Improving Access to Health Records

ONC’s mission includes reducing health disparities, ensuring secure and protected patient health information, and reducing health care costs. As such, we are challenging multidisciplinary teams to create and test a module or application that makes it easy for people with disabilities to access their health information stored in electronic health records (EHRs). Individuals with disabilities constitute approximately 19 percent of the non-institutionalized population five years of age or older. Their health expenditures are estimated at $400 billion annually, more than a quarter of the national total (U.S. Census Bureau, 2000).

Health information technology (health IT) and EHRs hold great promise in improving the health outcomes and coordination of care for people with disabilities. The accessibility and usability of health IT is a matter of serious concern to people with a wide range of disabilities, including those who have vision, hearing, intellectual, manual dexterity, mental health, developmental, and other types of disabilities.

Mobile App Challenge Details

Do you think you have a game-changing design idea that can help improve access to health records for people with disabilities?

Now is the time to prove it! Submissions are due by July 23, 2012.

Keep in mind, ease of use will play a significant role in determining the winner as it is an area that desperately needs innovative thinking. Advances that help people with disabilities interact with their electronic health information could also expand into widespread use.

A range of prizes will be awarded to the highest finishers. The winner will receive $60,000 and an opportunity to demo the solution at a future, prominent conference!

For More Information

Complete details about this challenge are available at http://www.health2challenge.org/ehr-accessibility-module/.

Over the years, economists and health IT experts have projected a wide range of cost savings from health IT implementation. These kinds of analyses are challenging because they require experts to predict how health IT will influence changes in provider and consumer behavior, and how those changes in behavior in turn influence quality and financial outcomes.

Yet it is still important to understand how health IT can support the nation’s efforts to “bend the cost curve” and ultimately slow the growth of health care spending, while improving outcomes and the health of the population. Within this context, a single health care health IT-enabled intervention that achieves the goal of improving health care quality may be more likely to spread if that intervention has also demonstrated measurable net reductions in health care expenditures.

Roundtable to Promote Value in America’s Health Care System

On October 28, 2011, the Engelberg Center for Health Care Reform at the Brookings Institution and the Office of the National Coordinator for Health Information Technology (ONC) convened a small group of national experts—economists, actuaries, and health IT experts from the private sector and government—to discuss common approaches for understanding the financial impact of clinical interventions that make use of health IT.  At the meeting, entitled the “Roundtable to Promote Value in Health Care,” the expert panelists analyzed the potential financial impacts of health IT-enabled interventions being implemented in three Beacon Communities (in central Pennsylvania , Tulsa , and western Colorado ) and considered lessons for other communities and care delivery organizations embarking on similar care innovations.

“Developing tools for measuring cost impact from multiple perspectives has been an objective for the Engelberg Center for some time,” said Mark McClellan, director of the Engelberg Center for Health Care Reform. “I thought the meeting was hugely productive, and we look forward to sharing the output.”

One of the Problems

The organizations that implement innovative interventions that result in quality improvements and cost reductions are often not the sole beneficiaries of these interventions’ cost savings. Providers often touch patients covered by multiple insurers (such as Medicare, Medicaid, private insurers, and employer-owned health plans), each with its own strategic and financial imperatives. Encounter-based claims data and other information needed to measure holistic cost impact can be inaccessible, leading implementing organizations to take a “wait and see” approach. For example, they may hope that clinical improvements such as reduced readmissions will convince payers or other stakeholders to work with them to sustain the intervention, even though the impact on costs may not be fully demonstrated.

How the Beacon Communities Fit In

The Beacon Community Program funded 17 communities with average three-year awards of $15 million each to demonstrate replicable health IT-enabled interventions that achieve the three-part aim. In many ways, these communities are no different from delivery systems and their partnering organizations that are working on health IT-enabled transformations across the country. However, by participating in the Beacon Program, they have agreed to openly share their processes of change, including their processes for engaging payers in conversations about financial impact and sustainability. Part of our job at ONC is to ensure we learn as much as possible from these innovative communities, and share their lessons effectively with the rest of the country.

What We Accomplished

The Engelberg Center’s roundtable discussion was not intended to serve as a formal evaluation meeting that would render a final evaluation of the Beacon Communities’ current efforts. Rather, the output of this meeting made it easier for Beacon Communities and others engaged in similar work around the country to prospectively study the impact of promising IT-supported care improvement initiatives on overall health care spending.

