt an EHR by 2015 would be penalized one percent of Medicare payments, increasing to three percent over three years. In order to receive the EHR stimulus money, the HITECH act (ARRA) required doctors to show "meaningful use" of an EHR system.[8]

Health information exchange (HIE) has emerged as a core capability for hospitals and physicians to achieve meaningful use and receive stimulus funding. Starting in 2015, hospitals and doctors would be subject to financial penalties under Medicare if they were not using electronic health records.

Meaningful use

The main components of meaningful use are:

  • The use of a certified EHR in a meaningful manner, such as e-prescribing
  • The use of certified EHR technology for electronic exchange of health information to improve quality of health care
  • The use of certified EHR technology to submit clinical quality and other measures

In other words, providers need to show they're using certified EHR technology in ways that can be measured significantly in quality and in quantity.[9]

The meaningful use of EHRs intended by U.S. government incentives is categorized as follows:

  • Improve care coordination
  • Reduce healthcare disparities
  • Engage patients and their families
  • Improve population and public health
  • Ensure adequate privacy and security

The Obama Administration's Health IT program intends to use federal investments to stimulate the market of electronic health records:

  • Incentives, for providers who use IT
  • Strict and open standards, to ensure users and sellers of EHRs work towards the same goal
  • Certification of software, to provide assurance that the EHRs meet basic quality, safety, and efficiency standards

Meaningful Use standards were to be rolled out in three stages until 2015. Stage 1 was finalized in July 2010[10] while Stage 2 was finalized in August 2012.[11] Proposed rules for Stage 3 were published in the Federal Register in March 2015, with the comment period ending on May 29.[12]

Meaningful use Stage 1

The first steps in achieving meaningful use were to have a certified electronic health record (EHR) and to be able to demonstrate that it is being used to meet the requirements. Stage 1 contained 25 objectives for eligible professionals and 24 objectives for eligible hospitals. The objectives were divided into a core set and menu set. The EHRs had to meet all objectives in the core set and meet half of the menu-set items during Stage 1, one of which had to be a public health objective.[13]

Core Requirements:

  1. Use computerized order entry for medication orders.
  2. Implement drug-drug, drug-allergy checks.
  3. Generate and transmit permissible prescriptions electronically.
  4. Record demographics.
  5. Maintain an up-to-date problem list of current and active diagnoses.
  6. Maintain active medication list.
  7. Maintain active medication allergy list.
  8. Record and chart changes in vital signs.
  9. Record smoking status for patients 13 years old or older.
  10. Implement one clinical decision support rule.
  11. Report ambulatory quality measures to CMS or the States.
  12. Provide patients with an electronic copy of their health information upon request.
  13. Provide clinical summaries to patients for each office visit.
  14. Capability to exchange key clinical information electronically among providers and patient authorized entities.
  15. Protect electronic health information (privacy & security).

Menu Requirements:

  1. Implement drug formulary checks.
  2. Incorporate clinical lab-test results into certified EHR as structured data.
  3. Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, and outreach.
  4. Send reminders to patients per patient preference for preventive/follow-up care.
  5. Provide patients with timely electronic access to their health information (including lab results, problem list, medication lists, allergies).
  6. Use certified EHR to identify patient-specific education resources and provide to patient if appropriate.
  7. Perform medication reconciliation as relevant.
  8. Provide summary care record for transitions in care or referrals.
  9. Capability to submit electronic data to immunization registries and actual submission.
  10. Capability to provide electronic syndromic surveillance data to public health agencies and actual transmission.

