858543 Federal HIT Strategic Plan.docx

Office of the

National

Coordinator

for Health

Information

Technology

(ONC)

Federal Health

Information

Technology

Strategic Plan

2011 – 2015

Table of

Contents

Introduction 3

Federal Health IT Vision and Mission 6

Federal Health IT Principles 7

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

Federal Health IT Strategic Plan 3

Federal Health IT Strategic Plan 4

Introduction

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.

However, these technologies – including electronic

health records (EHRs), personal health records

(PHRs), telehealth devices, remote monitoring

technologies, and mobile health applications – are

remarkably underutilized today. In 2010, only 25

percent of physician offices and 15 percent of acute

care hospitals took advantage of EHRs.

Even fewer

used remote monitoring and telehealth technologies.

While many consumers access their banking

information online daily, only 7 percent have used

the web to access their personal health information.

Recent legislation has established an agenda and

committed significant resources for health IT. The

Health Information Technology for Economic and

Clinical Health (HITECH) Act, passed as part of the

American Recovery and Reinvestment Act of 2009,

allocated billions of dollars for the health care system

to adopt and meaningfully use health IT to improve

health. The Patient Protection and Affordable Care

Act of 2010, as amended by the Health Care and

Education Reconciliation Act of 2010, (referred to

collectively as the Affordable Care Act) builds on the

HITECH Act and recognizes health IT as a critical

enabler to broad transformations in health care. This

document is the Federal Health IT Strategic Plan,

developed under the leadership of the Office of the

National Coordinator for Health Information

Technology (ONC) and in close collaboration with

other federal partners, for working with the private

and public sectors to realize Congress and the

Administration’s health IT agenda.

The first Federal Health IT Strategic Plan was

published in June 2008. Section 3001(c)(3) of the

Public Health Service Act, as added by the HITECH

Act, requires the National Coordinator to update

and republish the Plan. This Plan updates the

previous version to take into account the rapidly

changing landscape of health IT and health IT

policy. In order to update the Plan, ONC leveraged

the strategic framework put forth by the HIT Policy

Committee and obtained additional input by

conducting interviews with representatives from

federal agencies/offices and the private sector.

ONC also engaged its federal partners, the private

sector and members of the public to provide

comments on multiple versions of the Plan.

Goal I, “Achieve Adoption and Information

Exchange through Meaningful Use of Health IT”

discusses the centerpiece of the government’s health

IT strategy over the next five years. “Meaningful

use” is aimed at widespread adoption and

information exchange in its first two stages, and will

then build to improve health outcomes in the third

stage. Activities are focused on two areas: defining

the meaningful use of certified EHR technology; and

encouraging the achievement of meaningful use

through the CMS administered Medicare and

Medicaid EHR Incentive Programs and the support

of meaningful use through grant programs, including

information exchange with public health

departments and laboratories.

Goal II, “Improve Care, Improve Population Health,

and Reduce Health Care Costs through the Use of

Health IT,” discusses the specific ways health IT is

contributing to the goals of health care reform:

improved care, improved population health, and

reduced per capita costs of health care. Widespread

adoption of EHRs, information exchange, quality

improvement initiatives, and health care reform

pilots are required to implement the Affordable Care

Act. As part of each of these activities, the

government is investing in and leveraging health IT

to transform the health care system.

Goal III, “Inspire Confidence and Trust in Health

IT,” focuses on government efforts to update its

approach to privacy and security issues related to

health IT, and build greater confidence and trust in

Federal Health IT Strategic Plan 5

EHRs and health information exchange among

providers and the public. The digitization of health

records will create a new set of challenges for

protecting the privacy and security of health

information, but it will also open new opportunities

for improving safeguards.

Goal IV, “Empower Individuals with Health IT to

Improve their Health and the Health Care System,”

discusses how the government is designing health IT

policies and programs to meet individual needs and

expectations, provide individuals with access to their

information, help facilitate a strong consumer health

IT market, and better integrate individuals’ and

clinicians’ communications through health IT. A

public that has a voice in designing national health

IT policies and programs and is empowered with

access to its health information through useful tools

can be a powerful driver in moving toward patient-

centered health care.

Goal V, “Achieve Rapid Learning and Technological

Advancement,” focuses on demonstrating ways

health IT and meaningful use can enable innovation

and appropriate use of health information to

improve knowledge about health care across

populations. In the long run, the government is

pursuing a vision of a learning health system, in

which a vast array of health care data can be

appropriately aggregated, analyzed, and leveraged

using real-time algorithms and functions.

iii

ONC will track national progress towards achieving

the goals laid out in this Plan. Ongoing

collaboration with federal agencies, states and

providers will be necessary in order to realize these

goals. The Plan is meant to be a living document

that will be updated based on experience with stage

one meaningful use and the implementation of a

robust evaluation program.

This

future will require technical innovation to build on

the foundation of meaningful use, as well as finding

new ways to use that foundation in the practice of

health care.

Figure 1; Federal Health IT Strategy Map

Federal Health IT Strategic Plan 6

Federal Health IT Vision and Mission

Vision

A health system that uses information to empower individuals and

to improve the health of the population.

