Final Federal IT Health Plan


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he technologies collectively known as health information technology (health IT) share a common attribute: they enable the secure collection and exchange of vast amounts of health data about individuals. The collection and movement of this data will power the health care of the future. Health IT has the potential to empower individuals and increase transparency; enhance the ability to study care delivery and payment systems; and ultimately achieve improvements in care, efficiency, and population health.

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Final Federal IT Health Plan

  1. 1. Office of the NationalCoordinator for HealthInformationTechnology (ONC)Federal Health Information TechnologyStrategic Plan 2011 – 2015
  2. 2. Introduction 3Table of Federal Health IT Vision and Mission 6 Federal Health IT Principles 7Contents Goal I: Achieve Adoption and Information Exchange through Meaningful Use of Health IT 8 Goal II: Improve Care, Improve Population Health, and Reduce Health Care Costs through the Use of Health IT 21 Goal III: Inspire Confidence and Trust in Health IT 28 Goal IV: Empower Individuals with Health IT to Improve their Health and the Health Care System 36 Goal V: Achieve Rapid Learning and Technological Advancement 43 Appendix A: Performance Measures 49 Appendix B: Programs, Initiatives, and Federal Engagement 51 Appendix C: HIT Standards and HIT Policy Committees Information Flow 65 Appendix E: Statutes and Regulations 67 Appendix F: Goals, Objectives, and Strategies 70 Appendix G: Acronyms 74 ONC 77 Acknowledgements 77 Notes 78
  3. 3. Federal Health IT Strategic Plan 3
  4. 4. IntroductionT he technologies collectively known as health Public Health Service Act, as added by the HITECH information technology (health IT) share a Act, requires the National Coordinator to update common attribute: they enable the secure and republish the Plan. This Plan updates the collection and exchange of vast amounts of previous version to take into account the rapidlyhealth data about individuals. The collection and changing landscape of health IT and health ITmovement of this data will power the health care of policy. In order to update the Plan, ONC leveragedthe future. Health IT has the potential to empower the strategic framework put forth by the HIT Policyindividuals and increase transparency; enhance the Committee and obtained additional input byability to study care delivery and payment systems; conducting interviews with representatives fromand ultimately achieve improvements in care, federal agencies/offices and the private sector.efficiency, and population health. ONC also engaged its federal partners, the private sector and members of the public to provideHowever, these technologies – including electronic comments on multiple versions of the records (EHRs), personal health records(PHRs), telehealth devices, remote monitoring Goal I, “Achieve Adoption and Informationtechnologies, and mobile health applications – are Exchange through Meaningful Use of Health IT”remarkably underutilized today. In 2010, only 25 discusses the centerpiece of the government’s healthpercent of physician offices and 15 percent of acute IT strategy over the next five years. “Meaningfulcare hospitals took advantage of EHRs. i Even fewer use” is aimed at widespread adoption andused remote monitoring and telehealth technologies. information exchange in its first two stages, and willWhile many consumers access their banking then build to improve health outcomes in the thirdinformation online daily, only 7 percent have used stage. Activities are focused on two areas: definingthe web to access their personal health information. ii the meaningful use of certified EHR technology; and encouraging the achievement of meaningful useRecent legislation has established an agenda and through the CMS administered Medicare andcommitted significant resources for health IT. The Medicaid EHR Incentive Programs and the supportHealth Information Technology for Economic and of meaningful use through grant programs, includingClinical Health (HITECH) Act, passed as part of the information exchange with public healthAmerican Recovery and Reinvestment Act of 2009, departments and laboratories.allocated billions of dollars for the health care systemto adopt and meaningfully use health IT to improve Goal II, “Improve Care, Improve Population Health,health. The Patient Protection and Affordable Care and Reduce Health Care Costs through the Use ofAct of 2010, as amended by the Health Care and Health IT,” discusses the specific ways health IT isEducation Reconciliation Act of 2010, (referred to contributing to the goals of health care reform:collectively as the Affordable Care Act) builds on the improved care, improved population health, andHITECH Act and recognizes health IT as a critical reduced per capita costs of health care. Widespreadenabler to broad transformations in health care. This adoption of EHRs, information exchange, qualitydocument is the Federal Health IT Strategic Plan, improvement initiatives, and health care reformdeveloped under the leadership of the Office of the pilots are required to implement the Affordable CareNational Coordinator for Health Information Act. As part of each of these activities, theTechnology (ONC) and in close collaboration with government is investing in and leveraging health ITother federal partners, for working with the private to transform the health care system.and public sectors to realize Congress and the Goal III, “Inspire Confidence and Trust in HealthAdministration’s health IT agenda. IT,” focuses on government efforts to update itsThe first Federal Health IT Strategic Plan was approach to privacy and security issues related topublished in June 2008. Section 3001(c)(3) of the health IT, and build greater confidence and trust in Federal Health IT Strategic Plan 4
  5. 5. EHRs and health information exchange among improve knowledge about health care acrossproviders and the public. The digitization of health populations. In the long run, the government isrecords will create a new set of challenges for pursuing a vision of a learning health system, inprotecting the privacy and security of health which a vast array of health care data can beinformation, but it will also open new opportunities appropriately aggregated, analyzed, and leveragedfor improving safeguards. using real-time algorithms and functions. iii This future will require technical innovation to build onGoal IV, “Empower Individuals with Health IT to the foundation of meaningful use, as well as findingImprove their Health and the Health Care System,” new ways to use that foundation in the practice ofdiscusses how the government is designing health IT health care.policies and programs to meet individual needs andexpectations, provide individuals with access to their ONC will track national progress towards achievinginformation, help facilitate a strong consumer health the goals laid out in this Plan. OngoingIT market, and better integrate individuals’ and collaboration with federal agencies, states andclinicians’ communications through health IT. A providers will be necessary in order to realize thesepublic that has a voice in designing national health goals. The Plan is meant to be a living documentIT policies and programs and is empowered with that will be updated based on experience with stageaccess to its health information through useful tools one meaningful use and the implementation of acan be a powerful driver in moving toward patient- robust evaluation program.centered health care.Goal V, “Achieve Rapid Learning and TechnologicalAdvancement,” focuses on demonstrating wayshealth IT and meaningful use can enable innovationand appropriate use of health information to Federal Health IT Strategic Plan Figure 1; Federal Health IT Strategy Map 5
  6. 6. Federal Health IT Vision and MissionVisionA health system that uses information to empower individuals andto improve the health of the population.MissionTo improve health and health care for all Americans through theuse of information and technology. Federal Health IT Strategic Plan 6
  7. 7. Federal Health IT PrinciplesIn developing and executing the federal health IT strategy, the government strives to Put individuals and their interests first. In order to enhance the health and well-being of all Americans, the government must meet the needs and protect the rights of each individual. Be a worthy steward of the country’s money and trust. The government seeks to use its resources judiciously. This means relying to the extent possible on private markets to accomplish important societal objectives, and acting to correct market failures when necessary. It also means developing governmental policies through open and transparent processes. Support health IT benefits for all. All Americans should have equal access to quality health care. This includes the benefits conferred by health IT. The government will endeavor to assure that underserved and at-risk individuals enjoy these benefits to the same extent as all other citizens. Focus on outcomes. Federal health IT policy will constantly focus on improving the outcomes of care, so as to advance the health of Americans and the performance of their health care system. Build boldly on what works. The government will set ambitious goals and then work methodically to achieve them, monitoring health IT successes, and looking for ways to expand upon programs that work. It will seek to be nimble and action-oriented: evaluating existing government activities, learning from experience, and changing course if necessary. Encourage innovation. The government is working to create an environment of testing, learning, and improving, thereby fostering breakthroughs that quickly and radically transform health care. The government will support innovation in health IT. Federal Health IT Strategic Plan 7