To receive federal incentive money, CMS required participants in the Medicare EHR Incentive Program to attest that during a 90-day reporting period they used a certified EHR and met Stage 1 criteria for meaningful use objectives and clinical quality measures. For the Medicaid EHR Incentive Program, providers follow a similar process using their state's attestation system.[13]

National Coordinator for Health Information Technology

There is established within the Department of Health and Human Services an Office of the National Coordinator for Health Information Technology (ONC). The National Coordinator is appointed by the Secretary and reports directly to the Secretary. The National Coordinator is responsible for the development of the Nationwide Health Information Network.[14]

HIT Policy Committee

The HIT Policy Committee recommends a policy framework for the development and adoption of a nationwide health information technology infrastructure that permits the electronic exchange and use of health information.[14]

HIT Standards Committee

The HIT Standards Committee recommends to the National Coordinator standards, implementation specifications, and certification criteria. The Standards Committee also harmonizes, test pilots, and ensures consistency with the Social Security Act.[14]

Part 2--Application and Use of Adopted Health Information Technology Standards; Reports

Subtitle B — Testing of Health Information Technology

This section covered the National Institute for Standards and Technology Testing as well as research and development programs.

Subtitle C — Grants and Loans Funding

This section covered grant, loan, and demonstration programs.

Subtitle D — Privacy

Part 1 — Improved Privacy Provisions and Security Provisions

The HITECH Act required entities covered by the Health Insurance Portability and Accountability Act (HIPAA) to report data breaches to the United States Department of Health and Human Services (HHS), to the news media, and to the people affected by the data breaches.[15] This subtitle also extended the complete Privacy and Security Provisions of HIPAA to the business associates of covered entities.[16] This included the extension of updated civil and criminal penalties to the pertinent business associates. These changes were also required to be included in any business associate agreements among the covered entities, effective November 30, 2009.[17]

Another significant change brought about was the new breach notification requirements. This imposed new notification requirements on covered entities, business associates, vendors of personal health records (PHR) and related entities if a breach of unsecured protected health information (PHI) occurs. Both HHS and the Federal Trade Commission (FTC) were required under the HITECH Act to issue regulations associated with the new breach notification requirements. The HHS rule was published in the Federal Register on August 24, 2009[18], and the FTC rule was published on August 25, 2009.[18]

The final significant change implemented new rules for the accounting of disclosures of a patient's health information. It extended accounting for disclosure requirements to information used to carry out treatment, payment, and health care operations when an organization is using an EHR. This new requirement also limited the time frame for the accounting to three years instead of six. These changes took effect January 1, 2011 for organizations implementing EHRs between January 1, 2009 and January 1, 2011; and January 1, 2013 for organizations that had implemented an EHR prior to January 1, 2009.

On July 14, 2010, HHS issued a rule that listed categories that included 701,325 entities and 1.5 million business associates who would have access to patient information without patient consent after the patient had given general consent to their medical practitioner's HIPAA release.[19][20]

External links

Notes

This article heavily reuses content from the Wikipedia article.