Mission

To improve health and health care for all Americans through the

use of information and technology

Federal Health IT Strategic Plan 7

Federal Health IT Principles

In 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 8

Goal I: Achieve Adoption and Information Exchange

through Meaningful Use of Health IT

he first priority in realizing the benefits of

health IT is to achieve nationwide adoption

of EHRs and widespread information

exchange. As patients and providers

experience the benefits of EHRs, they will demand

nothing less from their health care practices. The

Medicare and Medicaid EHR Incentive Programs

accelerate the realization of this future by offering

financial incentives to hundreds of thousands of

eligible professionals, eligible hospitals and critical

access hospitals for incorporating certified EHR

technology into their practices. “Meaningful use” is

much more than just adoption – these providers will

also be required to maintain data confidentiality,

share information securely with each other, engage

patients with their electronic health information, and

improve care.

There are a few well-defined barriers that have

slowed acceptance of EHRs and widespread

information exchange. Small- and medium-sized

providers often do not have sufficient capital to

implement EHR systems. There is a lack of skilled

health IT professionals to support providers as they

transition from paper records to EHRs. Using EHRs

may alter current provider workflows, and many

providers struggle to select systems, use them in

ways that will improve care, and make the necessary

changes to their processes. Finally, information

exchange, which is central to realizing the benefits of

EHRs, is not fully possible today – there is no

interoperable infrastructure to securely exchange

health information nationwide among providers,

between providers and patients, and between

providers and public health agencies (see Objectives

I.B and I.C).

Through the HITECH Act, the Department of

Health and Human Services (HHS) created a set of

far-reaching programs to help providers overcome

such barriers. For the Medicare and Medicaid EHR

Incentive Programs, the three progressive stages of

meaningful use will define what eligible professionals

and hospitals can and should accomplish through

the adoption and use of EHRs over the next five

years. Stage one objectives focus on adopting EHRs

and beginning to take advantage of basic electronic

data capture, medication ordering, and decision-

support tools. We expect future stages to become

more rigorous, for example, by requiring providers

not only to adopt the technology but to use it to

exchange health information and – ultimately – to

achieve improvements in care, efficiency, and

population health (see Goal II). We anticipate that

future stages of meaningful use will be aligned to

support advancing nationwide-wide health goals, as

defined in the HHS Strategic Plan, and the priority

areas identified in the National Quality Strategy.

In addition to incentive payments, the HITECH Act

programs provide significant support for providers

to achieve adoption and meaningful use, including

implementation support, workforce training, and

information exchange support. Programs are

focused on the providers that need the most help –

solo and small group practices, community health

centers, critical access hospitals, and providers

located in rural and underserved areas. In 2010, HHS

issued rules establishing the requirements of the

first stage of meaningful use. HHS expects to

articulate two further stages through rulemaking

over the next five years. Participation in the

Medicare and Medicaid EHR Incentive Programs is

voluntary, but beginning in 2015, eligible

professionals and hospitals under the Medicare EHR

Incentive Programs will face payment reductions if

they do not meet the meaningful use requirements.

In implementing the Medicare and Medicaid EHR

Incentive Programs, the government is taking

advantage of the experience of federal agencies that

deliver health care (Department of Veterans Affairs,

Department of Defense, and Indian Health Service)

that have already-developed EHR systems which

have been in place for over a decade. These agencies’

experiences in using EHRs can offer important

insights and best practices for the nationwide

adoption of EHRs.

Federal Health IT Strategic Plan 9

It is the government’s goal that such a large-scale

movement will create a tipping point – that the

adoption and meaningful use of EHRs will become

ubiquitous across the nation. To this end, the

government is seeking to encourage meaningful use

through other mechanisms in addition to HITECH

Act programs. This includes supporting the above-

mentioned federal agencies that deliver health care and

federal grant recipients (critical access hospitals,

community health centers, etc.) in meeting meaningful

use requirements. We expect that medical societies and

professional licensing and certifying bodies will also

help to encourage meaningful use among their

members. Some private insurers are already mirroring

the Medicare and Medicaid EHR Incentive Programs

and providing incentives for the achievement of

meaningful use among their provider communities. For

providers ineligible for incentive payments under the

Medicare and Medicaid EHR Incentive Programs (for

example, long-term and post-acute care facilities,

community mental health centers, and some behavioral

health providers), the government is developing

technology and policy solutions that will build on the

Department’s meaningful use efforts and fit their

unique needs (see Strategy I.C.3).

The government’s objectives to “Achieve Adoption

and Information Exchange through Meaningful Use

of Health IT” are:

A. Accelerate adoption of electronic health

records

B. Facilitate information exchange to support

meaningful use of electronic health records

C. Support health IT adoption and

information exchange for public health and

populations with unique needs

Spotlight on Health Outcomes

Use of health IT can improve health outcomes and enhance care coordination

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.

George is a 62-year-old man with diabetes, hypertension, and heart failure

who smokes one pack of cigarettes every day. George’s primary care provider

(PCP) is reviewing an EHR-generated listing of patients with an HbA1c test

result over 9. She notices that George is on her list with an HbA1c of 11.2

and that he missed his last appointment and has not yet rescheduled.

