1. HITECH An ONC Perspective
Craig Brammer
Office of the National Coordinator for Health Information Technology (ONC)
June 18, 2010

2. Office of the National Coordinator for Health IT (ONC)
Resource for the entire U.S. health system
Supports and coordinates efforts to improve health care through:
Adoption of health information technology (HIT)
Nationwide health information exchange (HIE)
Created in 2004, then mandated in 2009 in the Health Information Technology for Economic and Clinical Health (HITECH) Act

3. HITECH Vision A major transformation in American health care
A major transformation in American health care
Each patient receives optimal care through nationwide health information exchange
Programs and regulations to help you overcome obstacles to adoption and Meaningful Use of electronic health records (EHRs)

4. Nationwide Health Information Exchange: Benefits
Private, secure, and comprehensive EHRs mean more informed clinical decision-making
Better clinician-patient communication
Efficient and convenient delivery of care
Early diagnosis of disease, with potential to improve health outcomes and reduce costs
Improved patient safety
Efficiencies for administrative tasks

5. Challenge: EHR Adoption Levels

6. Challenge: EHR Adoption Levels
Hospital adoption levels:
1.5% percent of U.S. hospitals have a comprehensive electronic records system
An additional 7.6% have a basic system
Only 17% of hospitals have implemented computerized provider-order entry for medications
Source: Jha A, DesRoches C, Campbell E, Donelan K, Rao S, Ferris T, Shields A, Rosenbaum S, Blumenthal D. “Use of Electronic Health Records in U.S. Hospitals”. New England Journal of Medicine: 360;16. April 16, 2009.

7. Barriers to EHR Adoption
Percent of Physicians Reporting a “Major Barrier”
Source: DesRoches CM et al. Electronic health records in ambulatory care—a national survey of physicians. N Engl J Med. 359(1):50-60, 2008 Jul 3.

8. Federal Government Responds: HITECH Act
Part of American Recovery and Reinvestment Act of 2009 (ARRA)
Goal: Every American to have an EHR by 2014
Systematically addresses major barriers to adoption and Meaningful Use:
Money/market reform
Technical assistance, support, and better information
Health information exchange
Privacy and security

9. Privacy and Security: The HITECH Response
Bans sale of health information
Requires ongoing audit trail
Strengthens civil and criminal enforcement of HIPAA
Expands patient rights to access their information
Requires innovative encryption technology to prevent breaches
Requires HHS Office for Civil Rights (OCR) to provide consumer education about protected health information

10. HITECH Regulations and Programs
Standards and Certification Criteria
Medicare & Medicaid EHR Incentive Programs (including Meaningful Use)
Regional Extension Centers (RECs)
State Health Information Exchange (HIE)
Workforce Training Programs
Beacon Communities
Strategic Health Information Technology Advanced Research Projects (SHARP)
Nationwide Health Information Network (NHIN)

11. How HITECH Addresses Barriers to Adoption
Obstacle
Intervention
Funds Allocated
Market Failure, Need for
Financial Resources
Medicare and Medicaid EHR Incentive Programs for “Meaningful Use”
$27.3 B*
Addressing Adoption
Difficulties
Regional Extension Centers
Health IT Research/Resource Center
$643 M
$50 M
Workforce Training
Workforce Training Programs
$84 M
Addressing Technology
Challenges and Providing
Breakthrough Examples
Strategic Health Information Technology Advanced Research Projects
Beacon Communities Programs
$60 M
$250 M
Privacy and Security
Policy Framework
New Privacy and Security Policies
Addressed
across all
Programs
Need for Platform for Health
Information Exchange
NHIN, Standards and Certification
State Cooperative Agreement Program
$64.3 M
$548 M
*$27.3 B is high scenario

12. Regional Extension Centers
HITECH: How the Pieces Fit Together
Regional Extension Centers
Workforce Training
ADOPTION
Improved Individual &
Population Health
Outcomes
Increased
Transparency &
Efficiency
Improved
Ability to Study &
Improve Care Delivery
Medicare and Medicaid
Incentives and Penalties
MEANINGFUL USE
EXCHANGE
State Grants for Health Information Exchange
Standards & Certification Framework
Privacy & Security Framework
Health IT Practice Research 12