References

  1. ↑ "HHS.gov/Recovery". HHS. Archived from [http:/www.hhs.gov/recovery/ the original] on 27 September 2013. http://wayback.archive-it.org/3909/20130927155638/http:/www.hhs.gov/recovery/. Retrieved 01 June 2015. 
  2. ↑ O'Harrow Jr., Robert (16 May 2009). "The Machinery Behind Health-Care Reform". WashingtonPost.com. The Washington Post Company. http://www.washingtonpost.com/wp-dyn/content/article/2009/05/15/AR2009051503667.html. Retrieved 01 June 2015. 
  3. ↑ 3.0 3.1 Shay, Kevin James (24 July 2009). "Contractors hungry for stimulus". Gazette.net. Post Community Media, LLC. http://ww2.gazette.net/stories/07242009/businew181942_32521.shtml. Retrieved 01 June 2015. 
  4. ↑ Gropper, Adrian (5 March 2009). "Why and How Secretary Sebelius Should Avoid a Network Monopoly". The Health Care Blog. http://thehealthcareblog.com/blog/2009/03/05/why-and-how-secretary-sebelius-should-avoid-a-network-monopoly/. Retrieved 01 June 2015. 
  5. ↑ "Meaningful Use: Introduction". Centers for Disease Control and Prevention. 11 October 2012. http://www.cdc.gov/ehrmeaningfuluse/introduction.html. Retrieved 01 June 2015. 
  6. ↑ Blumenthal, David (February 2010). "Launching HITECH". The New England Journal of Medicine 362: 382–385. doi:10.1056/NEJMp0912825. http://www.nejm.org/doi/full/10.1056/NEJMp0912825. 
  7. ↑ Blumenthal, David; Tavenner, Marilyn (August 2010). "The “Meaningful Use” Regulation for Electronic Health Records". The New England Journal of Medicine 363: 501–504. doi:10.1056/NEJMp1006114. http://www.nejm.org/doi/full/10.1056/NEJMp1006114. 
  8. ↑ Habib, Jamie L. (4 June 2010). "EHRs, Meaningful Use, and a Model EMR". Drug Benefit Trends 22 (4). Archived from the original on 28 July 2010. https://web.archive.org/web/20100728133252/http://dbt.consultantlive.com/display/article/1145628/1581538. Retrieved 01 June 2015. 
  9. ↑ "EHR Incentive Programs". Centers for Medicare & Medicaid Services. 22 April 2015. http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/index.html. Retrieved 01 June 2015. 
  10. ↑ "Secretary Sebelius Announces Final Rules To Support ‘Meaningful Use’ of Electronic Health Records". Centers for Medicare & Medicaid Services. 13 July 2010. http://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2010-Press-releases-items/2010-07-13.html. Retrieved 01 June 2015. 
  11. ↑ "HHS Announces Next Steps to Promote Use of Electronic Health Records and Health Information Exchange". Centers for Medicare & Medicaid Services. 23 August 2012. http://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-Releases/2012-Press-Releases-Items/2012-08-232.html. Retrieved 01 June 2015. 
  12. ↑ "EHR Incentive Programs". Centers for Medicare & Medicaid Services. 22 April 2015. Archived from the original on 01 June 2015. https://web.archive.org/web/20150601220726/http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/index.html. Retrieved 01 June 2015. 
  13. ↑ 13.0 13.1 "An Introduction to Medicare EHR Incentive Program for Eligible Professionals" (PDF). Centers for Medicare & Medicaid Services. April 2014. http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/EHR_Medicare_Stg1_BegGuide.pdf. Retrieved 01 June 2015. 
  14. ↑ 14.0 14.1 14.2 "H.R. 1, Subtitle A, Sec. 3001 and 3002". The Library of Congress. http://thomas.loc.gov/cgi-bin/query/z?c111:H.R.1:/. Retrieved 01 June 2015. 
  15. ↑ "HIPAA/HITECH Enforcement Action Alert". The National Law Review. Morgan, Lewis & Bockius LLP. 22 March 2012. http://www.natlawreview.com/article/hipaahitech-enforcement-action-alert. Retrieved 01 June 2015. 
  16. ↑ "42 U.S.C. §17931". U.S. Government Publishing Office. http://www.gpo.gov/fdsys/pkg/USCODE-2009-title42/html/USCODE-2009-title42-chap156-subchapIII-partA-sec17931.htm. Retrieved 01 June 2015. 
  17. ↑ "HHS Strengthens HIPAA Enforcement". Thomson Reuters. 30 October 2009. http://www.reuters.com/article/2009/10/30/idUS213956+30-Oct-2009+BW20091030. Retrieved 01 June 2015. 
  18. ↑ 18.0 18.1 "Breach Notification for Unsecured Protected Health Information" (PDF). Federal Register 74 (162): 42740–42770. 24 August 2009. http://www.gpo.gov/fdsys/pkg/FR-2009-08-24/pdf/E9-20169.pdf. Retrieved 01 June 2015.  Cite error: Invalid <ref> tag; name "FR74162" defined multiple times with different content
  19. ↑ "Modifications to the HIPAA Privacy, Security, and Enforcement Rules Under the Health Information Technology for Economic and Clinical Health Act". Federal Register. U.S. Government Printing Office. 14 July 2010. https://www.federalregister.gov/articles/2010/07/14/2010-16718/modifications-to-the-hipaa-privacy-security-and-enforcement-rules-under-the-health-information. Retrieved 01 June 2015. 
  20. ↑ "Proposed Changes to Privacy Rule Won’t Ensure Privacy". Health Freedom Watch. Institute for Health Freedom. September 2010. http://www.forhealthfreedom.org/Newsletter/September2010.html. Retrieved 01 June 2015. 
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