George’s PCP emails him via secure messaging to request he make an

appointment and get the following tests in advance of the visit: HbA1c and

cholesterol panel. She orders these tests via computerized provider order

entry (CPOE). George goes online to schedule his appointment. Prior to his

appointment, George’s PCP checks his lab results which are sent

electronically to the EHR and sees that his HbA1c and cholesterol are still

elevated. A nurse uses clinical decision support to determine that George

would benefit from diabetes self-management and smoking cessation

counseling, which she gives before his appointment. During his appointment,

George’s PCP talks to him about adding a new medication to better control

his diabetes and increasing the dose of his cholesterol medicine. She sends

the new prescriptions electronically to George’s pharmacy so that they will be

ready for pick-up when he leaves the office visit. Clinical decision support

also reminds the PCP that George is due for eye and foot exams. She

performs a foot exam and sends an electronic referral to the

ophthalmologist’s office, who will contact George via secure messaging to

schedule an appointment. The ophthalmologist has access to George’s record

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.

Jane is an 83-year-old woman with COPD,

hypertension, and peripheral vascular disease

who is admitted to the hospital with

pneumonia. As the admitting physician is

ordering an antibiotic for pneumonia, a

drug-allergy warning pops up on the screen

alerting the physician that Jane had an

anaphylactic reaction to penicillin in the past

and another antibiotic is preferred – saving

Jane from an adverse drug event. Jane is at

high-risk for developing a clot in her legs,

which can lead to a pulmonary embolism. As

part of the admissions order set, the

physician is prompted to choose a type of

prophylaxis for clots, which reduces her risk

of developing this complication and a

prolonged hospital stay. The nurse who

admits Jane notices a small decubitus ulcer

present on admission. She documents the

ulcer on her mobile device and monitors and

treats it with the aid of clinical decision

support

Federal Health IT Strategic Plan 10

OBJECTIVE A

Accelerate adopt

ion of electronic

health records

Strategy I.A.1: Provide financial incentive

payments for the adoption and meaningful

use of certified EHR technology.

Central to the HITECH Act is the establishment of

the Medicare and Medicaid EHR Incentive

Programs, which makes available incentive payments

that could total an estimated $27 billion over 10

years, to encourage eligible professionals and

hospitals to adopt and meaningfully use certified

EHR technology.

 Recording patient information into EHRs, such as

gender, race, preferred language, height, weight,

smoking status, and blood pressure

The programs generally require

providers to do the following:adopt EHRs that are

certified according to standards, implementation

specifications, and certification criteria adopted by

the Secretary, and meet certain objectives and

measures using certified EHR technology established

for progressive stages of meaningful use as defined

in CMS rules. CMS’ final rule for stage one

meaningful use was published in July 2010. Stage

one meaningful use objectives include:

 Using a software application to inform clinical

decisions

 Entering medical prescriptions electronically

 Providing patients with a timely electronic copy of

their health information

 Securing EHRs to protect the privacy of patient

data

Future stages of meaningful use are likely to include

a combination of new objectives, some of which

may require new EHR functionality, changes to

existing objectives, such as an increase in the

threshold or broadening of the definition. In the

future stages of the Medicare and Medicaid EHR

Incentive Programs, the government expects to

reward improvement against predetermined

thresholds that are associated with the adoption and

use of EHRs. Stages two and three are anticipated to

transition gradually away from further process

requirements like those included in stage one, to

requirements for improvement in outcomes and

quality of care. Any such improvement measures will

be in line with nationwide health goals as laid out in

the HHS Strategic Plan and with the national

priorities identified in the National Quality Strategy.

Strategy I.A.2: Provide implementation

support to health care providers to help

them adopt, implement, and use certified

EHR technology.

In order to receive incentive payments, eligible

providers must demonstrate that they can use

certified EHR technology to incorporate more

sophisticated uses of health IT, such as clinical

decision support (CDS), patient registries, reminder

systems, and changes to workflow and clinical care

redesign into their practices (see Goal II).

The Regional Extension Center (REC) Program,

established through the HITECH Act with more

than $720 million in grants over a four-year project

period, has set up 62 centers across the nation with

staff and resources dedicated to helping providers

implement and become meaningful users of certified

EHR technology. Additionally, HRSA’s Health

Center Controlled Network (HCCN) Program

provides resources to community health centers to

implement health IT, including EHRs. Further

support is provided by the Health Information

Technology Research Center (HITRC), which will

work to gather relevant information on effective

practices and help the RECs collaborate with one

another and with relevant stakeholders to identify

and share best practices in EHR adoption,

meaningful use, and provider support. Through its

regional offices and other outlets, CMS offers

support to states to encourage adoption of EHR

technology.

Strategy I.A.3: Support the development of a

trained workforce to implement and use

health IT technologies.

To meet the anticipated growth in demand for

health IT professionals, HITECH made available

$118 million to support the training and

development of more than 50,000 new health IT

Federal Health IT Strategic Plan 11

professionals. Four grant programs will prepare

qualified individuals to serve in 12 high priority roles

related to the implementation and maintenance of

EHR systems.

Three grant programs work together to prepare a

workforce in six of these priority roles for which

community colleges are the natural home for

training: Community College Consortia to Educate

Health Information Technology Professionals;

Curriculum Development Centers; and Competency

Examination for Individuals Completing Non-

Degree Training. A fourth program, Assistance for

University-Based Training, will prepare students for

six different roles, for which universities are the

natural home for training.

