Health IT Moves Forward With Privacy, Consent

The federal government continues to move ahead with implementing various provisions of the American Recovery and Reinvestment Act of 2009. This update summarizes significant developments in July and August.

Committee OKs Privacy Recommendations

The Office of the National Coordinator for Health Information Technology's HIT Policy Committee approved patient privacy recommendations from the privacy and security work group (Tiger Team) last month, marking a key milestone on one of the most difficult roadblocks on the road to widespread use of electronic records in health care.

According to the recommendations, the direct exchange of health information between two providers generally does not require patient consent beyond current mandates. Consent, however, might be needed when a physician gives up control of a patient's health information after sending it through a health information exchange to another physician practice or testing lab. If the HIE adds the record to its database for future distribution to providers in its network, patient consent would be necessary.

The recommendations also state that providers are required to offer alternative data exchange models to patients who choose to opt out of a multipoint health data exchange network. The HIT Policy Committee will submit these recommendations to ONC, which will decide whether to adopt the proposed guidelines for the Medicare and Medicaid Electronic Health Record Incentive Programs.

In its July 21 meeting, the ONC HIT Policy Committee focused discussions on several areas:

• Beginning to address recommendations for Stage 2 "meaningful use" criteria, including additional objectives for administrative transactions, increased thresholds for computerized physician order entry, reporting of clinical quality measures and provider attestation of meaningful use achievement;
• Outlining key changes in the ONC final rule on standards and certification for EHRs, and highlighting final rule specificity related to standards and interoperability requirements; and
• Recommendations from the Tiger Team work group on collection, use and disclosure limits, and consent policies for individually identifiable health information. The Tiger Team and HIT Policy Committee were not able to reach a consensus on whether providers should use an opt-in or opt-out default for patient consent of information exchange.

Standards Committee Tackles Enrollment, Documents

ONC's HIT Standards Committee met in July and on Aug. 30. Discussions focused on the meaningful use final rule and work group activities, including:

• Enrollment Work group: Made a series of recommendations, including using National Information Exchange Model guidelines to develop, disseminate, and support standards and processes that enable consistent, efficient and transparent exchange of data elements between programs and states. This work group is co-chaired by California HealthCare Foundation Vice President of Programs Sam Karp. CHCF publishes California Healthline;
• Clinical Operations Work group: Discussed the need for a range of standard document types (e.g. inpatient discharge summaries), in addition to the Continuity of Care Record and others';
• Privacy and Security Tiger Team: Addressed fair information practices in HIE, focusing on collection, use and disclosure limits (including data re-use and retention) and general-level consent issues;
• Harmonization Processes & Governance: Discussed standards and implementation, including a framework that will consist of working with organizations throughout the health domain and creating a shared understanding of the requirements for interoperability and documenting that information; and
• Vocabulary Task Force: Shared information about upcoming hearings (Sept. 2 and Sept. 3), which would include panels on measure developers, among others.

NIST Publishes EHR Certification Guidelines

The National Institute of Standards and Technology released procedures for certification bodies to use in testing EHRs to ensure compatibility with other EHRs. ONC-authorized certifying bodies are required to use these procedures to evaluate EHRs marketed by vendors. In addition, ONC held two informational calls in August on the final temporary EHR certification rule (published in the June 24 Federal Register). Call recordings and transcripts are available here.

ONC is requesting public comments on the ONC temporary EHR certification program's recording and reporting requirement for applicants seeking to become ONC-Authorized Testing and Certification Bodies. Comments on the burden, utility and necessity of the requirements are due by Oct. 15.

ONC announced last month last month that the Certification Commission for Health Information Technology and the Drummond Group are the first technology review bodies that have been authorized to test and certify EHRs. Certification will signify to eligible professionals and hospitals that an EHR has the capabilities necessary to support their efforts to meet the goals and objectives of meaningful use.

