ONC earned its nickname as the “Office of No Christmas” during the 2009 Holiday season roughly two years ago when we, along with our colleagues at the Centers for Medicare & Medicaid Services (CMS), announced the proposed regulations to govern the Medicare and Medicaid Electronic Health Record Incentive Programs (EHR Incentive programs) established under the American Recovery and Reinvestment Act of 2009 (Recovery Act). CMS’s proposed rule outlined provisions governing the EHR Incentive programs, including defining the central concept of “meaningful use” of EHR technology.
At the same time, ONC issued an interim final regulation that set initial standards, implementation specifications, and certification criteria for EHR technology. In the closing months of 2009, ONC also issued a flurry of funding opportunities to support health information technology adoption, information exchange, and the workforce needed to make this important Recovery Act program succeed.
A year later, by the 2010 holiday season, vendors, newly accredited certification bodies, and a few vanguard providers were gearing up for the official launch of the EHR Incentive programs, which opened for registration on January 3, 2011. What has happened in the 12 months since then?
I would like to highlight ten of this year’s most notable developments in the world of health information technology and ONC.
1. January: Launch of the Medicare and Medicaid EHR Incentive Programs
Over the past 12 months, the concept of Meaningful Use has thoroughly permeated EHR development and implementation. The marketplace of certified products has grown quickly, interest in Meaningful Use among providers and hospitals is sky-high, and the pace of incentive payments has continued to accelerate.
- Products: As of today more than 1,500 EHRs—about 1,000 ambulatory and 500 inpatient EHRs— have been certified by one of the six private-sector Authorized Testing and Certification Bodies selected by ONC, up from 300 certified products at the start of the year. To date, 672 vendors have products certified under the program (60% of those vendors are small businesses with 50 or fewer employees), which is more than a three-fold increase in the number of vendors with certified products at the beginning of the year. This growth fosters competition, innovation, and gives providers more choices than ever before.
- Eligible Professionals and Hospitals: As we conclude the year, participation in the Medicare and Medicaid EHR Incentive Programs is strong and growing at an impressive rate. As of November 30, 2011, 154,362 eligible professionals and 2,868 eligible hospitals have registered with either of the EHR Incentive Programs. According to a recent survey, more than two-thirds of hospital CIOs and CEOs identified achieving Meaningful Use as their top IT priority. More than half of office-based physicians say they intend to apply for the Medicare or Medicaid EHR Incentive Programs.
More than 20,000 eligible professionals and 1,200 hospitals have already received their incentive payments from CMS, totaling $1.8 billion so far, with December shaping up to be the biggest month yet.
2. February: Launch of DIRECT
The Direct Project provides a simple, secure, standards-based way for providers and other participants to send encrypted health information directly to trusted recipients over the internet—a kind of “health email.” During 2011, the Direct Project went from publishing its first set of consensus-approved specifications to testing in pilots , to initial production implementation across vendor and state boundaries.
The Direct Project’s 200+ committed members reached consensus on two key specifications enabling secure directed transport of health information. Thirteen pilot communities across the nation put these specifications into practice, and successfully exercised and validated them. Technology and service vendors began offering production Direct capabilities to statewide health information exchanges, state and federal agencies, and health care professionals, with more than 35 vendors having implemented Direct by the end of 2011. Larger communities using Direct in production started to emerge, with Direct as part of the core strategy of 40 state HIE grantees.
3. March: The National Quality Strategy
In March, HHS released the National Quality Strategy for health improvement, the first effort to create a national framework to help guide local, state, and national efforts to improve the quality care in the United States. The National Quality Strategy recognizes health information technology as critical to improving the quality of care, improving health outcomes, and ultimately reducing the costs. Putting the National Quality Strategy into action, HHS subsequently launched two key initiatives that set specific national targets:
- Partnership for Patients, which is working with a wide variety of private and public stakeholders to make hospital care safer by reducing hospital acquired conditions by 40%, and improving care transitions upon release from the hospital so that readmissions are reduced by 20%.
- Million Hearts campaign, which is a public-private initiative to prevent 1 million heart attacks and strokes over the next five years by improving access to care and increasing adherence with basic preventive medicine.
The evidence shows that, health information technology, along with delivery system improvements, will be a key ingredient to the success of these campaigns and other efforts around the country to improve health outcomes. A study published this September in the New England Journal of Medicine which looked at diabetes care in Cleveland found:
- 51% of the patients being treated by physicians practices using an EHR received care that met all endorsed standards of diabetes care compared to 7% of patients treated by non-EHR practices
- 44% of patients treated by EHR practices met at least four out of five outcome standards for diabetes compared to 16% of patients in paper-based practices with similar outcomes
4. April: Launch of the Standards “Summer Camp”
At the April HIT Standards Committee meeting , Doug Fridsma, Director of the Office of Standards and Interoperability and Acting Chief Science Officer, kicked off the Summer of Standards—an accelerated effort to support the Stage 2 standards and certification requirements for the EHR Incentive Programs.
These activities took place within the Standards and Interoperability Forums. One of the major accomplishments of summer camp was reaching consensus around Consolidated Clinical Document Architecture (CDA): This summer, 150 committed members of the Standards and Interoperability Framework Transitions of Care Initiative—including providers, technology vendors, informaticists, standards institutions, and federal agencies—worked toward consensus on a single standard for transmitting care transitions data. After more than 1,000 balloted issues were resolved, the standard was approved, and subsequently recommended by the HIT Standards Committee for inclusion in the Stage 2 standards and certification requirements for the Medicare and Medicaid Incentive Programs.
For the first time in our country’s history there is a single, broadly-supported electronic data standard for patient care transitions!