  8. 8. Goal I: Achieve Adoption and Information Exchangethrough Meaningful Use of Health ITT he first priority in realizing the benefits of the adoption and use of EHRs over the next five health IT is to achieve nationwide adoption years. Stage one objectives focus on adopting EHRs of EHRs and widespread information and beginning to take advantage of basic electronic exchange. As patients and providers data capture, medication ordering, and decision-experience the benefits of EHRs, they will demand support tools. We expect future stages to becomenothing less from their health care practices. The more rigorous, for example, by requiring providersMedicare and Medicaid EHR Incentive Programs not only to adopt the technology but to use it toaccelerate the realization of this future by offering exchange health information and – ultimately – tofinancial incentives to hundreds of thousands of achieve improvements in care, efficiency, andeligible professionals, eligible hospitals and critical population health (see Goal II). We anticipate thataccess hospitals for incorporating certified EHR future stages of meaningful use will be aligned totechnology into their practices. “Meaningful use” is support advancing nationwide-wide health goals, asmuch more than just adoption – these providers will defined in the HHS Strategic Plan, and the priorityalso be required to maintain data confidentiality, areas identified in the National Quality Strategy.share information securely with each other, engage In addition to incentive payments, the HITECH Actpatients with their electronic health information, and programs provide significant support for providersimprove care. to achieve adoption and meaningful use, includingThere are a few well-defined barriers that have implementation support, workforce training, andslowed acceptance of EHRs and widespread information exchange support. Programs areinformation exchange. Small- and medium-sized focused on the providers that need the most help –providers often do not have sufficient capital to solo and small group practices, community healthimplement EHR systems. There is a lack of skilled centers, critical access hospitals, and providershealth IT professionals to support providers as they located in rural and underserved areas. In 2010, HHStransition from paper records to EHRs. Using EHRs issued rules establishing the requirements of themay alter current provider workflows, and many first stage of meaningful use. HHS expects toproviders struggle to select systems, use them in articulate two further stages through rulemakingways that will improve care, and make the necessary over the next five years. Participation in thechanges to their processes. Finally, information Medicare and Medicaid EHR Incentive Programs isexchange, which is central to realizing the benefits of voluntary, but beginning in 2015, eligibleEHRs, is not fully possible today – there is no professionals and hospitals under the Medicare EHRinteroperable infrastructure to securely exchange Incentive Programs will face payment reductions ifhealth information nationwide among providers, they do not meet the meaningful use requirements.between providers and patients, and between In implementing the Medicare and Medicaid EHRproviders and public health agencies (see Objectives Incentive Programs, the government is takingI.B and I.C). advantage of the experience of federal agencies thatThrough the HITECH Act, the Department of deliver health care (Department of Veterans Affairs,Health and Human Services (HHS) created a set of Department of Defense, and Indian Health Service)far-reaching programs to help providers overcome that have already-developed EHR systems whichsuch barriers. For the Medicare and Medicaid EHR have been in place for over a decade. These agencies’Incentive Programs, the three progressive stages of experiences in using EHRs can offer importantmeaningful use will define what eligible professionals insights and best practices for the nationwideand hospitals can and should accomplish through adoption of EHRs. Federal Health IT Strategic Plan 8
  9. 9. It is the government’s goal that such a large-scale Medicare and Medicaid EHR Incentive Programs (formovement will create a tipping point – that the example, long-term and post-acute care facilities,adoption and meaningful use of EHRs will become community mental health centers, and some behavioralubiquitous across the nation. To this end, the health providers), the government is developinggovernment is seeking to encourage meaningful use technology and policy solutions that will build on thethrough other mechanisms in addition to HITECH Department’s meaningful use efforts and fit theirAct programs. This includes supporting the above- unique needs (see Strategy I.C.3).mentioned federal agencies that deliver health care and The government’s objectives to “Achieve Adoptionfederal grant recipients (critical access hospitals, and Information Exchange through Meaningful Usecommunity health centers, etc.) in meeting meaningful of Health IT” are:use requirements. We expect that medical societies andprofessional licensing and certifying bodies will also A. Accelerate adoption of electronic healthhelp to encourage meaningful use among their recordsmembers. Some private insurers are already mirroring B. Facilitate information exchange to supportthe Medicare and Medicaid EHR Incentive Programs meaningful use of electronic health recordsand providing incentives for the achievement of C. Support health IT adoption andmeaningful use among their provider communities. For information exchange for public health andproviders ineligible for incentive payments under the populations with unique needs Spotlight on Health Outcomes Use of health IT can improve health outcomes and enhance care coordination George is a 62-year-old man with diabetes, hypertension, and heart failure Jane is an 83-year-old woman with COPD, who smokes one pack of cigarettes every day. George’s primary care provider hypertension, and peripheral vascular disease (PCP) is reviewing an EHR-generated listing of patients with an HbA1c test who is admitted to the hospital with result over 9. She notices that George is on her list with an HbA1c of 11.2 pneumonia. As the admitting physician is and that he missed his last appointment and has not yet rescheduled. ordering an antibiotic for pneumonia, a George’s PCP emails him via secure messaging to request he make an drug-allergy warning pops up on the screen appointment and get the following tests in advance of the visit: HbA1c and alerting the physician that Jane had an cholesterol panel. She orders these tests via computerized provider order anaphylactic reaction to penicillin in the past entry (CPOE). George goes online to schedule his appointment. Prior to his and another antibiotic is preferred – saving appointment, George’s PCP checks his lab results which are sent Jane from an adverse drug event. Jane is at electronically to the EHR and sees that his HbA1c and cholesterol are still high-risk for developing a clot in her legs, elevated. A nurse uses clinical decision support to determine that George which can lead to a pulmonary embolism. As would benefit from diabetes self-management and smoking cessation part of the admissions order set, the counseling, which she gives before his appointment. During his appointment, physician is prompted to choose a type of George’s PCP talks to him about adding a new medication to better control prophylaxis for clots, which reduces her risk his diabetes and increasing the dose of his cholesterol medicine. She sends of developing this complication and a the new prescriptions electronically to George’s pharmacy so that they will be prolonged hospital stay. The nurse who ready for pick-up when he leaves the office visit. Clinical decision support admits Jane notices a small decubitus ulcer also reminds the PCP that George is due for eye and foot exams. She present on admission. She documents the performs a foot exam and sends an electronic referral to the ulcer on her mobile device and monitors and ophthalmologist’s office, who will contact George via secure messaging to treats it with the aid of clinical decision schedule an appointment. The ophthalmologist has access to George’s record support and can input data and recommendations that are viewable by his PCP, thus creating a “seamless care” model. To help him with his multiple conditions, George is set up with a case manager who will work with George to develop strategies to quit smoking and eat healthier/exercise more. The case manager has access to the full EHR and can communicate directly with the rest of the team to update them on George’s progress. These “Spotlight on Health Outcomes” are intended to highlight exemplary ways that widespread adoption and use of health IT and electronic health information exchange could help transform and improve health care. Some of these examples are only aspirational today or only exist in select communities or health systems. However, these examples illustrate the type of transformed health care that could be possible with the achievement of the goals of this Plan. Federal Health IT Strategic Plan 9