13. Standards and Certification Criteria
Develop interoperability specifications that:
Identify harmonized standards
Provide detailed technical specifications for how those standards need to be used
Work with health care organizations and standards-development organizations to ensure that standards are available for use nationally

14. EHR Incentive Programs and Meaningful Use
Criteria for Medicare- and Medicaid-eligible professionals and hospitals to receive incentives for using certified EHR technology in a meaningful manner
The Recovery Act specifies the following 3 components of Meaningful Use:
Use of certified EHR in a meaningful manner (e.g., e-prescribing)
Use of certified EHR technology for electronic exchange of health information to improve quality of care
Use of certified EHR technology to submit clinical quality and other measures

15. Meaningful Use: Health Outcome Policy Priorities
Improving quality, safety, efficiency, and reducing health disparities
Engage patients and families in their health care
Improve care coordination
Improve population and public health
Ensure adequate privacy and security protections for personal health information

16. Regional Extension Centers (RECs)
Goal: Assist at least 100,000 providers in achieving Meaningful Use by 2012
Establish RECs nationwide to support providers in adopting and becoming Meaningful Users of HIT through comprehensive, “on-the-ground” services:
Outreach and education
EHR vendor selection support
Project management assistance
Workflow redesign support
Help with achieving Meaningful Use

17. RECs
Focus on supporting primary care providers that are least likely to achieve Meaningful Use on their own:
Small practices with less then 10 providers
Public and critical access hospitals
Community health centers and rural health clinics

18. Current RECs

19. REC Map Legend ID Organization Cohort ID Organization Cohort 1
Hawaii Health Information Exchange 2
Northern California Regional Extension Center 3
Southern California Regional Extension Center 4
Local Initiative Health Authority for Los Angeles County 5
Arizona Health-eConnection 6
Lovelace Clinic 7
Texas Tech University Health Sciences Center 8
The TAMUS Health Science Center Research Foundation 9
Univ. of Texas Health Sciences Center at Houston 10
eQHealth Solutions, Inc. 11
Louisiana Health Care Quality Forum 12
Community Health Centers Alliance, Inc 13
University of South Florida-- USF Health 14
Health Choice Network, Inc. 15
UCF College of Medicine 16
South Carolina Research Foundation 17
VHQC and the Center for Innovative Technology, for The Virginia Consortium 18
National Indian Health Board 19
District of Columbia Primary Care Association (DCPCA) 20
Quality Insights of Delaware 21
NJ Institute of Technology 22
Fund for Public Health NY 23
New York eHealth Collaborative (NYeC) 24
eHealth Connecticut Inc. 25
Rhode Island Quality Institute 26
Massachusetts Technology Collaborative 27
HealthInfoNet 28
Vermont Information Technology Leaders ID
Organization
Cohort 29
North Carolina Area Health Education Centers Program 1 30
Quality Insights of Pennsylvania (Eastern) 2 31
Quality Insights of Pennsylvania (Western) 32
Chesapeake Regional Information For Our Patients 33
West Virginia Health Improvement Institute, Inc. 34
National Center for Primary Care, Morehouse School of Medicine 35
University of South Alabama Center for Strategic Health Innovation 36
Dallas- Fort Worth Hospital Council Education and Research Foundation 37
Oklahoma Foundation for Medical Quality 38
Arkansas Foundation For Medical Care 39
Qsource (TN) 40
University of Kentucky/UK HealthCare 41
Greater Cincinnati HealthBridge 42
Ohio Health Information Partnership (OHIP) 43
Altarum Institute 44
Purdue University 45
Northwestern University 46
Northern Illinois University 47
MetaStar, Inc. 48
The Curators of the University of Missouri 49
Kansas Foundation for Medical Care, Inc. 50
CIMRO of Nebraska 51
Iowa IFMC 52
Key Health Alliance (Stratis Health) 53
South Dakota HIT Regional Extension Center 54
Colorado RHIO 55
HealthInsight 56
Mountain-Pacific Quality Health Foundation 57
OCHIN, Inc. 58
Qualis Health 59
Alaska eHealth Network