“This meeting was overdue,” said Aaron McKethan, former director of the Beacon Community Program. “While some of the Beacon Communities are advanced in their payer relationships and in measuring cost savings, there are many implementers out there who are not yet able to show the payer community that claims about the cost effects of their interventions are credible. This creates noise, and it is hard to differentiate between what will have a real sustainable impact, and what will only increase health care spending in the long run.”

George Schneider, chief financial officer at Geisinger Health System, Keystone Beacon Community, added:

“As a health plan as well as a delivery system, Geisinger is a strong believer in the idea that high quality care is efficient care. Providers are partners with insurers in developing innovations in the care delivery process supported by innovations in reimbursement approaches that include payments for quality. We were very pleased to have an opportunity to share our experience in cost measurement with the Roundtable and to learn how other Beacons are addressing critical measurement and partnership issues around paying for quality in their own communities.”

What Are These Beacons doing?

• The Keystone Beacon Community is using health IT to support chronic disease management for persons with frailty and multiple chronic conditions, aiming to reduce avoidable hospital admissions and other preventable forms of health care utilization while improving quality of life for patients;
• The Colorado Beacon Community is training physician practices how to most effectively take advantage of making meaningful use of health IT to improve care;
• The Tulsa Beacon Community is using health IT in new and exciting ways to help doctors in different clinical settings involved in a patient’s care to communicate more effectively about how best to support the patient and his caregiver in receiving optimal care.

These efforts are representative of Beacon Communities more broadly and are similar to initiatives cropping up across the country.

We Want to Hear From You!

We look forward to sharing additional outputs of this meeting and ongoing efforts to learn from all of our Beacon Communities. Stay tuned and please share your comments!

To Learn More

• Beacon Community Program
• HealthIT.gov

Milwaukee Area Technical College is one of the 82 community colleges funded by the Office of the National Coordinator for Health Information Technology’s (ONC) Community College Consortia Program to offer and develop health information technology (health IT) training programs.

Students in the Milwaukee Area Technical College health IT program are being trained to help health care providers across the country adopt EHRs and other health IT tools so they can better and more efficiently care for their patients.

Recruiting Students to Help Accelerate EHR Adoption

Aurora Health Care was in the process of carrying out an accelerated EHR adoption and deployment plan at one of its largest hospitals, and it needed qualified health IT professionals to assist. The hospital was specifically seeking:

• Health IT professionals who could work directly with health care providers, and
• IT professionals who could work on the system or design workflows for the implementation of the EHR system.

To help Aurora fulfill its employment needs, Dr. Richard Ammon, associate dean of health sciences at Milwaukee Area Technical College and director of the college’s Health Information Technology Certificate Program, used the resources of the college to refer students from the health IT program to Aurora Health Care. As a result, Aurora hired 11 MATC health IT recent graduates and students at the area hospital!

“In going through the interview and hiring process, we felt these MATC graduates had more than just the skills the job required, but also came from diverse backgrounds and had strong problem-solving faculties,” said Russ Hinz, director of hospital deployments at Aurora Health Care.

“We are pleased with the individuals we hired from MATC and look forward to future opportunities.”

About the Health IT Program at Milwaukee Area Technical College

MATC’s health IT program is designed to train existing health care, IT, and project management professionals in new and emerging health IT professions. The program helps students leverage their existing experience and apply their new skills in real-world settings.

“Our goal is three-fold,” said Dr. Ammon of MATC. “Recruit students, train them, and help them to make the link between the curriculum that they have learned, their prior experience, and the employer.”

Unique Approach to Helping Students Obtain Health IT Careers

With Aurora Health Care, MATC had a unique opportunity to showcase its students’ previous work experience and current health IT training. To help introduce its students to other potential employers, MATC uses a “trading card” approach. The trading card features a photo of the MATC student as well as a snapshot of his or her professional and academic experience, which MATC distributes at job fairs and health IT-related organizations.

In addition to networking students with companies, using trading cards, and job fairs, MATC also uses a job board to connect students with potential health IT job opportunities.

Bright Future for Health IT Professionals

This story is but one example of how community colleges across the country, part of the Community College Consortia Program, are working hard to train the health IT workforce needed to help America modernize its health care system through health IT. The good news for health IT students is that employers are actively seeking such skilled and qualified health IT workers!