  10. 10. OBJECTIVE A transition gradually away from further process requirements like those included in stage one, toAccelerate adoption of electronic requirements for improvement in outcomes andhealth records quality of care. Any such improvement measures will be in line with nationwide health goals as laid out inStrategy I.A.1: Provide financial incentive the HHS Strategic Plan and with the nationalpayments for the adoption and meaningful priorities identified in the National Quality Strategy. vuse of certified EHR technology. In order to receive incentive payments, eligibleCentral to the HITECH Act is the establishment of providers must demonstrate that they can usethe Medicare and Medicaid EHR Incentive certified EHR technology to incorporate morePrograms, which makes available incentive payments sophisticated uses of health IT, such as clinicalthat could total an estimated $27 billion over 10 decision support (CDS), patient registries, reminderyears, to encourage eligible professionals and systems, and changes to workflow and clinical carehospitals to adopt and meaningfully use certified redesign into their practices (see Goal II).EHR technology. iv The programs generally require Strategy I.A.2: Provide implementationproviders to do the following:adopt EHRs that are support to health care providers to helpcertified according to standards, implementation them adopt, implement, and use certifiedspecifications, and certification criteria adopted by EHR technology.the Secretary, and meet certain objectives andmeasures using certified EHR technology established The Regional Extension Center (REC) Program,for progressive stages of meaningful use as defined established through the HITECH Act with morein CMS rules. CMS’ final rule for stage one than $720 million in grants over a four-year projectmeaningful use was published in July 2010. Stage period, has set up 62 centers across the nation withone meaningful use objectives include: staff and resources dedicated to helping providers implement and become meaningful users of certified Recording patient information into EHRs, such as EHR technology. Additionally, HRSA’s Health gender, race, preferred language, height, weight, Center Controlled Network (HCCN) Program smoking status, and blood pressure provides resources to community health centers to Using a software application to inform clinical implement health IT, including EHRs. Further decisions support is provided by the Health Information Technology Research Center (HITRC), which will Entering medical prescriptions electronically work to gather relevant information on effective Providing patients with a timely electronic copy of practices and help the RECs collaborate with one their health information another and with relevant stakeholders to identify and share best practices in EHR adoption, Securing EHRs to protect the privacy of patient meaningful use, and provider support. Through its data regional offices and other outlets, CMS offersFuture stages of meaningful use are likely to include support to states to encourage adoption of EHRa combination of new objectives, some of which technology.may require new EHR functionality, changes toexisting objectives, such as an increase in the Strategy I.A.3: Support the development of athreshold or broadening of the definition. In the trained workforce to implement and usefuture stages of the Medicare and Medicaid EHR health IT technologies.Incentive Programs, the government expects to To meet the anticipated growth in demand forreward improvement against predetermined health IT professionals, HITECH made availablethresholds that are associated with the adoption and $118 million to support the training anduse of EHRs. Stages two and three are anticipated to development of more than 50,000 new health IT Federal Health IT Strategic Plan 10
  11. 11. professionals. Four grant programs will prepare specifications and certification criteria, as well as aqualified individuals to serve in 12 high priority roles process for EHR technology to gain certification.related to the implementation and maintenance of These programs aid providers in selecting certifiedEHR systems. EHR technologies that support them in becoming meaningful users. ONC collaborated extensivelyThree grant programs work together to prepare a with the National Institute of Standards andworkforce in six of these priority roles for which Technology (NIST) to establish the certificationcommunity colleges are the natural home for Community College Consortia to EducateHealth Information Technology Professionals; Established through rulemaking in 2010 and 2011,Curriculum Development Centers; and Competency ONC’s certification programs specify howExamination for Individuals Completing Non- organizations can become authorized by theDegree Training. A fourth program, Assistance for National Coordinator to certify EHR technology asUniversity-Based Training, will prepare students for being compliant with the standards, implementationsix different roles, for which universities are the specifications, and certification criteria adopted bynatural home for training. vi the HHS Secretary.Strategy I.A.4: Encourage the inclusion of ONC published the Initial Set of Standards,meaningful use in professional certification Implementation Specifications, and Certificationand medical education. Criteria interim final rule in January 2010 and a final rule in July 2010. The certification criteria establishThe federal government will encourage meaningful the required capabilities, standards, anduse to be incorporated into the U.S. medical implementation specifications in EHR technologyeducation and accreditation processes. To this end, that supports the achievement of meaningful useONC and CMS are collaborating with various stage one. The certification criteria will continue toprofessional certification and medical education evolve with future rulemakings, as further stages oforganizations to assist providers in adopting and meaningful use are established.becoming meaningful users and to incorporatemeaningful use into the professional certification ONC, with its federal partners, will consider whetherand medical education organizations’ professional to adopt certification criteria for health IT that isrequirements. The American Board of Medical used by non-eligible providers (such as long-termSpecialties, a professional certification body, has and post-acute care facilities), and whether thetaken steps to assist and encourage physicians in the availability of certification for specific types of healthadoption and meaningful use of EHRs, with the IT would be beneficial.ultimate goal that such EHR use and competencies Strategy I.A.6: Communicate the value ofshould become an element of professional EHRs and the benefits of achievingcertification. meaningful use.Strategy I.A.5: Establish criteria and a HHS is conducting outreach to providers to increaseprocess to certify EHR technology that can awareness of the HITECH Act programs that aresupport meaningful use criteria. available to support efforts to attain meaningful useIn order for eligible providers, eligible hospitals, and and to share evidence and best practices on the usecritical access hospitals to qualify for the Medicare of health IT to improve health. Primary careand Medicaid EHR Incentive Programs, they must providers are a primary audience for this strategyfirst adopt certified EHR technology that meets (see Strategies III.B.1 and IV.A.2 for outreachestablished criteria, which are aligned with the directed at individuals). The strategy will have fourMedicare and Medicaid EHR Incentive Programs aims:meaningful use requirements. The HHS Secretaryhas adopted EHR standards, implementation Federal Health IT Strategic Plan 11
