History of EHR Adoption
The Quest for EHR Adoption
Executive Order 13335 (69 FR 24059) – GW Bush
- Established the Office of the National Coordinator for Health Information Technology (ONC) on April 24, 2004.
- The ONC will report to the Secretary of HHS
- In an effort to “provide leadership for the development and nationwide implementation of an interoperable health information technology infrastructure to improve the quality and efficiency of health care”
The First ONC
May 2004 – David Brailer, MD is appointed the first National Coordinator
July 2004 – ONC published the “Strategic Framework: The Decade of Health Information Technology: Delivering Consumer-centric and Information-rich Health Care” and strategies were developed.
Clinical Foundation – Enough studies show Healthcare IT saves lives and save money
Business Foundation – The potential benefits of HIT far outweigh manageable costs; the federal government should provide leadership and industry will engage and follow; stakeholder incentives are needed to foster adoption.
Technical Foundation – Request for information on development of the Nationwide Health Information Network (NHIN) was overwhelming:
- Should be decentralized architecture built on the internet
- should protect privacy of personal health information
- Existing technologies, federal leadership, and certification of EHRs will be the critical enablers of the NHIN
- Challenges included; additional and refined standards, privacy concerns, and accurately verifying patients
Federal Advisory Committee Formed
July 2005 -formation of the public-private collaboration and Federal Advisory Committee, American Health Information Community.
November 2005 -American Health Information Community first meeting and announced workgroups.
- Consumer Empowerment
- Chronic Care
- Electronic Health Records (EHRs)
HHS Issues Five Contracts
- Standards Harmonization – awarded to American National Standards Institute to convene the Health Information Technology Standards Panel (HITSP)
- Compliance Certification – awarded to the Certification Commission for Health Information Technology (CCHIT) to develop criteria and evaluation processes for certifying EHRs
- NHIN Architecture – $18.6 M awarded to four consortia of health care and HIT organizations to develop prototype architectures for the NHIN (Accentrue, CSC, IBM, and Northrop Grumman)
- Security and privacy – awarded to RTI International in association with the National Governors Association Center for Best Practices to identify security and privacy variations and barriers in business and state laws. States were also invited to participate and receive awards.
- EHR Adoption Study – awarded to George Washington U and Mass General Hospital Harvard Institute for Health Policy to measure the state of EHR adoption and determining the effectiveness of policies to accelerate adoption.
Terms are Defined
April 2008 – The National Alliance for Health Information Technology (NAHIT) was hired by ONCHIT to create key health IT definitions which were released in a report in April of 2008. The Executive Summary of the report tells us why defined terms are needed.
The contract to NAHIT was to reach consensus on definitions for the terms EMR, EHR, PHR, HIE and RHIO. HIO was added to the definitions once it was determined that HIE had a process and an entity meaning.
Obama Administration Health Care Agenda the Vision Continues
1. Focus on coverage
2. Focus on improving health system performance
3. David Blumenthal, MD, is appointed new ONC.
American Recovery and Reinvestment Act (ARRA)
The Health Information Technology for Economic and Clinical Health (HITECH) Act amended the Public Health Service Act (PHSA) and created “Title XIII and Title IV” – Health Information Technology and Quality” to:
- improve healthcare quality,
- safety and
- efficiency through the promotion of HIT and the electronic exchange of health information.
Section 3004(b)(1) of the PHSA required the Secretary of HHS to adopt an initial set of standards, implementation specifications, and certification criteria by December 31, 2009 to enhance the interoperability, functionality, utility and security of health information technology. Which would be finalized after a 60 day Public Commentary period.
Creating the rules
The ONC continues to build and revise on the previous Strategic Plan and the information acquired from the American Health Information Community. That committee will now be replaced by 2 new committees, the HIT Policy Committee and the HIT Standards Committee. Along with the National Committee on Vital and Health Statistics (NCVHS), these 3 committees will now advise and recommend to the new ONC to meet the HITECH Act mandates.
Federal Advisory Committees
Health IT Policy Committee - created in 2009 through the ARRA. It is responsible for, among other duties, recommending priorities for standards, implementation specifications, and certification criteria.
Health IT Standards Committee - created in 2009 through the ARRA. It is responsible for recommending standards, implementation specifications, and certification criteria for adoption under section 3004 of the PHSA.
National Committee on Vital and Health Statistics - created in 1949 through recommendations from the World Health Organization post WWII. The NCVHS advises the Secretary of HHS in the area of health data, statistics, and national health information policy.
The Committees Begin Work
- Defining Meaningful Use of certified EHRs
- Selecting Standards
- Implementation specification guidelines
- Certification criteria for EHR systems
May through December 2009 – monthly update and progress meetings were held openly by the HIT Policy and HIT Standards committees. Committees and workgroups held hearings and heard testimonies from all stakeholders. The committees made recommendations to the ONC.
December 30, 2009 - The ONC and CMS issued rules based on the recommendations from the committees.
- ONC Interim Final Rules (IFR) were published in the Federal Registry
- CMS Notice of Proposed Rulemaking (NPRM) were published in the Federal Registry
- The customary 60 day comment period for both rules began on January 13th and ends March 15th.
- Comment period ends for the ONC IFR and CMS NPRM.
- Over 2000 comments were received from all types of stakeholders
Certification Programs are established.
New Policy Committee Workgroups
- Enrollment -to recommend standards which would facilitate enrollment in Federal and state health and human services programs
- Privacy & Security Tiger Team -to address the requirements of HITECH Act and the needs of many new organizations created under that law
Stage 1 Final Rules published in the Federal Register
- 42 CFR Parts 412, 413, 422 et al., Medicare and Medicaid Programs; Electronic Health Record Incentive Program; Final Rule for Stage 1 was published in the Federal Register
- 45 CFR Part 170, Health Information Technology: Revisions to Initial Set of Standards, Implementation Specifications, and Certification Criteria for Electronic Health Record Technology for Stage 1 was published in the Federal Register
New Policy Committee Workgroups
- Governance -to draft recommendations on the scope and process of governance for nationwide HIE, including measures to ensure accountability and oversight
- Quality Measures -to produce initial recommendations on quality measure prioritization and the quality measure convergence process pertaining to measure gaps and opportunities for Stage 2 Meaningful Use
ONC Grants $642 million to establish Regional Extension Centers
- They will Provide outreach and support services to at least 100,000 priority primary care providers within two years
- February 2010 -32 awards announced
- April 2010 -28 awards announced
Health IT Workforce Development Program
- $84 million in grants focusing on key resources needed to rapidly expand the availability of skilled health IT professionals who will support broad adoption and use of health IT in the provider community
- April 2010 awards were given to recipients in these programs:
- Community College Consortia Program
- Curriculum Development Centers Program
- Competency Examination Program
- University-Based Training Program
July 2010 – Final Rules are Released establishing use of certified EHR technology in Stage 1.
February 2012 – Notice of Proposed Rules are released for Stage 2 Meaningful Use of certified EHR technology.
August 2012 – Final Rules released for Stage 2 Meaningful Use of certifided EHR technology.