The federal government continued to implement the HITECH Act, enacted as part of the American Recovery and Reinvestment Act, during the fourth quarter of 2012. Below is a summary of key developments and milestones achieved between Oct. 1, 2012 and Dec. 31, 2012.
The fourth quarter of 2012 saw a number of important developments:
ONC Issues Draft Health IT Patient Safety Action and Surveillance Plan for Public Comment. On Dec. 21, 2012, the Office of the National Coordinator for Health IT released a draft Health IT Safety Plan to improve health IT and patient safety. Drawn from a 2011 Institute of Medicine report, the draft plan provides safety-related recommendations for the health IT industry to focus on during the next two years. Recommendations include using electronic health records to report adverse events and training surveyors to identify safe and unsafe health IT practices. Comments may be submitted through Feb. 4.
ONC Releases Stage 3 Meaningful Use Request for Comment. On Nov. 14, 2012, ONC released a request for comment regarding the Stage 3 criteria for meaningful use of EHRs. ONC requested comments on meaningful use objectives and measures, quality measures, and privacy and security issues. Comments were due Jan. 14. A Notice of Proposed Rule Making on Stage 3 of the EHR Incentive Programs is expected this spring.
CMS Revises Meaningful Use Stage 2 Final Rules. On Dec. 7, 2012, the CMS and ONC released an interim final rule with comment period making a number of changes under Stage 2 of the EHR Incentive Programs (e.g., updating standards and adding alternative measures). Comments are due Feb. 5. CMS had earlier released technical and typographical corrections to the Stage 2 Final Rule on Oct. 23, 2012.
CMS Requests Comments on Hospital and Vendor Readiness for EHR Quality Data Reporting. On Dec. 28, 2012, CMS filed a Request for Information regarding stakeholder readiness to report hospital inpatient quality data through EHRs. CMS intends to streamline quality reporting and reduce administrative burden through the use of EHRs, but the agency would like hospital and vendor feedback on issues such as operational challenges, prioritization of electronic reporting and participation in government pilots. Comments were due Jan. 22.
Health IT Policy & Standards Committees
Health IT Standards Committee Submits Comments Regarding FDA's Unique Device Identification System
During the fourth quarter of 2012, the Health IT Standards Committee discussed the meaningful use Stage 3 request for comment, work group updates and the Standards and Interoperability Framework -- an ONC-supported effort that consists of a group of volunteers who use established processes and tools to solve different interoperability issues. The Standards Committee also submitted comments to ONC regarding FDA's Unique Device Identification (UDI) System Notice of Proposed Rule Making, in which FDA proposed that most medical devices distributed in the U.S. carry a unique device identifier in an effort to improve the quality of information in medical device adverse event reports. The committee's comments generally supported FDA's efforts but noted that many retail devices excluded from UDI requirements in the proposed rule should be included.
Health IT Policy Committee Discusses Stage 3 Draft Recommendations
During the fourth quarter of 2012, the Health IT Policy Committee received updates on the EHR Incentive Programs and other ONC initiatives. The Policy Committee also focused on revising its draft Stage 3 meaningful use criteria and held a public hearing on Nov. 30, 2012, on clinical quality data improvement. Additionally, the Policy and Standards committees' work groups held a joint hearing on Nov. 29, 2012, to discuss patient identity verification and will conduct another joint public hearing on Jan. 29 to discuss health information exchange activities, and drivers and barriers to HIE adoption. The committees also accepted membership applications for two new consumer work groups through an online database.
ONC Approves 2014 Edition Test Method
On Dec. 14, 2012, ONC approved the 2014 Edition Test Method for use in the ONC Health IT Certification Program. Testing laboratories and certification bodies will use these test procedures, test data and test tools to evaluate EHRs beginning in 2014.
Medicare and Medicaid EHR Incentive Programs
CMS Provides Updates on EHR Incentive Program
CMS reported that, as of November 2012, three out of four eligible hospitals and approximately one out of three eligible professionals have received incentive payments under the Medicare and Medicaid EHR Incentive Programs. More than $9.3 billion has been distributed since 2011 to 3,393 hospitals and 173,168 professionals.
CMS Releases Stage 2 Meaningful Use Specification Sheets
On Nov. 12, 2012, CMS released Stage 2 meaningful use specification sheets for eligible hospitals and professionals to assist them in participating in the EHR Incentive Programs. The sheets include information on the measures, exclusions, definitions and attestation requirements associated with each meaningful use objective.