Strategy I.A.4: Encourage the inclusion of

meaningful use in professional certification

and medical education.

The federal government will encourage meaningful

use to be incorporated into the U.S. medical

education and accreditation processes. To this end,

ONC and CMS are collaborating with various

professional certification and medical education

organizations to assist providers in adopting and

becoming meaningful users and to incorporate

meaningful use into the professional certification

and medical education organizations’ professional

requirements. The American Board of Medical

Specialties, a professional certification body, has

taken steps to assist and encourage physicians in the

adoption and meaningful use of EHRs, with the

ultimate goal that such EHR use and competencies

should become an element of professional

certification.

Strategy I.A.5: Establish criteria and a

process to certify EHR technology that can

support meaningful use criteria.

In order for eligible providers, eligible hospitals, and

critical access hospitals to qualify for the Medicare

and Medicaid EHR Incentive Programs, they must

first adopt certified EHR technology that meets

established criteria, which are aligned with the

Medicare and Medicaid EHR Incentive Programs

meaningful use requirements. The HHS Secretary

has adopted EHR standards, implementation

specifications and certification criteria, as well as a

process for EHR technology to gain certification.

These programs aid providers in selecting certified

EHR technologies that support them in becoming

meaningful users. ONC collaborated extensively

with the National Institute of Standards and

Technology (NIST) to establish the certification

processes.

Established through rulemaking in 2010 and 2011,

ONC’s certification programs specify how

organizations can become authorized by the

National Coordinator to certify EHR technology as

being compliant with the standards, implementation

specifications, and certification criteria adopted by

the HHS Secretary.

ONC published the Initial Set of Standards,

Implementation Specifications, and Certification

Criteria interim final rule in January 2010 and a final

rule in July 2010. The certification criteria establish

the required capabilities, standards, and

implementation specifications in EHR technology

that supports the achievement of meaningful use

stage one. The certification criteria will continue to

evolve with future rulemakings, as further stages of

meaningful use are established.

ONC, with its federal partners, will consider whether

to adopt certification criteria for health IT that is

used by non-eligible providers (such as long-term

and post-acute care facilities), and whether the

availability of certification for specific types of health

IT would be beneficial.

Strategy I.A.6: Communicate the value of

EHRs and the benefits of achieving

meaningful use.

HHS is conducting outreach to providers to increase

awareness of the HITECH Act programs that are

available to support efforts to attain meaningful use

and to share evidence and best practices on the use

of health IT to improve health. Primary care

providers are a primary audience for this strategy

(see Strategies III.B.1 and IV.A.2 for outreach

directed at individuals). The strategy will have four

aims:

Federal Health IT Strategic Plan 12

 Raise awareness among providers about the

availability and benefits of EHRs and other health

 Educate providers about privacy and security

protections as they relate to EHRs and other

health IT

 Encourage providers to participate in HITECH

Act programs and other federal initiatives (e.g.,

Medicare and Medicaid EHR Incentive Programs,

grants, contracts) in order to take full advantage of

EHRs and other health IT

 Increase provider understanding of health IT

products and services, so that they may make

informed decisions and take full advantage of the

technologies’ benefits

The education and outreach strategy is being

developed by ONC, CMS, and the Office for Civil

Rights (OCR), and will be implemented over the

next two years.

Strategy I.A.7: Align federal programs and

services with the adoption and meaningful

use of certified EHR technology.

HHS is committed to encouraging providers that are

not eligible for the Medicare and Medicaid EHR

Incentive Programs to use EHR technologies to

improve the care they provide to patients. For future

stages of meaningful use, HHS plans to propose

more rigorous health information exchange

requirements which may encourage providers that

are not eligible for the incentive programs (e.g., long-

term and post-acute care facilities, community

mental health centers or substance use disorder

treatment providers) to adopt health IT and

participate in health information exchange. The

Federal Health IT Taskforce,

vii

consisting of the

National Coordinator for Health IT, administration

officials, and other federal agency leads for health

IT, is the key federal committee responsible for

coordinating federal health IT investments and

aligning programs to support meaningful use of

certified EHR technology.

Specifically, the Department of Defense (DoD),

Department of Veterans Affairs (VA), and Indian

Health Service (IHS) are developing plans for their

health care systems to align with meaningful use.

Similarly, the Health Resources and Services

Administration (HRSA) and the Federal

Communications Commission (FCC) are developing

plans to encourage their grantees and subsidy

recipients, respectively, to become meaningful users.

The Substance Abuse and Mental Health Services

Administration (SAMHSA) is working to foster

adoption and implementation of certified EHRs

among its providers that are ineligible for the

Medicare and Medicaid EHR Incentive Programs,

including community mental health centers and

substance use disorder treatment facilities. Finally,

the Office of Personnel Management (OPM) is

developing a strategy to encourage health plans that

provide coverage through the Federal Employee

Health Benefits (FEHB) Program to support EHR

adoption and meaningful use among their networks

of providers.

Strategy I.A.8: Work with private sector

payers and provider groups to encourage

providers to achieve meaningful use.