5. June: Spurring Health Information Technology Innovation
Announced June 8, 2011, and made possible by the America Competes Act, the Investing in Innovations (i2) Program is the first-of-its-kind government effort to use prizes and challenges to stimulate and accelerate the development of solutions to targeted health care problems. Prizes and challenges are attracting a wide range of innovators from both inside and outside traditional health care communities to address tough problems, spurring industry-wide innovation and rewarding only best-in-class work.
Since June, several i2 challenges have been launched, including:
“One in a Million Hearts” challenge, a multidisciplinary call to innovators and developers to create applications activating and empowering patients to improve their heart health.
“Ensuring Safe Transitions from Hospital to Home” challenge, a collaboration with the Partnership for Patients called on software developers to create easy-to-use applications for consumers and caregivers improving care transitions. Winners include: Axial Transition Suite, ibluebutton, and FlexisVolDSPAN .
6. July: Health Information Technology Workforce
The growth in the number of providers adopting EHR systems, as well as the number of vendors developing EHR products, is positively affecting employment in the health information technology sector. The Bureau of Labor Statistics estimates that within the fast-growing health field, the fastest growth has been among IT-related health workers, which added more than 50,000 jobs from 2008 to 2010 alone.
ONC is helping train the health IT workforce the marketplace is demanding through 82 community colleges and nine universities nationwide. As of October 2011, the participating community colleges have graduated 5,717 health information technology professionals, with 10,065 more students currently in the training pipeline. As of November 2011, the universities have produced more than 500 post-graduate and masters-level health information technology professionals, with more than 1,700 expected to graduate by July 2013.
In July, ONC open-sourced the health information technology curriculum initially implemented and tested in the community college program. We have been amazed by the level of interest from across the country and around the world.
7. September: Breach Reporting and Increasing Security Awareness
In early September, HHS’s Office for Civil Rights (OCR) issued the first report to Congress on breaches of unsecured protected health information. According to the Health Information Technology for Economic and Clinical Health (HITECH) Act, health care providers and their business associates must now notify HHS, affected individuals, and in certain cases the media, about breaches of unsecured protected health information (PHI).
Notifying individuals and officials of security and privacy breaches serves a number of important purposes:
- It helps ensure that appropriate steps are taken to mitigate any adverse consequences of a breach;
- Promotes public transparency regarding such incidents; and
- Encourages providers and their business associates to take action to avoid such incidents.
With this in mind, providers and vendors are increasingly focused on the need to encrypt data, particularly on mobile devices and to regularly conduct risk analyses.
8. September: Consumer eHealth Comes to the Fore
In September, ONC organized a Consumer Health IT Summit that formally launched a Consumer e-Health Program. The Summit initiated a pledge program for public and private sector organizations to support individuals in being partners in their health via information technology.
CMS and CDC issued proposed regulations that would make it easier for patients to access lab data, and developed tools to make it easier for consumers to understand how sensitive information held in personal health records may be used.
More than 250 organizations, such as Aetna, the Mayo Clinic, Microsoft, AARP, and Consumers Union, have agreed to make health information easily available to consumers. The Blue Button, for example, which originated with the Veterans Affairs health system as a way of allowing veterans to download key parts of their medical record, is now being made available to millions of others by numerous public and private healthcare organizations.
Together, these organizations cover approximately 100 million people –equivalent to about a third of the population of the nation.
9. October: Regional Extension Centers Surpass their Goals
Adopting and using an EHR can be a daunting proposition for providers, especially those with limited resources, such as small primary care practices and critical access hospitals. ONC has funded 62 Regional Extension Centers (RECs) nationwide and a national Health Information Technology Research Center (HITRC) to help overcome the barriers to adoption and Meaningful Use.
We have also launched healthit.gov, a web-based information resource that serves as the virtual 63rd REC. The REC program offers providers training, information, and technical assistance to accelerate the adoption of certified EHR systems and the achievement of meaningful use. As of mid-December, the REC program had enrolled over 116,000 priority primary care providers, well exceeding its goal to enroll 100,000 priority primary care providers by the end of 2011. What’s more, the majority of primary care providers in rural areas are enrolled with an REC –70% of rural primary care providers in small practices are receiving REC assistance to make the transition to EHRs and meaningful use.
10. November: Growth in the Adoption of EHRs
Data from the CDC’s gold-standard survey of office-based physicians released in November showed that the percentage of non-hospital based physicians who have adopted a basic EHR has doubled from 17% in 2008 to 34% in 2011. Nearly 40% of primary care physicians have adopted an EHR.
The story is similar for hospitals. Prior to passage of the HITECH Act, only 10% of hospitals had adopted basic EHRs, and only 2% of hospitals were believed to have implemented most of the functionality called for in the Medicare and Medicaid Incentive Programs. In the most recent survey of hospitals, 41% of hospitals eligible for the EHR Incentive Programs had adopted certified systems, with an even higher percentage among larger hospitals and academic medical systems.
The growth in EHR adoption has been accompanied by a sharp increase in the number of providers using EHRs to electronically prescribe. Data show that 42% of non-hospital based physicians are submitting electronic prescriptions through an EHR system, more than a five-fold increase since 2000. In addition, a startling 93% of pharmacies are now capable of receiving electronic prescriptions.
What an amazing year it’s been for health IT and all of us involved in this shared effort and collaborative partnerships.
We’ve navigated through the tumult of these changes by focusing on our key principles:
- Open and inclusive decision-making;
- Focusing on the goal, not the technology;
- Building on what works best;
- Fostering innovation using the market;
- Watching out for the least capable participants; and above all,
- Putting patients’ interests in the center of everything we do.
I’m looking forward to 2012, and I will be blogging next about the five big health IT trends I see for the year to come. Send me your ideas by using the comment section below!