A Brief History of the HITECH Act

There’s been so much interest in the evolution of Electronic Health Records recently. The impact on every physician’s office that chooses to accept insurance approved patients, or those on medicare will be staggering. For those that don’t want to play, they’ll be relegated to a “cash” business and face extensive costs to enter the market late.

The net result for those in the software development business is a new horizon of opportunity. We’re asked on occasion about the history of the HITECH Act, and the more recent activities related to the evolution of EHR. As such, here is a brief history of activity (spoiler alert: if you’re not involved in the medical community, this is boring stuff).

February 2009

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.

January 2010

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.

March 2010

Comment period ends for the ONC IFR and CMS NPRM.
Over 2000 comments were received from all types of stakeholders

June 2010

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

July 2010

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

August 2010

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

Rules for Stage 2 Meaningful Use of certified EHR technology are released

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