The federal government will support the efforts of

private payers and private provider groups to

encourage their networks of providers to achieve

meaningful use. Some major payers have begun to

implement incentive programs that will work in

parallel with the Medicare and Medicaid EHR

Incentive Programs and utilize meaningful use

objectives. These programs have the potential to

play a role in expanding the number of providers

who achieve meaningful use, and may also provide

incentives for providers who are not eligible for the

Medicare and Medicaid EHR Incentive Programs. In

addition, some private sector payers are

implementing new payment models that increasingly

rely on collaboration among health care providers to

coordinate patient care and achieve efficiencies.

These new payment models are helping to create a

business case for providers not eligible for incentives

under the Medicare and Medicaid EHR Incentive

Programs to adopt health IT and participate in

health information exchange.

Strategy I.A.9: Encourage and facilitate

improved usability of EHR technology.

Federal Health IT Strategic Plan 13

The government is collaborating with industry and

researchers to improve the usability of EHRs. The

usability of EHRs is considered a key barrier to

adopting health IT and achieving meaningful use.

NIST is conducting ongoing research and advancing

the development of standards and test methods that

can be used to evaluate and improve the usability of

EHRs. It has released a Common Industry Format

(CIF), a standard for developers to report usability

test findings and demonstrate evidence of usability in

their products in a format that allows for

independent evaluation of a single product and

comparison across multiple products. NIST is also

developing guidance and tools for RECs and

professional societies on available tools and

resources to incorporate concepts of usability in

selecting and implementing EHR systems. The Food

and Drug Administration (FDA), in collaboration

with NIST and the Agency for Healthcare Research

and Quality (AHRQ), will develop best practices to

address systematic evaluation of usability with regard

to patient safety to ultimately improve patient care.

AHRQ is developing toolkits that medical practices

can use to assess the usability of EHR systems and

assess the redesign workflow. In addition, AHRQ is

conducting research and convening industry

workgroups that provide perspectives on what

constitutes usability and how to systematically

improve the usability of EHRs.

ONC will explore ways to improve the ability of

providers to select or change EHR products by

improving data portability. Reducing the cost

associated with switching products while increasing

data fluidity and choice can help drive market

competition to improve the usability of EHR

products.

ONC has directed one of its four Strategic Health IT

Advanced Research Projects (SHARP) (see Strategy

V.B.2) to further EHR usability through the

identification and development of better cognitive

and user-centered design. In addition, ONC is

working with private sector groups to encourage the

collection of usability information and its

dissemination to vendors and consumers through

mechanisms they can trust.

OBJECTIVE B

Facilitate information exchange to

suppor

t meaningful use of electronic

health records

For future stages of meaningful use, the plan is to

propose health information exchange and

interoperability requirements that are more rigorous,

so that patient information follows patients to the

point of care and informs critical health decisions.

This will require overcoming barriers across

geographies and stakeholders (i.e. providers,

laboratories, hospitals, pharmacies, behavioral health

clinics, and patients), including insufficient demand

for electronic health information, lack of a business

model for facilitating exchange, and disparate

federal, state, and local policies that hinder exchange.

It will also require more rigorous standards to

support interoperability so that the data that is

exchanged can be used for multiple purposes.

Historically there have been significant barriers to

the adoption and use of EHRs to exchange

information, including their cost, low provider

demand, the perceived lack of financial return for

investing in them, and the technical and logistical

challenges involved in installing, maintaining and

updating them.

viii

But the Medicare and Medicaid

EHR Incentive Programs and the Affordable Care

Act payment reforms are sparking a paradigm shift

in the collection and use of health care data that

addresses some of these challenges head on. First,

the Medicare and Medicaid EHR Incentive

Programs reward eligible professionals and hospitals

who digitize health care information. We anticipate

that the requirements for sharing information

electronically across provider settings will grow

stronger in future stages. Second, ongoing payment

reforms initiated by the Affordable Care Act –

including accountable care organizations, medical

home models, and bundled payments – are an even

more important potential driver of provider

motivation to exchange information. Private sector

payers may also adopt similar payment reforms to

align with Medicare and Medicaid. To prepare for

such reforms, hospitals are already reaching out to

their surrounding community providers to share

Federal Health IT Strategic Plan 14

information and EHR systems. Eventually, as digital

health information becomes more widely available,

exchanging it will be more natural and incentives will

become less relevant. Several challenges also exist to

creating a national infrastructure whereby business

networks can connect to one another, including but

not limited to the development of consistent

standards to ensure interoperability and privacy and

security protocols to ensure trust that the network

will handle information appropriately. Health

information exchanges (HIEs) must be designed to

address legal, organizational, and technical challenges

that might otherwise impede their sustainability.

With demand increasing, the government is helping

to ensure that exchange standards and infrastructure

are in place to meet it. This does not mean

constructing significant new national infrastructure

from scratch. Rather, the federal government, in

close collaboration with state governments, is

helping evolve the various current exchange models,

so that – taken together – they may serve every

health care provider and meet a broader set of health

care needs. There are many examples of information

sharing that are already occurring in the health care

system, and the government will foster the growth

and development of these models. Where there are

gaps in exchange options, the government will

identify the specific barriers to exchange and develop

plans to address them. Finally, so that

communication and information sharing can take

place across various information exchange models –

both public and private – the government will

advance national adoption of key exchange

standards.