For More Information

• Community College Consortia Program

• Milwaukee Area Technical College HIT Program

For more information on health information technology, visit HealthIT.gov.

An Asthma Management Toolkit for Schools

The first stage of the program is a web-based asthma management toolkit that offers multiple resources and templates for school administrators, nurses, teachers, and other staff, including:

• A written action plan for every student with asthma, including the student’s medical information, daily management guidelines, and specific steps for responding to worsening asthma symptoms
• Written policies and processes for parental consent
• Specific actions staff members can perform as part of an asthma management program
• School policies and procedures for administering medications, including protocols for emergency response to a severe asthma episode
• Education for staff and students about asthma
• Communication templates

The asthma management toolkit is now available to 48 school districts in southeastern Minnesota, where an estimated 12 percent of the area’s 14,000 students have chronic asthma. Schools are already using toolkit resources to adopt parental consent policies and establish individual treatment protocols for affected students.

“This asthma management toolkit will help districts promote school environments where children with asthma can feel safe, be healthy, and remain active,” says Barbara Yawn, M.D., a Beacon co-investigator and pioneer of the Community Collaborative Asthma Project in Olmsted County. “We are very pleased that Beacon gives us the opportunity to develop reliable ways to share asthma-related information between physicians, parents, school nursing and other staff. It is so important that schools and parents have up-to-date and accurate information immediately available to deal with changes in symptoms or asthma attacks.”

Linking Schools with Parents and Providers

Stage two of the program will incorporate technologies that improve access to students’ medical information, efficiency in emergency response, confidential student tracking, and direct lines of communication with health professionals.

Participating schools will benefit from an electronic portal that stores care plans for individual students (with appropriate consent) and enables electronic incident reporting as well as direct communication with parents and providers.

Here is how the system will work when a student has an asthma attack at school:

• The school nurse has immediate access to the latest asthma action plan from the student’s health care provider. The nurse provides treatment per the plan.
• The nurse electronically logs an incident report of the visit and unplanned intervention and communicates with the parent and the provider.
• If the student visits the nurse’s office following the initial incident, the student’s physician and parents receive an electronic message notifying them of the visit, as well as a request to review and/or update the student’s asthma action plan.

Safeguarding Information

Safeguarding sensitive information is a lynchpin of the program’s design. All exchanges of information about a student will take place with previous consent.

“No one’s health information should be put at risk. That’s why we are developing safeguards and protections to improve security even further,” says Christopher Chute, M.D., Dr. P.H., Mayo Clinic informatics investigator. “All health care information involved in the network is used only with the informed and signed consent of the patient or their parents.”

Right Care at the Right Time

By connecting parents and health care providers, and linking them with technologies to improve care for students, the Southeast Minnesota Beacon Community is helping enable schools across the state ensure that students who have an asthma attack at school get the right care at the right time.

To Learn More

• Asthma Management Toolkit
• Southeastern Minnesota Beacon
• ONC’s Beacon Community Program

For more information on health information technology, visit HealthIT.gov.

As we start the New Year, I am excited about what the future holds and want to share what I see as five big health IT trends for the year to come.

Meaningful Use Takes Off. We sometimes refer to the stages of Meaningful Use as an escalator because it will get more rigorous and sophisticated over time. We might equally call it the necessary foundation upon which to build a truly 21^st Century health system where care is better coordinated, patient-centered, safer, and where we pay for the right care, not just more care. Successfully attesting to Meaningful Use will not by itself achieve these goals, but it does help ensure providers have the right information at the right time so patients get the right care.

As I mentioned in my previous blog, by the end of November 2011, more than 20,000 eligible professionals and 1,200 hospitals had received payments from the Medicare or Medicaid EHR Incentive Programs. These are pretty good numbers for the first year of a new program, especially when it involves doctors and hospitals making investments in new technology and changes to clinical workflow. There are other good signs that providers are taking up the challenge, including a survey indicating that attainment of Meaningful Use is a top priority for more than two-thirds of hospital executives and a five-fold increase in electronic prescribing by office-based physicians since 2000. My prediction is that at least 100,000 providers will receive Medicare or Medicaid EHR incentive payments by the end of 2012. But, in order for my prediction to come true, the entire health IT ecosystem, including technology vendors, physician and hospital leaders, Regional Extension Centers, state-level health IT coordinators, public health agencies, and many others need to pull together toward getting as many providers to Meaningful Use as possible. Let’s make 2012 the Year of Meaningful Use!

