12 Months of Health IT: A Year of Momentous Progress

ONC earned its nickname as the “Office of No Christmas” during the 2009 Holiday season roughly two years ago when we, along with our colleagues at the Centers for Medicare & Medicaid Services (CMS), announced the proposed regulations to govern the Medicare and Medicaid Electronic Health Record Incentive Programs (EHR Incentive programs) established under the American Recovery and Reinvestment Act of 2009 (Recovery Act).

ONC earned its nickname as the “Office of No Christmas” during the 2009 Holiday season roughly two years ago when we, along with our colleagues at the Centers for Medicare & Medicaid Services (CMS), announced the proposed regulations to govern the Medicare and Medicaid Electronic Health Record Incentive Programs (EHR Incentive programs) established under the American Recovery and Reinvestment Act of 2009 (Recovery Act). CMS’s proposed rule outlined provisions governing the EHR Incentive programs, including defining the central concept of “meaningful use” of EHR technology.

At the same time, ONC issued an interim final regulation that set initial standards, implementation specifications, and certification criteria for EHR technology. In the closing months of 2009, ONC also issued a flurry of funding opportunities to support health information technology adoption, information exchange, and the workforce needed to make this important Recovery Act program succeed.

A year later, by the 2010 holiday season, vendors, newly accredited certification bodies, and a few vanguard providers were gearing up for the official launch of the EHR Incentive programs, which opened for registration on January 3, 2011. What has happened in the 12 months since then?

I would like to highlight ten of this year’s most notable developments in the world of health information technology and ONC.

1. January: Launch of the Medicare and Medicaid EHR Incentive Programs

Over the past 12 months, the concept of Meaningful Use has thoroughly permeated EHR development and implementation. The marketplace of certified products has grown quickly, interest in Meaningful Use among providers and hospitals is sky-high, and the pace of incentive payments has continued to accelerate.

  • Products: As of today more than 1,500 EHRs—about  1,000 ambulatory and 500 inpatient EHRs— have been certified by one of the six private-sector Authorized Testing and Certification Bodies selected by ONC, up from 300 certified products at the start of the year.  To date, 672 vendors have products certified under the program (60% of those vendors are small businesses with 50 or fewer employees), which is more than a three-fold increase in the number of vendors with certified products at the beginning of the year.  This growth fosters competition, innovation, and gives providers more choices than ever before.
  • Eligible Professionals and Hospitals: As we conclude the year, participation in the Medicare and Medicaid EHR Incentive Programs is strong and growing at an impressive rate. As of November 30, 2011, 154,362 eligible professionals and 2,868 eligible hospitals have registered with either of the EHR Incentive Programs. According to a recent survey, more than two-thirds of hospital CIOs and CEOs identified achieving Meaningful Use as their top IT priority. More than half of office-based physicians say they intend to apply for the Medicare or Medicaid EHR Incentive Programs.

More than 20,000 eligible professionals and 1,200 hospitals have already received their incentive payments from CMS, totaling $1.8 billion so far, with December shaping up to be the biggest month yet.

2. February: Launch of DIRECT

The Direct Project provides a simple, secure, standards-based way for providers and other participants to send encrypted health information directly to trusted recipients over the internet—a kind of “health email.” During 2011, the Direct Project went from publishing its first set of consensus-approved specifications to testing in pilots, to initial production implementation across vendor and state boundaries.

The Direct Project’s 200+ committed members reached consensus on two key specifications enabling secure directed transport of health information. Thirteen pilot communities across the nation put these specifications into practice, and successfully exercised and validated them. Technology and service vendors began offering production Direct capabilities to statewide health information exchanges, state and federal agencies, and health care professionals, with more than 35 vendors having implemented Direct by the end of 2011. Larger communities using Direct in production started to emerge, with Direct as part of the core strategy of 40 state HIE grantees.

3. March: The National Quality Strategy

In March, HHS released the National Quality Strategy for health improvement, the first effort to create a national framework to help guide local, state, and national efforts to improve the quality care in the United States. The National Quality Strategy recognizes health information technology as critical to improving the quality of care, improving health outcomes, and ultimately reducing the costs. Putting the National Quality Strategy into action, HHS subsequently launched two key initiatives that set specific national targets:

  • Partnership for Patients, which is working with a wide variety of private and public stakeholders to make hospital care safer by reducing hospital acquired conditions by 40%, and improving care transitions upon release from the hospital so that readmissions are reduced by 20%.
  • Million Hearts campaign, which is a public-private initiative to prevent 1 million heart attacks and strokes over the next five years by improving access to care and increasing adherence with basic preventive medicine.

The evidence shows that, health information technology, along with delivery system improvements, will be a key ingredient to the success of these campaigns and other efforts around the country to improve health outcomes. A study published this September in the New England Journal of Medicine which looked at diabetes care in Cleveland found:

  • 51% of the patients being treated by physicians practices using an EHR received care that met all endorsed standards of diabetes care compared to 7% of patients treated by non-EHR practices
  • 44% of patients treated by EHR practices met at least four out of five outcome standards for diabetes compared to 16% of patients in paper-based practices with similar outcomes

4. April: Launch of the Standards “Summer Camp”

At the April HIT Standards Committee meeting, Doug Fridsma, Director of the Office of Standards and Interoperability and Acting Chief Science Officer, kicked off the Summer of Standards—an accelerated effort to support the Stage 2 standards and certification requirements for the EHR Incentive Programs.

These activities took place within the Standards and Interoperability Forums. One of the major accomplishments of summer camp was reaching consensus around Consolidated Clinical Document Architecture (CDA): This summer, 150 committed members of the Standards and Interoperability Framework Transitions of Care Initiative—including providers, technology vendors, informaticists, standards institutions, and federal agencies—worked toward consensus on a single standard for transmitting care transitions data. After more than 1,000 balloted issues were resolved, the standard was approved, and subsequently recommended by the HIT Standards Committee for inclusion in the Stage 2 standards and certification requirements for the Medicare and Medicaid Incentive Programs.

For the first time in our country’s history there is a single, broadly-supported electronic data standard for patient care transitions!

5. June: Spurring Health Information Technology  Innovation

Announced June 8, 2011, and made possible by the America Competes Act, the Investing in Innovations (i2) Program is the first-of-its-kind government effort to use prizes and challenges to stimulate and accelerate the development of solutions to targeted health care problems. Prizes and challenges are attracting a wide range of innovators from both inside and outside traditional health care communities to address tough problems, spurring industry-wide innovation and rewarding only best-in-class work.

Since June, several i2 challenges have been launched, including:

One in a Million Hearts” challenge, a multidisciplinary call to innovators and developers to create applications activating and empowering patients to improve their heart health.

Ensuring Safe Transitions from Hospital to Home” challenge, a collaboration with the Partnership for Patients called on software developers to create easy-to-use applications for consumers and caregivers improving care transitions. Winners include: Axial Transition Suite, ibluebutton, and FlexisVolDSPAN.

Continued on next page.

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