Strategy I.B.1: Foster business models that

create health information exchange.

Many sustainable exchange options already exist for

certain providers and certain types of health

information. Some hospital networks and group

provider practices have found a business case for

investing in information exchange within their

networks. Vendors of EHR systems are developing

“information networks” for their customers.

Communities are creating health information

networks to facilitate information sharing among

providers. Diagnostic lab companies and electronic

prescription companies are offering services that

enable exchange of specific pieces of health

information for providers able to pay for them. The

Nationwide Health Information Network standards,

services, and policies – including the Nationwide

Health Information Exchange and Direct protocols

– are being used by many health care organizations

as the preferred solution to exchanging information

across organizational and geographic boundaries.

Protocols such as Blue Button (see Strategy IV.B.2)

provide a method to electronically exchange health

information between providers and consumers. The

Blue Button is an initiative at DoD, VA, and CMS

that enables individuals to access a web-based portal

to download their personal health information and

share this information with health care providers,

caregivers, and others they trust.

For as many providers as possible, the first priority is

finding the right combination of already-available

exchange models that will enable them to

electronically exchange lab results, patient care

summaries, and medication histories. State-level

grantees in the State HIE Cooperative Agreement

Program are identifying, articulating, and promoting

adoption pathways that will help providers do just

that. RECs will work with individual providers to

identify and implement the right pathway.

ONC is also making it easier, faster, more secure,

and less expensive to transport health information.

The Direct project at ONC enables a simple, secure,

scalable, standards-based way to send authenticated,

encrypted information directly to known, trusted

recipients over the Internet. Direct helps some

providers satisfy the stage one meaningful use

requirements by allowing a secure method of

pushing content from a sender to a receiver. For

example, by leveraging Direct, a primary care

physician can send a secure email with a clinical

summary of a patient to a referring specialist. Direct

is a national solution to health information exchange

that can rapidly lower the cost and complexity of

local interfaces between providers, laboratories,

hospitals, pharmacies, and patients, in turn

substantially lowering the cost of providing

information exchange services. In some cases this

could make it possible for a small provider to

Federal Health IT Strategic Plan 15

connect to a lab company or a health information

exchange organization, where it may have been cost

prohibitive for them to do so otherwise. Federal

partners that provide health care services, including

the VA, are implementing Direct as a consistent,

national solution for directed exchange in local

communities. The RECs will promote EHRs that

already have the Nationwide Health Information

Network Direct interfaces built in, lowering the cost

of exchange for small providers. Continuing work to

simplify and extend the Nationwide Health

Information Network will continue to focus on

lowering the cost of exchange and improving the

interoperability of EHR systems.

ONC continues to work with the private sector and

federal health care organizations to further refine the

standards, services, and policies for securely

exchanging authorized health information between

providers through the Nationwide Health

Information Network Exchange protocols. For

example, the query/response protocols provide a

method of exchanging information, when

authorized, between a provider and another

authenticated entity that may have information on a

patient that is necessary for care. In this case, a

query is sent to providers with an authorization and

responses are sent with the needed information.

This model provides a high level of information

exchange potential and capability. It also requires a

robust electronic health record system and

investment. Currently, the Nationwide Health

Information Network Exchange is primarily used by

a group of federal agencies and private organizations

that have come together to securely exchange

electronic health information and are demonstrating

the capabilities of information exchange. Today,

select participants in the Nationwide Health

Information Network Exchange are: exchanging

summary patient records for Social Security

Administration (SSA) disability determination

purposes; exchanging summary patient records for

the Virtual Lifetime Electronic Health Record

(VLER); and participating in bio-surveillance and

case reporting with CDC. The Exchange protocols

and the pilot programs that are using them will help

pave the way for broader adoption of

query/response exchanges as envisioned by the

authors of the President’s Council of Advisors on

Science and Technology (PCAST) December 8, 2010

report, Realizing the Full Potential of Health Information

Technology To Improve Healthcare for Americans: The Path

Forward and many health information thought

leaders.

In addition to the exchange of health information

between providers, the exchange of information that

engages individuals and gives them access to their

health data is a top priority of the Medicare and

Medicaid EHR Incentive Programs. The best way to

empower individuals and reorient the health care

system to be more patient-centered is to give

patients access to their personal health information.

Information exchange protocols such as the Blue

Button format that was developed and adopted by

the VA, DoD, and CMS, is one way to put patients

at the center and give them control of their

information. ONC supports the exchange of

information with consumers and the re-use of such

information for themselves and with providers.

This portfolio of exchange mechanisms is part of a

broad national strategy to have an interconnected

health system through the Nationwide Health

Information Network. The Nationwide Health

Information Network is being developed by ONC to

provide the building blocks for a secure, nationwide,

interoperable health information infrastructure that

can connect providers, consumers, and others

involved in the health care system. Exchange, Direct

and evolving methods of health information

exchange create an infrastructure that is critical to

enabling health information to follow a patient and

be available for clinical decision making and uses

beyond patient care, such as measuring quality.

Finally, the government will also seek to remove

unnecessary regulatory barriers to sustainable

exchange options, helping them to develop. In

collaboration with the State HIE Cooperative

Agreement Program, for instance, state governments

will look for ways to align Medicaid policies to health

information exchange requirements.