Health Information Exchange Turns a Corner. A key element of the Meaningful Use roadmap is the electronic exchange of important clinical information. With the foundation we have built in Stage 1, increasingly rigorous health information exchange requirements in Stage 2 and payment reform as a constant drumbeat, I think exchange will take off in 2012.

The Direct Project now provides a simple, secure, standardized way to send encrypted health information to trusted recipients over the Internet, enabling providers to meet Stage 1 Meaningful Use exchange requirements. Through intensive collaboration with on-the-ground implementers, the protocol went from concept, to specification, to pilot testing in just a few months, and now we are seeing widespread adoption by EHR and health information exchange  vendors. Increased use of Direct should go a long way toward replacing the slow and inefficient way most providers currently share information via phone, fax, and mail—ultimately improving patient care and outcomes. However, Direct is only the first step in achieving the health information exchange we will need in the future.

Standards development is now focusing on the Nationwide Health Information Network (NwHIN) since the health information exchange requirements will become more rigorous in Stage 2 of Meaningful Use in order to support the care coordination functions and advanced care processes that providers will need to succeed under new payment approaches. As the business value for exchange increases, our standards efforts will bear fruit, reducing the cost and complexity of implementing basic exchange functions like sending a care summary or receiving lab results. With increased value and lowered cost, information will start to flow. But, it will only move at the speed of trust. Here too, ONC efforts are critical. Robust policies that protect information and create public trust will galvanize rapid growth and innovation in health information exchange.

Connecting the Dots on Health IT and Payment Reform. It is widely recognized that fee-for-service payment for health care tends to reward volume while providing little incentive to furnish care in ways that drive toward improved health outcomes or efficiency. All that is changing before our eyes as more health systems move away from fee-for-service and toward payment models that incentivize care coordination, quality improvement, prevention, and more efficient use of resources. New payment models, such as accountable care organizations, patient-centered medical homes, bundled payments, and quality measurement/improvement initiatives may seem disconnected from each other, but they all have a common denominator: Success depends on better information about each patient’s health needs than paper records can provide.

As more providers adopt EHRs and go through the process of attesting to Meaningful Use, I believe they will increasingly see the direct connections between health IT, new payment models, and the ways in which the former can help them succeed with the latter. Moreover, EHRs, health information exchange, and other forms of health IT will increasingly be seen as key enablers within new payment models themselves. We are headed toward a virtuous cycle where payment reform improves the business case for using health IT and greater use of health IT improves the chances that new payment models will succeed.

Consumers Use eHealth to Get More Involved. I believe this year we will see consumers and patients use information technology to become better informed about their health and more engaged with their own care than ever before. In large part, this will happen because it’s becoming easier for consumers to electronically access their own information. Personal health records are becoming easier to use as more data holders make it possible to download information through tools like Blue Button. Many health care providers are setting up patient portals which are directly connected to their EHRs. The Medicare and Medicaid EHR Incentive Programs already require providers to give patients access to their electronic health information, and I anticipate future stages will build on that notion. And the work that is being done on standards and interoperability will help make consumer access to their health information more seamless and more useful.

In addition, developers are coming out with more apps for mobile devices that make it easier for consumers and patients to get information about different diseases and track their own health over time. Along those lines, several Beacon Communities have launched txt4health, a consumer engagement campaign that uses cell phone text messaging to deliver information about diabetes care and management. ONC will diligently keep encouraging the marketplace to develop mobile apps and other consumer-friendly platforms that get patients engaged by sponsoring challenges like the Healthy Apps Challenge. Once consumers start to see their own information, they will be more empowered to be partners in their own care and come to expect that providers will use health IT as a tool to help deliver high-quality care.

Innovation Drives Improvement. Innovation is the lifeblood of technology, whether we are talking about health IT or otherwise. For health IT, innovation is being driven on many fronts, including ways of making EHR systems easier and less expensive to install and maintain, such as software-as-a-service and web-based systems. Mobile devices such as smart phones and tablets are being directly integrated into health IT systems, and I expect this trend will continue to pick up speed as capabilities such as voice recognition are perfected. The growing emphasis on value-based payment models will help fuel innovation around products and services that help providers perform quality measurement/improvement and population health management. There will be increasing emphasis on data analytics and finding ways of using data to support population health management, as well as feed information back into EHRs in ways that support a learning health system.