20. Helps people who get providers to meaningful use
The HITRC
Helps people who get providers to meaningful use
Mission
Accelerate the adoption and meaningful use of EHRs
The HITRC Convenes Regional Extension Centers and Provides tools and expertise toward collaboration in accelerating adoption and meaningful use of health information technology that is used to improve the quality of patient care.
Vision
When HITRC successfully realizes it mission, there will be at least 100,000 priority primary care physicians meaningfully using EHRs by 2012; all by 2014
Goals
Full (100%) participation in the Knowledge Sharing Network
The leading source of easily accessible health IT implementation information
Steady increase in level of EHR implementation capabilities and expertise
Objectives
Convene Regional Extension Centers
Provide Technical Assistance
Deliver usable tools and artifacts (“stuff”)

21. State Health Information Exchange
Goal: Give every provider options for meeting health information exchange (HIE) Meaningful Use requirements
4-year program to support state programs to ensure the development of HIE within and across their jurisdictions
56 states and territories awarded funding for HIE planning and implementation
States need an ONC-approved State Plan before federal funding can be used for implementation
Exchange must meet national standards

22. Workforce Training Programs
Goal: Help train up to 50,000 new HIT workers to assist providers in becoming Meaningful Users of EHRs
Four distinct programs that aim to support the education of new HIT professionals, including:
Community college consortia
Curriculum development centers
University-based training
Competency examination program

23. Workforce Training Programs
Community College Consortia
Five regional multi-institution consortia, creating non-degree training programs that can be completed in six months or less.
Curriculum Development Centers
Five awards to develop educational materials for key HIT topics to be used by Community College Consortia program.
University-Based Training Programs
Nine awards supporting existing programs to produce trained HIT professionals (most courses of study completed in ≤12 months).
Competency Examination Program
One award to create an objective assessment of basic competency for HIT individuals (non-degree programs and other members of workforce).

24. Work Force: Community College Consortia Program
Population and Target Grant Community Colleges by Region
Region A B C D E
Total
Census Population
23,171,056
47,460,504
65,115,773
97,020,826
75,669,343
308,437,502
Percentage of National Population 8%
15%
21%
31%
25%
100%
Minimum Students to be Trained Annually
750
1,650
2,250
3,300
2,550
10,500
Target Number of Member Community Colleges
5-8
11-14
13-18
16-22
17-23 70
Funding Allocation
$6,200,000
$10,750,000
$14,650,000
$21,150,000
$17,250,000
$70,000,000

25. The Beacon Community Program
Goal: Share best practices that help communities achieve cost savings and health improvement
15 demonstration communities* that will:
Build and strengthen their HIT infrastructure and exchange capabilities and showcase the Meaningful Use of EHRs
Provide valuable lessons to guide other communities to achieve measurable improvement in the quality and efficiency of health services or public health outcomes
*Two additional communities to be funded in Summer 2010

26. Patient-centered cognitive support
Strategic Health Information Technology Advanced Research Projects (SHARP)
Funded research program to find breakthrough advances to overcome barriers to HIT adoption
Projects focus on:
Security
Patient-centered cognitive support
Health care application and network-platform architectures
Secondary use of EHR data

27. The Nationwide Health Information Network (NHIN)
A set of policies, standards, and services that enable the secure exchange of health information over the Internet
Defines nationally recognized standards for interoperability and promotes their use in EHRs through certification programs

28. NHIN Improves patient care by linking:
Health information exchanges
Integrated delivery networks
Pharmacies
Government
Labs
Providers
Payers
Other stakeholders
Not a large database of patient records or a physical network that runs on HHS servers

29. Visit the ONC Web site: healthit.hhs.gov
For More Information
Visit the ONC Web site: healthit.hhs.gov