Strategy I.B.2: Monitor health information

exchange options and fill the gaps for

providers that do not have viable options.

Federal Health IT Strategic Plan 16

Many providers – particularly those in areas with low

hospital and provider density – are not currently

supported by sustainable information exchange

models. A main focus of the State HIE Cooperative

Agreement Program is expanding existing networks

to help these providers. The program is investing

over $500 million in supporting state-level initiatives

to expand capacity for exchanging health

information both within and across states. It

encourages states to develop statewide HIE plans

which will align with the nationally recognized

standards and services and state Medicaid initiatives.

States will support providers by building on existing

exchange activities, providing critical shared services

and infrastructure such as provider directories,

record locator services, and master patient indices,

increasing the use of standards, services, and policies

needed for widespread information sharing, and

enhancing the information exchange capabilities of

key trading partners including clinical laboratories,

pharmacies, and public health agencies.

In order to exchange health information

electronically, providers must have broadband

Internet access. The FCC’s Rural Healthcare

Program subsidizes broadband access for health care

providers that are disadvantaged in meeting this

requirement. The program is authorized to spend up

to $400 million per year to ease the burden of costly

telecommunications services for rural health care

providers. The program is divided into two different

components: one that subsidizes ongoing monthly

costs, and one that helps providers build new

infrastructure where the existing infrastructure is

insufficient. In addition, the U.S. Department of

Agriculture (USDA)’s Broadband Technologies

Opportunities Program (BTOP) and Department of

Commerce’s Broadband Initiatives Program (BIP)

were collectively funded by over $4 billion through

the Recovery Act to support broadband grants

around the country. Health care was one of the

strategic priorities of these grant programs.

The government will also encourage consumers to

gather and exchange their own individual health

information. Informed and engaged consumers who

have access to their own interoperable health records

can be a powerful force for bringing that

information with them to the point of care. See Goal

IV for more detail on how the government will

accelerate consumers’ and caregivers’ access to their

electronic health information in a format they can

use and reuse.

Strategy I.B.3: Ensure that health

information exchange takes place across

individual exchange models, and advance

health systems and data interoperability.

Electronic health information can be a critical

element in the implementation of business models,

such as bundled payments and accountable care

organizations being implemented through the

Affordable Care Act. These delivery system reform

models will rely on richer and more timely

information to better align payments with the actual

costs of providing efficient care. These efforts, as

well as future proposals for subsequent stages of

meaningful use, will rely on these emerging models

for sustainable information exchange and will likely

require greater capacity for connecting the various

models – so that providers may securely send health

information to any other authorized provider

through the Internet. HHS recognizes that the

government has a duty to help ensure that health

information can flow where needed and follow

patients where they go, consistent with patient

preferences. CMS recently reinforced this policy in

its proposed regulations on accountable care

organizations

Nationally, the government is developing a standards

and interoperability framework (S&I framework) to

harmonize existing standards and improve sharing of

standards across different organizations and federal

agencies, making it easier to broaden interoperability

through shared standards for data and services. In

order to support exchange and advance

interoperability, there are three types of standards

that the S&I framework will support.

. ONC is putting in place the

standards, services, and policies to support the

infrastructure needed to connect these emerging

models for exchange.

First, the S&I framework will focus on identifying

transport standards. These standards enable one

provider to exchange data with another provider, or

Federal Health IT Strategic Plan 17

one system to another system, securely. A second

type of standards is necessary for the data to be

interoperable between different providers, or

systems. These are known as content standards,

which allow data to be packaged or “read” in a way

that is useful for the provider. For example, the

Medicare and Medicaid Incentive Programs’ stage

one criteria require that an eligible professional

generate and transmit prescriptions electronically.

The S&I framework ensures that standards are

available that enable certified EHR technology to

view data in a way that is usable to the provider in

ordering the prescription and usable to the

pharmacist receiving the prescription. Lastly, the

S&I framework will identify vocabulary and

terminology standards and value sets in order to

achieve semantic interoperability at the level of

individual data elements. ONC will work to reduce

variability in vocabulary and terminology standards

which will help to reduce costs and to move toward

more semantically interoperable health information

exchange. ONC will work with its federal partners

and standards development organizations to

harmonize the existing standards and vocabularies

they produce to create the building blocks and

implementation packages in support of national

priorities, including meaningful use.

The S&I framework is intended to be flexible, so

that it can be used to establish meta-data standards,

or “data about data,” that include additional

information about the context in which the data has

been collected. The S&I framework will provide

tools, data and meta-data standards, value sets, and

service descriptions in an integrated and harmonized

way to support meaningful use and interoperability,

and focus these efforts on the highest priority kinds

of information exchange. ONC is leading this effort

in close collaboration with other federal agencies.

The S&I framework will support not only existing

specifications for the Nationwide Health

Information Network, but also support new meta-

data tagged approaches recommended by the

President’s Council of Advisors on Science and

Technology (PCAST) December 8, 2010 report,

Realizing the Full Potential of Health Information

Technology To Improve Healthcare for Americans: The Path

Forward.

