Module 2 chapter 4

Question 1

HITECH Act

Answer 1

critical, landscaping-changing event in the adoption and use of health information technology (primary goal build a nation HIT infrastructure capable particularly to improve quality of care and reduction cost)

Question 2

Office of national coordination for health information technology

Answer 2

Shift in focus from building infrastructure to using it

Major challenges around the HIT infrastructure
Office of the National Coordinator for Health Information Technology (ONC-HIT) 2004 implemented. In 2004 only 20% office based-physician were using EHR and few 10% hospitals were using computer provider order entry

Goal: promote full adoption of EHRs for the entire country by 2014
American Reinvestment and Recovery Act (ARRA) and the HITECH Act

Question 3

Rapidly Expanding HIT

Answer 3

HITECH funding provisions for six major initiatives
Mandatory spending (the EHR Incentive Program) administered by CMS
Programmatic spending (HIT adoption support) through ONC (office of national coordinator for HIT)

Initiatives designed to address supporting widespread adoption and use of HIT and to build on and support one another

Question 4

Initiatives

Answer 4

EHR incentive program (5-year program to encourage providers and hospitals to adopt and meaningfully use HER)

EHR certification program (national standard to ensure that EHR capable supporting meaningfully use MU
1. State HIE (health information exchange) program

2. Regional Extension Center (REC) (program help providers qualify for HER incentive programs)
3. Beacon community program
4. Workforce development
   1 Community-college curriculum
5. University-based training

Question 5

Initiatives cont..

Answer 5

Health IT Advanced Research Projects (SHARP)
1) Security and technology,

2) Usability and Alignment of technology to physician cognition and decisions making,
3) EHR information architecture, and

4) integration and utilization of EHR data for quality improvement purposes.
Only the EHR incentive program was not housed completely within the ONC

Question 6

HITECH Act Challenges

Answer 6

Strategic Health IT Advanced Research Projects (SHARP)
1) Security and technology,
2) Usability and Alignment of technology to physician cognition and decisions making,
3) EHR information architecture, and
4) integration and utilization of EHR data for quality improvement purposes.
Only the EHR incentive program was not housed completely within the ONC

Question 7

EHR Incentive Program

Answer 7

Framework for promoting EHR adoption (EHR incentive program)

Provided funds to eligible providers and hospitals (for the adoption and meaningfully use OF certified EHR)

Broadly administered by the CMS, partially implemented through state Medicaid offices

Billing thresholds vary for types of providers

Question 8

Health Information Exchanges

Answer 8

ONC application-only program to states to build HIE capabilities

Primary concern was development of functional, sustainable infrastructure

Nationwide Health Information Network Direct, or simply Direct

Limited in that it does not support ability to monitor and improve quality

Question 9

REC Programs

Answer 9

By 2010, every area of the United States was covered by one of the 62 RECs
Differences in size, scope, and initial challenges

80% of REC programs were projects of three major types of parent organizations (1 quality improvement organization, 2 universities, 2 health center control networks)

Striking success: 140,000 providers in January 2016
Though RECs were expected to build a long-term sustainable financial model, most sought new funding sources

Question 10

Remaining HITECH Programs Under ONC

Answer 10

Beacon programs leading the way

Research and technology development SHARP grants (Strategic health IT advance research project grant given to universities or research institutions)
four target areas:
1. privacy and security university of Illinois.
2 physician cognition university of Texas Houston.
3 Smart application Harvard university 4. mayo clinic
Workforce development
Connection between advancing HIT infrastructure and development of new jobs

Separate initiatives intended to support broader development of HIT ecosystem

Question 11

From Building IT Infrastructure, to Using It

Answer 11

Link to the ACA and beyond

1. CMS began to play larger role in financial incentives after HITECH funding dwindled
2. Many projects designed to foster development of partnerships
3. Effects of emerging payment and reporting models

Accountable care organization (ACO) (hospitals or group of providers agree to assume some level of risk for Tx of large cohort of individuals)