Innovation will continue to influence and support all the other key factors I’ve mentioned here, and ONC will continue working with the market to foster innovation, including sponsoring challenges and encouraging focused collaboration. One particular aspect of health IT innovation to watch in 2012 is an increased emphasis on advancing the usability of EHRs. ONC has resources concentrated on promoting innovation while encouraging vendors and other stakeholders to learn systematically and act rapidly to continually improve usability.

In summary, I see 2012 as the year in which health IT truly comes of age. While much work still needs to be done, the groundwork is firmly in place for what promises to be a breakthrough year in the adoption and widespread use of health IT in ways that improve care for individuals, improve health outcomes for populations, and increase the value we get from our health care dollars.

I am excited to be a part of it and look forward to seeing these trends (as well as many others) unfold in the year and years ahead. I encourage each of you to get engaged now to help shape our bright future.

For more information on health information technology, visit HealthIT.gov.

Designing Apps for Health

On Oct. 31, 2011, we launched the Leading Health Indicators App Challenge. With it, we’ve challenged developers and experts to design applications that make it easy for the public to use and learn from the leading health indicators—that is, the nation’s critical health priorities that have been developed by Healthy People 2020.

The possibilities for what successful apps for health might do are endless. They could include tools that integrate:

• Health topic areas, measures, and evidence-based resources of interest;
• Community, county, and state health status comparisons;
• Real-time communication tools to stay in touch with peers;
• Educational curricula to teach health promotion and disease prevention; and/or
• Related news, analyses, and blogs from outside resources.

Apps for health may focus on one or a variety of audiences and purposes. For instance:

• Helping a social worker meet the prevention needs of her clients by connecting clients with nearby resources and tracking their progress from arranging visits to completing assessments.
• Creating a simple and effective way for a primary care physician to employ a population health approach to her work, grouping patients according to risk factors, and providing them with relevant evidence-based interventions. This could then integrate with the practice’s electronic health records.
• Partnering with a university or faculty member to deliver an interactive academic curriculum to students, leveraging multimedia case studies to educate about the leading health indicators and their impact on community health.
• Helping an exercise therapist work with professional workplaces to integrate physical activity guidelines into her office.

We’re looking for the most innovative approaches to using the leading health indicators and solving the nation’s priority health problems. Multiple prizes will be awarded for submissions—up  to $10,000 and the opportunity to demo at the 2012 National Health Promotion Summit.

Additional Details

Think you have a creative idea? Submissions are due Friday, March 9, 2012. More details can be found at www.Challenge.gov/ONC/255.

Learn more about health information technology by visiting HealthIT.gov.

Electronic health records (EHRs) and health information technology will modernize the way that health care professionals do their work and provide care to patients by giving them the tools to offer their patients better, more efficient care. There are also great tools like popHealth available to help providers make the transition to EHRs.

popHealth Automates Process for Meaningful Use Reporting

popHealth is an open source software service that automates the process of meaningful use reporting to the Medicare and Medicaid EHR Incentive Programs, and integrates with provider EHR systems using continuity of care records and nationally recognized data standards.

It’s easy to use, and has an interface designed for health care professionals, making it easier for them to integrate EHRs into their practice (and easier for meaningful use reporting for the Medicare and Medicaid EHR Incentive Programs).

popHealth Tools Development Innovation Challenge

ONC’s Investing in Innovation program (i2) is hosting the popHealth Tools Development Innovation Challenge – with $100,000 in prizes! We’re looking for teams to develop creative applications based on the popHealth framework.

Apps submitted for the challenge should help providers improve patient safety by, for example, helping providers use the quality measure calculations to better engage with patients and caregivers, or address disparities in care. Apps may target patients with high disease burden in need of early intervention, and may aggregate multiple sources of data to help public health officials and organizations develop more clearly defined pictures of the health status and risk factors within communities.

Additional Details

We’re delighted to see innovative solutions and applications being submitted, and look forward to more. There’s still time! The challenge closes Friday, January 20. Get more details on the popHealth Tool Development Challenge at www.Challenge.gov/ONC/246.