  12. 12.  Raise awareness among providers about the health care systems to align with meaningful use. availability and benefits of EHRs and other health Similarly, the Health Resources and Services IT Administration (HRSA) and the Federal Communications Commission (FCC) are developing Educate providers about privacy and security plans to encourage their grantees and subsidy protections as they relate to EHRs and other recipients, respectively, to become meaningful users. health IT The Substance Abuse and Mental Health Services Encourage providers to participate in HITECH Administration (SAMHSA) is working to foster Act programs and other federal initiatives (e.g., adoption and implementation of certified EHRs Medicare and Medicaid EHR Incentive Programs, among its providers that are ineligible for the grants, contracts) in order to take full advantage of Medicare and Medicaid EHR Incentive Programs, EHRs and other health IT including community mental health centers and substance use disorder treatment facilities. Finally, Increase provider understanding of health IT the Office of Personnel Management (OPM) is products and services, so that they may make developing a strategy to encourage health plans that informed decisions and take full advantage of the provide coverage through the Federal Employee technologies’ benefits Health Benefits (FEHB) Program to support EHRThe education and outreach strategy is being adoption and meaningful use among their networksdeveloped by ONC, CMS, and the Office for Civil of providers.Rights (OCR), and will be implemented over thenext two years. Strategy I.A.8: Work with private sector payers and provider groups to encourageStrategy I.A.7: Align federal programs and providers to achieve meaningful with the adoption and meaningful The federal government will support the efforts ofuse of certified EHR technology. private payers and private provider groups toHHS is committed to encouraging providers that are encourage their networks of providers to achievenot eligible for the Medicare and Medicaid EHR meaningful use. Some major payers have begun toIncentive Programs to use EHR technologies to implement incentive programs that will work inimprove the care they provide to patients. For future parallel with the Medicare and Medicaid EHRstages of meaningful use, HHS plans to propose Incentive Programs and utilize meaningful usemore rigorous health information exchange objectives. These programs have the potential torequirements which may encourage providers that play a role in expanding the number of providersare not eligible for the incentive programs (e.g., long- who achieve meaningful use, and may also provideterm and post-acute care facilities, community incentives for providers who are not eligible for themental health centers or substance use disorder Medicare and Medicaid EHR Incentive Programs. Intreatment providers) to adopt health IT and addition, some private sector payers areparticipate in health information exchange. The implementing new payment models that increasinglyFederal Health IT Taskforce, vii consisting of the rely on collaboration among health care providers toNational Coordinator for Health IT, administration coordinate patient care and achieve efficiencies.officials, and other federal agency leads for health These new payment models are helping to create aIT, is the key federal committee responsible for business case for providers not eligible for incentivescoordinating federal health IT investments and under the Medicare and Medicaid EHR Incentivealigning programs to support meaningful use of Programs to adopt health IT and participate incertified EHR technology. health information exchange.Specifically, the Department of Defense (DoD), Strategy I.A.9: Encourage and facilitateDepartment of Veterans Affairs (VA), and Indian improved usability of EHR technology.Health Service (IHS) are developing plans for their Federal Health IT Strategic Plan 12
  13. 13. The government is collaborating with industry and OBJECTIVE Bresearchers to improve the usability of EHRs. Theusability of EHRs is considered a key barrier to Facilitate information exchange toadopting health IT and achieving meaningful use. support meaningful use of electronicNIST is conducting ongoing research and advancing health recordsthe development of standards and test methods thatcan be used to evaluate and improve the usability of For future stages of meaningful use, the plan is toEHRs. It has released a Common Industry Format propose health information exchange and(CIF), a standard for developers to report usability interoperability requirements that are more rigorous,test findings and demonstrate evidence of usability in so that patient information follows patients to thetheir products in a format that allows for point of care and informs critical health decisions.independent evaluation of a single product and This will require overcoming barriers acrosscomparison across multiple products. NIST is also geographies and stakeholders (i.e. providers,developing guidance and tools for RECs and laboratories, hospitals, pharmacies, behavioral healthprofessional societies on available tools and clinics, and patients), including insufficient demandresources to incorporate concepts of usability in for electronic health information, lack of a businessselecting and implementing EHR systems. The Food model for facilitating exchange, and disparateand Drug Administration (FDA), in collaboration federal, state, and local policies that hinder exchange.with NIST and the Agency for Healthcare Research It will also require more rigorous standards toand Quality (AHRQ), will develop best practices to support interoperability so that the data that isaddress systematic evaluation of usability with regard exchanged can be used for multiple patient safety to ultimately improve patient care. Historically there have been significant barriers toAHRQ is developing toolkits that medical practices the adoption and use of EHRs to exchangecan use to assess the usability of EHR systems and information, including their cost, low providerassess the redesign workflow. In addition, AHRQ is demand, the perceived lack of financial return forconducting research and convening industry investing in them, and the technical and logisticalworkgroups that provide perspectives on what challenges involved in installing, maintaining andconstitutes usability and how to systematically updating them. viii But the Medicare and Medicaidimprove the usability of EHRs. EHR Incentive Programs and the Affordable CareONC will explore ways to improve the ability of Act payment reforms are sparking a paradigm shiftproviders to select or change EHR products by in the collection and use of health care data thatimproving data portability. Reducing the cost addresses some of these challenges head on. First,associated with switching products while increasing the Medicare and Medicaid EHR Incentivedata fluidity and choice can help drive market Programs reward eligible professionals and hospitalscompetition to improve the usability of EHR who digitize health care information. We anticipateproducts. that the requirements for sharing information electronically across provider settings will growONC has directed one of its four Strategic Health IT stronger in future stages. Second, ongoing paymentAdvanced Research Projects (SHARP) (see Strategy reforms initiated by the Affordable Care Act –V.B.2) to further EHR usability through the including accountable care organizations, medicalidentification and development of better cognitive home models, and bundled payments – are an evenand user-centered design. In addition, ONC is more important potential driver of providerworking with private sector groups to encourage the motivation to exchange information. Private sectorcollection of usability information and its payers may also adopt similar payment reforms todissemination to vendors and consumers through align with Medicare and Medicaid. To prepare formechanisms they can trust. such reforms, hospitals are already reaching out to their surrounding community providers to share Federal Health IT Strategic Plan 13
  14. 14. information and EHR systems. Eventually, as digital prescription companies are offering services thathealth information becomes more widely available, enable exchange of specific pieces of healthexchanging it will be more natural and incentives will information for providers able to pay for them. Thebecome less relevant. Several challenges also exist to Nationwide Health Information Network standards,creating a national infrastructure whereby business services, and policies – including the Nationwidenetworks can connect to one another, including but Health Information Exchange and Direct protocolsnot limited to the development of consistent – are being used by many health care organizationsstandards to ensure interoperability and privacy and as the preferred solution to exchanging informationsecurity protocols to ensure trust that the network across organizational and geographic boundaries.will handle information appropriately. Health Protocols such as Blue Button (see Strategy IV.B.2)information exchanges (HIEs) must be designed to provide a method to electronically exchange healthaddress legal, organizational, and technical challenges information between providers and consumers. Thethat might otherwise impede their sustainability. Blue Button is an initiative at DoD, VA, and CMS that enables individuals to access a web-based portalWith demand increasing, the government is helping to download their personal health information andto ensure that exchange standards and infrastructure share this information with health care providers,are in place to meet it. This does not mean caregivers, and others they trust.constructing significant new national