Under the HITECH Act, passed as part of the American Recovery and Reinvestment Act of 2009, Congress established a series of financial incentives and penalties to compel hospitals and health care professionals to become "meaningful" users of certified electronic health record (EHR) technology.
The legislative language left open many questions:
- What constitutes meaningful use of EHR, and how would meaningful use be demonstrated?
- What are the rules for the incentive programs?
- What constitutes certified EHR technology, and who is in charge of certification?
- How will the privacy and security of health data be protected?
- How will the standards enabling national data exchange be developed?
The federal government's effort to accelerate the deployment of EHR technology and establish a national system for the exchange of health data relies on a variety of federal offices and advisory committees within the U.S. Department of Health & Human Services (HHS).
- What is the Office of the National Coordinator?
- What is the Centers for Medicare & Medicaid Services?
- What is the National Committee on Vital and Health Statistics?
- What is the Health IT Standards Committee?
- What is the Health IT Policy Committee?
The Office of the National Coordinator for Health Information Technology (ONC), a division of HHS, is the lead organization in the federal government's effort to promote widespread adoption of health IT and create a national system for the exchange of health data. The position of national coordinator was created by executive order in 2004 and was mandated under the HITECH Act. President Obama appointed Dr. David Blumenthal national coordinator in March 2009.
The HITECH Act established financial incentives and penalties for hospitals and health care professionals to become meaningful users of certified, interoperable EHR systems. Further, it directed the ONC (along with the Centers for Medicare & Medicaid Services) to develop rules for the incentives program, including definitions for meaningful use and certified EHR technology.
In recognizing EHR certification programs, the ONC must consult with the director of the National Institute of Standards and Technology in the process. In March, the ONC proposed two EHR certification programs, one temporary and one permanent. Under the temporary program, the ONC would serve in an accrediting capacity, authorizing the organizations that want to become EHR certification bodies. Under the permanent program, the responsibilities for testing and certification would be separate. A private-sector accrediting body would have to be approved by the ONC, and accreditation requirements would have to be met.
Finally, the HITECH Act gave the ONC the task of developing a national system for health information exchange.
The Centers for Medicare & Medicaid Services (CMS) administers the federal Medicare program, and works with states to administer Medicaid and other programs. The Social Security Act of 1965 created the CMS -- then called the Health Care Financing Administration -- as a division of HHS. The agency was renamed in 2001.
The HITECH Act directed the CMS to work with the ONC to develop rules for the meaningful use incentive program, and put the CMS in charge of administering incentive payments.
As of July 15, the CMS also will bear the responsibility for establishing accreditation program requirements for hospitals and other health care providers that are eligible for Medicare reimbursement. The Joint Commission, a private, not-for-profit organization that has provided accreditation programs since 1951, currently has the statutory authority to determine those accreditation requirements.
Congress created the National Committee on Vital and Health Statistics (NCVHS) in 1949 to advise the HHS on health data, statistics and national health information policy. The committee received a revised charter in 1996, when its responsibilities increased under the Health Insurance Portability and Accountability Act (HIPAA) to reflect new health data concerns, including a lack of standards. The revised charter authorizes the committee to spur collaborative efforts to promote a consensus between the public and private sectors on data privacy and standards.
The NCVHS has 18 members who are experts in a variety of health-related fields, including statistics, data exchange, privacy, security, public health, research, consumer interests, standards and epidemiology. Congress chooses two members, and the HHS secretary appoints the other 16.
Recently the NCVHS issued recommendations for implementing provisions of the HITECH Act, including those related to protecting health data privacy and security, measuring meaningful use of EHR, and implementing HIPAA transaction standards.
Created through the HITECH Act, the Health IT Standards Committee develops recommendations for standards, implementation and certification of electronic health data exchange systems, and submits them to the ONC. Committee members come from health care companies, insurance companies, technology vendors, research facilities, federal agencies and other organizations.
The standards committee recently offered its recommendations on the financial incentives program administered by the CMS to promote the meaningful use of EHR, and on how meaningful use should align with federal health IT standards. The committee also intends to issue its thoughts on electronic insurance enrollment later this year.
Also created through the HITECH Act, the Health IT Policy Committee develops recommendations for a framework for developing a national health information infrastructure, and submits them to the ONC. The recommendations address such topics as the meaningful use of EHR, certification and adoption of EHR, data exchange, privacy and security policy, and a Nationwide Health Information Network.
Of the committee's 20 members, the Acting Comptroller General of the United States appoints 13, the majority and minority leaders of the U.S. Senate and the speaker and minority leader of the U.S. House of Representatives appoint four, and the HHS secretary selects three.
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