Three Reports Publish EHR Adoption Figures
In December 2012, a National Center for Health Statistics data brief, titled, "Use and Characteristics of Electronic Health Record Systems Among Office-Based Physician Practices: United States, 2001-2012," and an ONC data brief, titled, "Physician Adoption of Electronic Health Record Technology To Meeting Meaningful Use Objectives: 2009-2012," published results from the National Ambulatory Medical Care Survey and National Electronic Health Records Survey, respectively. Of note, approximately 72% of ambulatory physicians in the U.S. use EHRs and, since HITECH was implemented, physician adoption of EHRs to meet meaningful use has increased by at least 66%. The Government Accountability Office also published a report, titled, "Electronic Health Records: Number and Characteristics of Providers Awarded Medicaid Incentive Payments for 2011," which noted that the median hospital payment under the Medicaid EHR Incentive Program was $613,000 and that 97% of eligible professionals received the maximum payment of $21,250.
CMS Releases 2014 Clinical Quality Measures
On Oct. 26, 2012, CMS posted the 2014 clinical quality measures and specifications required for EHR certification. Beginning in 2014, health care providers must submit clinical quality measures electronically to receive meaningful use incentive payments; the specifications outline the data elements and technical requirements for measure submission and EHR certification.
OIG Releases Report on Obstacles in the Medicare EHR Incentive Program
On Nov. 29, 2012, HHS' Office of the Inspector General released a report, titled, "Early Assessment Finds That CMS Faces Obstacles in Overseeing the Medicare EHR Incentive Program." The report focused on the first year of the incentive program and provided recommendations, including that ONC should improve the EHR certification process to ensure accurate reports.
OIG Surveys Hospitals in the Medicare EHR Incentive Program
In October 2012, OIG asked at least ten hospitals that participated in the Medicare EHR Incentive Program to respond to a survey to assess their data entry habits, coding processes and security practices. OIG aims to identify fraud and abuse, particularly after claims that providers are using EHRs to increase upcoding practices.
ONC Releases Updated Dashboard
On Dec. 7, 2012, ONC released interactive maps tracking EHR Incentive Program activity around the country, including program milestones by state and provider type. Information on state health information exchanges, Regional Extension Centers, Beacon Communities and workforce training programs also is available.
Health Information Exchange
ONC Transitions the Nationwide Health Information Network Exchange to Healtheway
On Oct. 1, 2012, ONC transitioned operational responsibility for the Nationwide Health Information Network (NwHIN) Exchange to Healtheway, a not-for-profit public-private partnership. Healtheway will support the NwHIN Exchange, now renamed the eHealth Exchange. Healtheway's operational tasks include testing and certifying new eHealth Exchange participants and supporting technology infrastructure.
ONC Releases HIE Funding Opportunity Announcement
On Dec. 20, 2012, ONC released a funding opportunity announcement for state governments and not-for-profits to further develop HIE policies, requirements, and business criteria. Awards will range from $200,000 to $400,000, and responses are due Feb. 4.
ONC Supports Nationwide Health Information Exchange
Also on Dec. 20, 2012, ONC stated that it will support HIE governance through a number of activities, including hosting an open listening session in January to hear from stakeholders regarding their HIE issues, priorities and concerns; publishing governance guidelines for effective and trusted HIE; and launching a monitoring program to ensure goals are met.
ONC Releases HIE Case Studies
On Nov. 30, 2012, ONC released studies profiling HIE governance structures, technical services, and privacy and security frameworks in five states. The studies also include challenges and lessons learned.
Other Health IT Developments
Beacon Community Programs Provide Updates on Activities
During the fourth quarter of 2012, all 17 Beacon Community Programs provided details on their current progress through updated fact sheets. Information included the number of lives impacted by Beacon interventions, the number of health care partners involved in each initiative and program approaches.
ONC Holds Annual Meeting
On Dec. 12, 2012, ONC held its Annual Meeting. Meeting participants discussed health IT successes, challenges and interoperability, and states were recognized for their progress in EHR adoption. ONC 2012 Video Challenge winners, who showcased their experience adopting health IT, were also announced.
ONC Awards Challenge Winners
ONC held a number of challenges during the fourth quarter of 2012 including the:
ONC also held video challenges including the:
ONC Highlights Benefits of EHRs During Disasters
In the aftermath of Hurricane Sandy, ONC noted the benefits of EHRs during disasters; when paper records were lost in floods, EHRs allowed for access to health information. Drawing from provider experiences, ONC recommended that providers store data at a remote location, turn off IT systems if they are able to before the event, back up data continuously and purchase a generator to keep records secure during a disaster.