infrastructurefrom scratch. Rather, the federal government, in For as many providers as possible, the first priority isclose collaboration with state governments, is finding the right combination of already-availablehelping evolve the various current exchange models, exchange models that will enable them toso that – taken together – they may serve every electronically exchange lab results, patient carehealth care provider and meet a broader set of health summaries, and medication histories. State-levelcare needs. There are many examples of information grantees in the State HIE Cooperative Agreementsharing that are already occurring in the health care Program are identifying, articulating, and promotingsystem, and the government will foster the growth adoption pathways that will help providers do justand development of these models. Where there are that. RECs will work with individual providers togaps in exchange options, the government will identify and implement the right pathway.identify the specific barriers to exchange and develop ONC is also making it easier, faster, more secure,plans to address them. Finally, so that and less expensive to transport health information.communication and information sharing can take The Direct project at ONC enables a simple, secure,place across various information exchange models – scalable, standards-based way to send authenticated,both public and private – the government will encrypted information directly to known, trustedadvance national adoption of key exchange recipients over the Internet. Direct helps somestandards. providers satisfy the stage one meaningful useStrategy I.B.1: Foster business models that requirements by allowing a secure method ofcreate health information exchange. pushing content from a sender to a receiver. For example, by leveraging Direct, a primary careMany sustainable exchange options already exist for physician can send a secure email with a clinicalcertain providers and certain types of health summary of a patient to a referring specialist. Directinformation. Some hospital networks and group is a national solution to health information exchangeprovider practices have found a business case for that can rapidly lower the cost and complexity ofinvesting in information exchange within their local interfaces between providers, laboratories,networks. Vendors of EHR systems are developing hospitals, pharmacies, and patients, in turn“information networks” for their customers. substantially lowering the cost of providingCommunities are creating health information information exchange services. In some cases thisnetworks to facilitate information sharing among could make it possible for a small provider toproviders. Diagnostic lab companies and electronic Federal Health IT Strategic Plan 14
  15. 15. connect to a lab company or a health information authors of the President’s Council of Advisors onexchange organization, where it may have been cost Science and Technology (PCAST) December 8, 2010prohibitive for them to do so otherwise. Federal report, Realizing the Full Potential of Health Informationpartners that provide health care services, including Technology To Improve Healthcare for Americans: The Paththe VA, are implementing Direct as a consistent, Forward and many health information thoughtnational solution for directed exchange in local leaders.communities. The RECs will promote EHRs that In addition to the exchange of health informationalready have the Nationwide Health Information between providers, the exchange of information thatNetwork Direct interfaces built in, lowering the cost engages individuals and gives them access to theirof exchange for small providers. Continuing work to health data is a top priority of the Medicare andsimplify and extend the Nationwide Health Medicaid EHR Incentive Programs. The best way toInformation Network will continue to focus on empower individuals and reorient the health carelowering the cost of exchange and improving the system to be more patient-centered is to giveinteroperability of EHR systems. patients access to their personal health information.ONC continues to work with the private sector and Information exchange protocols such as the Bluefederal health care organizations to further refine the Button format that was developed and adopted bystandards, services, and policies for securely the VA, DoD, and CMS, is one way to put patientsexchanging authorized health information between at the center and give them control of theirproviders through the Nationwide Health information. ONC supports the exchange ofInformation Network Exchange protocols. For information with consumers and the re-use of suchexample, the query/response protocols provide a information for themselves and with providers.method of exchanging information, when This portfolio of exchange mechanisms is part of aauthorized, between a provider and another broad national strategy to have an interconnectedauthenticated entity that may have information on a health system through the Nationwide Healthpatient that is necessary for care. In this case, a Information Network. The Nationwide Healthquery is sent to providers with an authorization and Information Network is being developed by ONC toresponses are sent with the needed information. provide the building blocks for a secure, nationwide,This model provides a high level of information interoperable health information infrastructure thatexchange potential and capability. It also requires a can connect providers, consumers, and othersrobust electronic health record system and involved in the health care system. Exchange, Directinvestment. Currently, the Nationwide Health and evolving methods of health informationInformation Network Exchange is primarily used by exchange create an infrastructure that is critical toa group of federal agencies and private organizations enabling health information to follow a patient andthat have come together to securely exchange be available for clinical decision making and useselectronic health information and are demonstrating beyond patient care, such as measuring quality.the capabilities of information exchange. Today,select participants in the Nationwide Health Finally, the government will also seek to removeInformation Network Exchange are: exchanging unnecessary regulatory barriers to sustainablesummary patient records for Social Security exchange options, helping them to develop. InAdministration (SSA) disability determination collaboration with the State HIE Cooperativepurposes; exchanging summary patient records for Agreement Program, for instance, state governmentsthe Virtual Lifetime Electronic Health Record will look for ways to align Medicaid policies to health(VLER); and participating in bio-surveillance and information exchange reporting with CDC. The Exchange protocols Strategy I.B.2: Monitor health informationand the pilot programs that are using them will help exchange options and fill the gaps forpave the way for broader adoption ofquery/response exchanges as envisioned by the providers that do not have viable options. Federal Health IT Strategic Plan 15
  16. 16. Many providers – particularly those in areas with low information with them to the point of care. See Goalhospital and provider density – are not currently IV for more detail on how the government willsupported by sustainable information exchange accelerate consumers’ and caregivers’ access to theirmodels. A main focus of the State HIE Cooperative electronic health information in a format they canAgreement Program is expanding existing networks use and help these providers. The program is investing Strategy I.B.3: Ensure that healthover $500 million in supporting state-level initiativesto expand capacity for exchanging health information exchange takes place acrossinformation both within and across states. It individual exchange models, and advanceencourages states to develop statewide HIE plans health systems and data interoperability.which will align with the nationally recognized Electronic health information can be a criticalstandards and services and state Medicaid initiatives. element in the implementation of business models,States will support providers by building on existing such as bundled payments and accountable careexchange activities, providing critical shared services organizations being implemented through theand infrastructure such as provider directories, Affordable Care Act. These delivery system reformrecord locator services, and master patient indices, models will rely on richer and more timelyincreasing the use of standards, services, and policies information to better align payments with the actualneeded for widespread information sharing, and costs of providing efficient care. These efforts, asenhancing the information exchange capabilities of well as future proposals for subsequent stages ofkey trading partners including clinical laboratories, meaningful use, will rely on these emerging modelspharmacies, and public health agencies. for sustainable information exchange and will likelyIn order to exchange health information require greater capacity for connecting the variouselectronically, providers must have