More Guidance on Medicaid EHR Incentive Programs

CMS last month issued a second State Medicaid Directors letter providing guidance on the State Medicaid EHR incentive program, which provides incentive payments for the adoption and meaningful use of certified EHR technology. CMS guidance focused on the following elements:

• EHR Incentive Program administration activities potentially eligible for reimbursement, with the caveat that certain activities should be cost-allocated across all entities that benefit, not shouldered entirely by the State Medicaid agency;
• Formalized and expanded key criteria that CMS will consider when determining which and at what level activities will funded;
• Encouraging states to collaborate with state-level and local partners in the design and implementation of the EHR Incentive Program; and
• Highlighting the importance of program integrity and oversight activities, including providing examples of such activities potentially eligible for HITECH administrative funding.
• CMS announced the approval of another round of federal funding for state planning activities related to the Medicaid EHR incentive program. Connecticut, Delaware, the District of Columbia, Indiana, New Hampshire, Rhode Island and West Virginia will be able to access a total of $5.75 million in 90% federally matched funds.

Bills To Modify EHR Incentive Program

A number of proposals have been introduced in the U.S. Senate and House of Representatives that would impact the EHR Incentive Program. Proposals include:

• The EHR Incentives for Multi-Campus Hospitals Act (S 3708): Expands eligibility for Medicare and Medicaid EHR incentives to all qualified hospitals that are part of larger multi-campus hospital systems. No action has been taken on this bill or its House companion measure (HR 6072);
• The HIT Extension for Behavioral Health Services Act of 2010 (S 3709): Makes a number of changes affecting behavioral health professionals and facilities, including expanding funding opportunities. No action has been taken on this bill;
• The HITECH Extension for Behavioral Health Services Act of 2010 (HR 5025): Expands the definition of health care provider to include a behavioral or mental health professional, a substance abuse professional, a psychiatric hospital, a behavioral and mental health clinic, and a substance abuse treatment facility in terms of eligibility for EHR incentives. No action has been taken on this bill; and
• The Ensuring Equality for Early EHR Adoption Act of 2010 (HR 6005): Allows EHRs that enable providers to demonstrate meaningful use of EHRs, but were not yet certified by federally authorized testing bodies, to be considered certified in the first two years of the incentive program. No action has been taken on this bill.

New NHIN Governance Panel Has First Meeting

The newly created Nationwide Health Information Network governance panel met this month for the first time. ONC established the panel to make recommendations about rules for organizations participating in the NHIN.

ONC funding to Lockheed Martin would support the development of real-world NHIN models to demonstrate feature among other activities. Awards to Stanley would fund the building of a standards database and support technical services (e.g. managing directories) to organizations preparing to participate in the NHIN.

Two New Beacon Communities Named

This month, the ONC named two new Beacon Communities: Greater Cincinnati HealthBridge and Southeastern Michigan Health Association in Detroit:

• HealthBridge and its partners will use an advanced HIE to develop new quality improvement and care coordination initiatives focusing on patients with pediatric asthma, adult diabetes, and encouraging smoking cessation; and
• SEMHA will use health IT tools and strategies to prevent and better manage diabetes, by leveraging existing and new technologies across health care settings to improve the availability of patient information at the point of care.

$1.2B in Rural Broadband Grants

The U.S. Department of Agriculture announced a second round of ARRA funding to support broadband access and adoption. USDA awarded $1.2 billion in grants and loans to 126 broadband infrastructure projects aimed at improving rural access to broadband internet in 38 states and several Native American reservations. Four grants, totaling more than $14 million, were awarded in California.

USDA's Rural Utilities Service and the Department of Commerce's National Telecommunications and Information Administration announced $1.8 billion in awards for 94 projects to increase broadband access in 37 states. The grants and loans include over $300 million for projects involving public safety broadband networks. Seven California grantees were named, funding projects in the Central Valley, rural San Diego County and others throughout in the state.

FCC Announces $400M for Broadband

The Federal Communications Commission introduced a health care connectivity program of up to $400 million in broadband services for medically underserved rural areas. The program would partner with public and not-for-profit providers to invest in regional and statewide broadband networks; provide subsidies to assist hospitals, clinics, and others for recurring network costs; and extend eligibility for payments.

The FCC released issued a Notice of Proposed Rulemaking for the program and comments can be submitted up to 30 days after being posted in the Federal Register.