But ensuring that all patients—especially those in high-risk groups—get a flu shot is not always a simple matter. Electronic health records (EHRs) can help by automating flu shot reminders and making it easier to identify patients who are in most need of the protection flu shots afford. 

Easier flu shot reminders

Practices can set up their EHR to automatically send out letters or secure email to all patients to remind them to come in for flu shots.

Dr. Lloyd Fisher, a pediatrician with Reliant Medical Group in Worcester, MA, plans to use this feature not just for flu shots but also for other preventive care and screenings.

“We are developing automated letters and emails through our secure patient portal to alert parents when their children are due for a variety of preventive care tests and procedures, including influenza vaccines,” says Dr. Fisher. 

Prioritizing flu shot distribution

While there have been no reports of flu vaccine shortages this year, it’s still most important to vaccinate those at highest risk for flu complications. EHRs can generate lists of patients in certain demographics (under 5 or over 65) or with underlying medical conditions (high blood pressure, diabetes, and other chronic conditions) or who are pregnant. Then practice staff can focus their outreach efforts on getting those patients in for vaccination first.

Dr. Christopher Tashjian, a family physician based in rural Ellsworth, WI, is using the data generated by his EHR to proactively reach out to patients with heart disease and diabetes who have not received the flu vaccine to advise them to come in for a flu shot, concentrating on the rest of his patient population according to risk and other chronic illnesses. He stated: “We could never do this kind of management with paper [records]!”

“EHRs are perfect for this sort of thing,” says Dr. Jen Brull, a family physician based in Plainville, KS. “With one push of a button, we know who needs our efforts and can target the population from top to bottom.” 

Prompting clinicians to offer patients flu shots

Patients are not the only ones who could use flu shot reminders. EHR systems can alert providers when a patient has not yet received a flu shot. Providers can then follow-up and ensure their patients are getting the right care at the right time. 

Coordinating data with state immunization directories

The availability of flu shots at the workplace or even in shopping malls and at grocery stores makes it easier for people to easily get the vaccination.

But, this new convenience can make it more difficult for primary care providers to track who has received the shot and who needs a flu shot reminder. EHRs can be set up to automatically send data to immunization registries, which help keep all the records up-to-date.

“When we record our immunizations in our EHR, this information automatically goes into the state’s immunization registry,” says Dr. Tashjian.

For More Information

HealthIT.gov

ONC Wants to Hear From You

How is your practice using health IT to prepare for flu season? Does your EHR generate flu shot reminders? Use the comment section below to share your stories. We want to hear from you!

About the Video Contest

ONC is challenging the public to create a short but impactful video capturing your New Year’s resolution to improve your health or the health of a loved one. Your resolution must involve the use of information technology, which could include anything from asking your doctor for a copy of your health information, to making sure the information is accurate and complete. Or, from using a wireless pedometer to track your activity, to joining an online community to learn about the best way to help a friend or loved one as they manage a new diagnosis.

The producers of the winning videos get a share of $5,000 in prize money, with a $2000 cash prize for the first place winner. The video contest launched today at http://healthynewyear.challenge.gov and is open until February 16, 2012.

We Need Your Help to Promote this Video Contest (#HealthIT4U2012) and Many More in 2012

The Healthy New Year Video Challenge will be the first in a series of 2012 challenges. We’re going to be active on YouTube sharing patient and family testimonials about how the use of health information technology (health IT) is changing lives! We’ve already started collecting compelling stories that appear on HealthIT.gov, but we need more to motivate and inspire others to adopt and use technology to improve their health and to be better partners in their own care, along with doctors, nurses, and other health care providers.

We need the support of organizations of many kinds (consumer groups, media outlets, employers, local businesses, etc.) to help us promote each video contest both at the launch, to drive video submissions, and after the contest to help the winning videos go viral.

Starting in January through the summer, there will be a variety of different contest themes.  The first few include a focus on:

• Using health IT to maintain a healthy heart;
• Supporting the role of caregivers; and
• Managing health care dollars and time more wisely.

We invite you to share ideas or links to videos you saw in 2011 that inspired you, and to use the Twitter hashtag #HealthIT4U2012 to tweet about the challenge.  The challenges start in January and will run throughout 2012.  All video contests will be posted on www.Challenge.gov.

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 63^rd 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!

Farzad