broadband models – so that providers may securely send healthInternet access. The FCC’s Rural Healthcare information to any other authorized providerProgram subsidizes broadband access for health care through the Internet. HHS recognizes that theproviders that are disadvantaged in meeting this government has a duty to help ensure that healthrequirement. The program is authorized to spend up information can flow where needed and followto $400 million per year to ease the burden of costly patients where they go, consistent with patienttelecommunications services for rural health care preferences. CMS recently reinforced this policy inproviders. The program is divided into two different its proposed regulations on accountable carecomponents: one that subsidizes ongoing monthly organizations ix. ONC is putting in place thecosts, and one that helps providers build new standards, services, and policies to support theinfrastructure where the existing infrastructure is infrastructure needed to connect these emerginginsufficient. In addition, the U.S. Department of models for exchange.Agriculture (USDA)’s Broadband Technologies Nationally, the government is developing a standardsOpportunities Program (BTOP) and Department of and interoperability framework (S&I framework) toCommerce’s Broadband Initiatives Program (BIP) harmonize existing standards and improve sharing ofwere collectively funded by over $4 billion through standards across different organizations and federalthe Recovery Act to support broadband grants agencies, making it easier to broaden interoperabilityaround the country. Health care was one of the through shared standards for data and services. Instrategic priorities of these grant programs. order to support exchange and advanceThe government will also encourage consumers to interoperability, there are three types of standardsgather and exchange their own individual health that the S&I framework will support.information. Informed and engaged consumers who First, the S&I framework will focus on identifyinghave access to their own interoperable health records transport standards. These standards enable onecan be a powerful force for bringing that provider to exchange data with another provider, or Federal Health IT Strategic Plan 16
  17. 17. one system to another system, securely. A second ONC, and its federal partners, will continue to usetype of standards is necessary for the data to be the HIT Policy and HIT Standards Committeesinteroperable between different providers, or (ONC’s federal advisory committees) to providesystems. These are known as content standards, recommendations on priorities for standards. ONC,which allow data to be packaged or “read” in a way and its partners, will promote the adoption ofthat is useful for the provider. For example, the standards through the Medicare and MedicaidMedicare and Medicaid Incentive Programs’ stage Incentive Programs and other federal criteria require that an eligible professional In establishing and maintaining the S&I framework,generate and transmit prescriptions electronically. ONC will leverage the National InformationThe S&I framework ensures that standards are Exchange Model (NIEM) processes. NIEM is aavailable that enable certified EHR technology to government collaborative of the U.S. Department ofview data in a way that is usable to the provider in Justice, the U.S. Department of Homeland Security,ordering the prescription and usable to the and HHS designed to develop, disseminate, andpharmacist receiving the prescription. Lastly, the support enterprise-wide information exchangeS&I framework will identify vocabulary and standards and processes to enable jurisdictions toterminology standards and value sets in order to effectively share critical information. NIEMachieve semantic interoperability at the level of processes will help ensure that existing applicableindividual data elements. ONC will work to reduce standards are re-used when possible, creatingvariability in vocabulary and terminology standards efficiencies in the government standards work. ONCwhich will help to reduce costs and to move toward will work with its federal partners to leverage themore semantically interoperable health information NIEM processes where possible and add to it asexchange. ONC will work with its federal partners necessary.and standards development organizations toharmonize the existing standards and vocabularies This strategy recognizes the experience andthey produce to create the building blocks and leadership of federal agencies and offices – includingimplementation packages in support of national National Institutes of Health/National Library ofpriorities, including meaningful use. Medicine (NIH/NLM), Centers for Disease Control and Prevention (CDC), CMS, AHRQ, FDA, and theThe S&I framework is intended to be flexible, so Office of the Assistant Secretary for Planning andthat it can be used to establish meta-data standards, Evaluation (ASPE) – and private sector standardsor “data about data,” that include additional development organizations and aims to leverageinformation about the context in which the data has existing standards and standards developmentbeen collected. The S&I framework will provide processes where possible. The federal governmenttools, data and meta-data standards, value sets, and has a role in ensuring that standards designated forservice descriptions in an integrated and harmonized U.S. health information exchange are readilyway to support meaningful use and interoperability, available and are regularly maintained and enhancedand focus these efforts on the highest priority kinds in response to feedback from implementers andof information exchange. ONC is leading this effort users. Federal agencies encourage the adoption andin close collaboration with other federal agencies. use of standards, participate and coordinate activelyThe S&I framework will support not only existing in standards development organizations, and directspecifications for the Nationwide Health and support specific standards development projectsInformation Network, but also support new meta- to address implementation problems and fill gaps. Indata tagged approaches recommended by the the case of some terminologies and code sets, federalPresident’s Council of Advisors on Science and agencies, including NIH, CDC, CMS, and FDA,Technology (PCAST) December 8, 2010 report, support the development and ongoing maintenanceRealizing the Full Potential of Health Information and free dissemination of designated standards andTechnology To Improve Healthcare for Americans: The PathForward. Federal Health IT Strategic Plan 17
  18. 18. promote their use across the spectrum of health health and populations with uniquecare, public health, and research. needsUsing the integrated set of specifications developedin the S&I framework and shared services and Strategy I.C.1: Ensure public healthinfrastructure (e.g., provider directories, record agencies are able to receive and sharelocator services, and master patient indices), the information with providers using certifiedNationwide Health Information Network will be the EHR technology.preferred solution to securely exchange informationnationwide to support meaningful use. Health care CDC, CMS, FDA, NIH, HRSA, the Assistantorganizations using the Nationwide Health Secretary for Preparedness and Response (ASPR),Information Network to share health information and ONC are working together to ensure thatcan serve as innovators, creating a pathway to more meaningful use of certified EHR technologyadvanced health information exchange and supports the needs of public health agencies.interoperability. Meaningful use stage one currently includes an objective on the menu set to submit electronicIn order to engender trust and interoperability and syndromic surveillance data, immunization registries,facilitate broad participation in the Nationwide and electronic lab reporting to public healthHealth Information Network, ONC will establish a agencies. This will pave the way for EHRs togovernance mechanism through rulemaking that exchange information with local, state, and federalseeks to include accountability and oversight of public health agencies and will set the stage for two-nationwide information exchange. The Nationwide way communication between providers and theseHealth Information Network governance rules will public health agencies prior to, during, and after anbe established as a voluntary solution to health incident. Eventually, information exchange betweeninformation exchange. The government will pursue providers and public health entities can be expanded.various options to encourage participation in this It can include routine and emergency public healthpreferred solution to nationwide information preparedness and response, and many-waysexchange. exchange of information (i.e., between differentIn carrying out its assigned duties, ONC is tracking providers, public health agencies at differentstandards activities in other countries and learning jurisdictions, and public health referencefrom their experiences with health IT and health laboratories) for immunizations, public health caseinformation exchange. Currently, ONC is working to reports, and situational awareness reports. CDC isidentify whether there are internationally recognized helping local and state public health agencies preparestandards that should be endorsed for use in the their systems and processes for such changes.United States. To further this effort, ONC intends to Through the State HIE Cooperative Agreementparticipate in international efforts to identify Program, state governments and state Medicaidinteroperability standards and implementation agencies will play a key role in building the publicspecifications for EHR technologies that will health infrastructure to support meaningful use. Asfacilitate data and systems integration. ONC’s input with clinical data, public health departments requireinto these international standards activities should public health standards to effectively exchangeensure that U.S. standards will work with the information. CDC’s Public Health Informatics andinternational community in the event of global Technology Program Office (PHITPO) at the Officepublic health emergencies. of Surveillance, Epidemiology and Laboratory Services (OSELS) is leading the development ofOBJECTIVE C public health standards in coordination with FDA,Support health IT adoption and NIH and other agencies, that align with certified EHR technology.information exchange for public Federal Health IT Strategic Plan 18
  19. 19. Strategy I.C.2: Track health disparities and standards developed to support meaningful use willpromote health IT that reduces them. strengthen data collection and quality measurement, enabling quality improvement efforts that reduceIn order to achieve nationwide adoption and health disparities.meaningful use of certified EHRs, it is critical thatproviders who face unequal challenges in adopting Existing health IT applications such as telehealth canand using EHRs be included in the government’s be used to address gaps in access and quality ofinitiatives. The RECs are providing outreach and health care services. Telehealth uses electronictechnical assistance to support providers who serve information and telecommunications technologiesunderserved communities and resource-poor such as videoconferencing and wirelesssettings, including small practice settings, rural communication to support long-distance care. Thehospitals/clinics, community health centers, and HRSA Health Disparities Collaboratives (HDC)Critical Access Hospitals. The RECs will work were created to assist in the transformation ofthrough community-based organizations and will primary health care practices in order to improve thedevelop tailored solutions and best practices to reach care provided to everyone and to eliminate healththese providers. RECs will also collaborate with disparities. HDC now continues as a privategroups representing underserved and minority endeavor. HRSA’s Telehealth Network Grantproviders on the national and local levels. Program supports established telehealth networks that are looking to expand the number of sites thatONC is also investing in better ways to monitor and are receiving clinical services. HRSA’s Telehealthidentify disparities in health IT adoption. This effort Resource Program funds Centers of Excellence,can enable ONC to measure health IT adoption which provide technical assistance on telehealth todisparities and focus resources on areas of greatest any HRSA grantee in the country. In addition, IHS,need to mitigate disparities. VA, CMS, and USDA all take advantage ofHHS is evaluating approaches for using health IT to telehealth technologies to meet the needs ofcollect and analyze data about disparities (on the disparate populations. In order to improve access tobases of race, ethnicity, gender, primary language, quality health care services through telehealth, ONCand disability status) in health and health care is working with states to increase medical licensureprovision, and using this data to improve the care of portability by streamlining licensure application andunderserved populations. Beacon Community credentials verification processes so providers cangrantees are acting as test sites for using health IT more easily apply for a license in multiple states.for this purpose. RECs will disseminate best ONC is also working with HRSA on developing apractices identified by Beacon Communities to report to Congress for the use of health informationproviders and other organizations serving technology in underserved communities.underserved communities. NIST will provide Strategy I.C.3: Support health IT adoptiontechnical guidance for EHR design and and information exchange in long-term/development, in order to help prevent the creationor exacerbation of health care disparities with the post-acute, behavioral health, andadoption and utilization of EHRs. emergency care settings.Through efforts underway related to the Medicare Providers working in long-term and post-acute careand Medicaid EHR Incentive Programs, the (LTPAC) and behavioral health settings are essentialChildren’s Health Insurance Program partners in patient care coordination. ONC, CMS,Reauthorization Act (CHIPRA) of 2009, and other and ASPE will collaborate to address qualityinitiatives authorized by the Affordable Care Act, measures and evolving clinical decision supportHHS is developing electronic clinical quality opportunities that will promote appropriatemeasures that enable providers and hospitals to exchange of health information in LTPAC andgauge the health status of their communities. Also, behavioral health care settings for optimal coordination of care. Federal Health IT Strategic Plan 19
  20. 20. HHS will build on meaningful use to adopt ONC is working with SAMHSA and HRSA toelectronic standards for the exchange of clinical data address the policies and standards concerning theamong facilities and community-based LTPAC unique needs of behavioral health IT adoption andsettings, including, where available, standards for information exchange. This includes work on datamessaging and nomenclature. ONC will leverage the and meta-data standards that can provide additionalState HIE and Beacon Community grant programs clinical context such as patient preferences andin demonstrating methods for which the electronic sources of data to help enable data segmentation andexchange of information with LTPAC entities can secure exchange of sensitive health information. Theimprove care coordination. In addition, HHS will ability to integrate mental health data into theidentify opportunities in the Affordable Care Act to primary care and related safety net system is essentialsupport the use of health information exchange for coordinating care.technologies by LTPAC and behavioral health Recognizing that emergency care settings areproviders to improve quality of care and care essential places for patient care coordination, ONCcoordination. and ASPR will explore ways to address the need forSAMHSA, in collaboration with ONC, will explore clinical data to be available in emergency careapproaches to support adoption of certified EHR situations and identify policies and standards that aretechnology within the behavioral health community. necessary to support these needs. Federal Health IT Strategic Plan 20
  21. 21. Goal II: Improve Care, Improve Population Health, andReduce Health Care Costs through the Use of Health ITT he recently passed Affordable Care Act will and reporting of health data. E-measures will transform American health care from a support federal and state quality improvement system that emphasizes transactions to a efforts and enable providers to assess their own system that emphasizes improved care, performance with their patients.improved population health, and reduced per capita Central to both the HITECH Act and thecosts of health care. The widespread adoption and Affordable Care Act is fostering and learning frommeaningful use of certified EHR technology is a breakthrough examples of health care deliverynecessary interim step in this transformation. It will system change, which can then serve as models forbe essential to build upon this health IT more widespread changes. The Beacon Communityinfrastructure and use the information made grants from the HITECH Act have created 17available by EHRs in order to move toward HHS’ demonstration communities in which clinicians,three overarching aims. But while health IT is hospitals, payers, and patients will show hownecessary to affect such changes, technology by itself advanced uses of health IT can achieveis insufficient. For this reason, federal health IT improvement goals in care, efficiency, andinvestments are being made in lockstep with other population health. The new CMS Center forreform efforts, many of which were initiated and Medicare and Medicaid Innovation will test a rangefunded by the Affordable Care Act. of innovative payment and service delivery models,Programs underway at ONC and AHRQ are looking many of which will require advanced uses of healthat ways to combine more sophisticated uses of IT to achieve their objectives. These examples mayhealth IT and clinical care redesign to achieve better employ the latest health IT – remote monitoring,health outcomes and improve health system telehealth, mobile health (mHealth) applications, andperformance. The HITRC and REC programs will the most advanced means of information exchange –make these best practices – such as using clinical and could become achievable, sustainable, anddecision support tools, patient registries, and replicable examples of how the government canreminder systems – available to providers build upon the nationwide adoption and meaningfulthroughout the country. The CHIPRA Quality use of EHRs.Demonstration grants are also expected to Finally, the Affordable Care Act directs HHS todemonstrate promising new ways that health IT can develop a national strategy for prevention and healthbe used to improve pediatric health care. CMS promotion. Health IT will play a fundamental role inexpects that for future stages of meaningful use, the supporting this national strategy, providing thefinancial incentives will encourage providers to use necessary infrastructure for disease prevention, earlymore sophisticated health IT to achieve higher level detection, and condition management before animprovement measures. HHS will leverage both the illness becomes severe. CDC, in collaboration withMedicare and Medicaid EHR Incentive Programs state, local, and other federal public health agencies,and the implementation of administrative leads federal efforts to provide and improve the coresimplification requirements under Section 1104 of capacities of the public health IT infrastructure.the Affordable Care Act to create cost savings Health IT facilitates coordination across publicthrough increased standardization and automation of health entities and other organizations, improveshealth care administrative functions. identification of at-risk populations and theirA key part of the Affordable Care Act is the adherence to public health guidelines, expeditesdevelopment of quality and outcome measures. E- responses to threats, notifiable conditions, andmeasures can facilitate the electronic capture, reuse adverse population events, and promotes consumer Federal Health IT Strategic Plan 21
  22. 22. participation in public health by encouraging healthy B. Better manage care, efficiency, andbehaviors and behaviors that screen for, detect, and population health through EHR-generatedeffectively manage disease. reporting measuresThe government has four objectives to “Improve C. Demonstrate health IT-enabled reform ofCare, Improve Population Health, and Reduce payment structures, clinical practices, andHealth Care Costs through the Use of Health IT”: population health management D. Support new approaches to the use ofA. Support more sophisticated uses of EHRs and health IT in research, public and population other health IT to improve health system health, and national health security performanceSpotlight on Health OutcomesHealth IT and information sharing can improve medical decision-making Meaningful use of EHRs can result in more effective While in the hospital, Jane’s physician notices she is slurring management of the risk factors associated with heart disease. her speech and exhibiting some slight right arm weakness. He George’s PCP works within a patient-centered medical home believes she is having a stroke and instructs the care team to model that provides the organizational infrastructure and start the appropriate treatment protocol. To confirm the support so that she can best manage George’s care. This diagnosis, Jane’s phycian consults her health record that is model helps to improve coordination of George’s care by shared by all the providers on her care team. He notices that enabling any specialists George sees and PCP to in a visit with her PCP last week, there is no indication of a electronically access and share critical information to make problem with Jane’s speech or strength in either arm, which better informed, appropriate and timely care decisions. suggests these symptoms are new. The physician discusses Through electronic information exchange, all the providers with Jane and her family that she is likely having a stroke. on George’s care team are able to seamlessly review George’s With the patient’s and her family’s consent, the medical team most recent blood pressure reading, smoking status, labs, performs a CT scan of Jane’s head and starts medication diagnostic tests, and clinic visit notes. George’s cardiologist is immediately to break up the clot and save Jane from a able to make recommendations using information in real potentially debilitating stroke. Without the shared time, and his PCP can view the care plan in the EHR. All of information on hand, Jane’s symptoms may not have been these providers can share in the reward for providing better noticed. value health care and keeping George healthy.These “Spotlight on Health Outcomes” are intended to highlight exemplary ways that widespread adoption and use of health IT and electronic healthinformation exchange could help transform and improve health care. Some of these examples are only aspirational today or only exist in selectcommunities or health systems. However, these examples illustrate the type of transformed health care that could be possible with the achievement ofthe goals of this Plan. See endnotes for citations. Federal Health IT Strategic Plan 22
  23. 23. OBJECTIVE A information, supply them with performance reports against quality measures, and assist them withSupport more sophisticated uses of diagnoses.EHRs and other health IT to improve AHRQ and CDC will continue their critical role inhealth system performance assessing and promoting best practices related to how health IT can be utilized to improve quality ofStrategy II.A.1: Identify and implement best care, patient engagement in self-care, management ofpractices that use EHRs and other health chronic diseases, and management of public andIT to improve care, efficiency, and population health.population health. Promising practices and lessons learned from theGoal I of this plan describes the Medicare and CMS CHIPRA Quality Demonstrations will beMedicaid EHR Incentive Programs’ payments communicated on a regular basis to State Medicaidavailable to providers who become meaningful users and CHIP programs to further promote successful– the centerpiece of the government’s health IT HIT and EHR initiatives important to vulnerablestrategy. The success of the meaningful use program populations.will create the fundamental health IT adoption With the establishment of the REC program, thewithin the health system necessary to support the government now has a way to disseminate tools andhealth reform efforts outlined in the Affordable Care best practices to providers that need the most helpAct. The Medicare and Medicaid EHR Incentive in implementing them into their practices. The RECsPrograms, as established by the HITECH Act, will build on their existing relationships with theserepresent a significant step in enhancing the providers to help them achieve improved healthperformance of the health system. The Medicare and outcomes through more sophisticated uses of EHRsMedicaid EHR Incentive Programs also create a and other health IT.basic health IT and information exchangefoundation that can support further improvement Strategy II.A.2: Create administrativeinterventions that are either not possible or too efficiencies to reduce cost and burden fordifficult and burdensome on providers without this providers, payers, and government healthfoundation. programs.The HITRC program makes tools and best practices For future stages of meaningful use, HHS expects toavailable to providers as they implement clinical care propose measures that simplify administrativeredesign and more sophisticated health IT into their processes and help lower costs in the clinical setting.offices. HITRC will identify ways to build on EHRuse by changing clinical workflows and integrating In January 2009, HHS adopted modifications to twoEHR software, patient registries, and medication HIPAA Administrative Simplification medical datareminder systems. The use of these tools can code set standards for medical diagnosis andsupport better decision-making at the point of care inpatient procedure coding. Under these regulations,and increased adherence to treatment regimens, covered entities will be required to transition fromhelping move health care from a reactive system to using the International Classification of Diseases,one that focuses on prevention and improved care Ninth Revision, Clinical Modification (ICD-9-CM)management. in HIPAA-covered transactions to using the International Classification of Diseases, TenthClinical decision support (CDS) systems are tools Revision, Clinical Modification (ICD-10-CM/PCS),that leverage EHRs to improve clinical processes. Procedure Coding System in October 2013. ICD-10-Broadly, these software systems build off of EHRs, CM/PCS code sets will enable a more granulargiving providers helpful information and analytical understanding of health care treatments andsupport at the point of care. Various clinical decision outcomes, and more complete analyses of treatmentsupport rules can help providers analyze patient Federal Health IT Strategic Plan 23