ONC, and its federal partners, will continue to use

the HIT Policy and HIT Standards Committees

(ONC’s federal advisory committees) to provide

recommendations on priorities for standards. ONC,

and its partners, will promote the adoption of

standards through the Medicare and Medicaid

Incentive Programs and other federal programs.

In establishing and maintaining the S&I framework,

ONC will leverage the National Information

Exchange Model (NIEM) processes. NIEM is a

government collaborative of the U.S. Department of

Justice, the U.S. Department of Homeland Security,

and HHS designed to develop, disseminate, and

support enterprise-wide information exchange

standards and processes to enable jurisdictions to

effectively share critical information. NIEM

processes will help ensure that existing applicable

standards are re-used when possible, creating

efficiencies in the government standards work. ONC

will work with its federal partners to leverage the

NIEM processes where possible and add to it as

necessary.

This strategy recognizes the experience and

leadership of federal agencies and offices – including

National Institutes of Health/National Library of

Medicine (NIH/NLM), Centers for Disease Control

and Prevention (CDC), CMS, AHRQ, FDA, and the

Office of the Assistant Secretary for Planning and

Evaluation (ASPE) – and private sector standards

development organizations and aims to leverage

existing standards and standards development

processes where possible. The federal government

has a role in ensuring that standards designated for

U.S. health information exchange are readily

available and are regularly maintained and enhanced

in response to feedback from implementers and

users. Federal agencies encourage the adoption and

use of standards, participate and coordinate actively

in standards development organizations, and direct

and support specific standards development projects

to address implementation problems and fill gaps. In

the case of some terminologies and code sets, federal

agencies, including NIH, CDC, CMS, and FDA,

support the development and ongoing maintenance

and free dissemination of designated standards and

Federal Health IT Strategic Plan 18

promote their use across the spectrum of health

care, public health, and research.

Using the integrated set of specifications developed

in the S&I framework and shared services and

infrastructure (e.g., provider directories, record

locator services, and master patient indices), the

Nationwide Health Information Network will be the

preferred solution to securely exchange information

nationwide to support meaningful use. Health care

organizations using the Nationwide Health

Information Network to share health information

can serve as innovators, creating a pathway to more

advanced health information exchange and

interoperability.

In order to engender trust and interoperability and

facilitate broad participation in the Nationwide

Health Information Network, ONC will establish a

governance mechanism through rulemaking that

seeks to include accountability and oversight of

nationwide information exchange. The Nationwide

Health Information Network governance rules will

be established as a voluntary solution to health

information exchange. The government will pursue

various options to encourage participation in this

preferred solution to nationwide information

exchange.

In carrying out its assigned duties, ONC is tracking

standards activities in other countries and learning

from their experiences with health IT and health

information exchange. Currently, ONC is working to

identify whether there are internationally recognized

standards that should be endorsed for use in the

United States. To further this effort, ONC intends to

participate in international efforts to identify

interoperability standards and implementation

specifications for EHR technologies that will

facilitate data and systems integration. ONC’s input

into these international standards activities should

ensure that U.S. standards will work with the

international community in the event of global

public health emergencies.

OBJECTIVE C

Support health IT adoption and

information exchange for public

health and populations with unique

needs

Strategy I.C.1: Ensure public health

agencies are able to receive and share

information with providers using certified

EHR technology.

CDC, CMS, FDA, NIH, HRSA, the Assistant

Secretary for Preparedness and Response (ASPR),

and ONC are working together to ensure that

meaningful use of certified EHR technology

supports the needs of public health agencies.

Meaningful use stage one currently includes an

objective on the menu set to submit electronic

syndromic surveillance data, immunization registries,

and electronic lab reporting to public health

agencies. This will pave the way for EHRs to

exchange information with local, state, and federal

public health agencies and will set the stage for two-

way communication between providers and these

public health agencies prior to, during, and after an

incident. Eventually, information exchange between

providers and public health entities can be expanded.

It can include routine and emergency public health

preparedness and response, and many-ways

exchange of information (i.e., between different

providers, public health agencies at different

jurisdictions, and public health reference

laboratories) for immunizations, public health case

reports, and situational awareness reports. CDC is

helping local and state public health agencies prepare

their systems and processes for such changes.

Through the State HIE Cooperative Agreement

Program, state governments and state Medicaid

agencies will play a key role in building the public

health infrastructure to support meaningful use. As

with clinical data, public health departments require

public health standards to effectively exchange

information. CDC’s Public Health Informatics and

Technology Program Office (PHITPO) at the Office

of Surveillance, Epidemiology and Laboratory

Services (OSELS) is leading the development of

public health standards in coordination with FDA,

NIH and other agencies, that align with certified

EHR technology.

Federal Health IT Strategic Plan 19

Strategy I.C.2: Track health disparities and

promote health IT that reduces them.

In order to achieve nationwide adoption and

meaningful use of certified EHRs, it is critical that

providers who face unequal challenges in adopting

and using EHRs be included in the government’s

initiatives. The RECs are providing outreach and

technical assistance to support providers who serve

underserved communities and resource-poor

settings, including small practice settings, rural

hospitals/clinics, community health centers, and

Critical Access Hospitals. The RECs will work

through community-based organizations and will

develop tailored solutions and best practices to reach

these providers. RECs will also collaborate with

groups representing underserved and minority

providers on the national and local levels.

ONC is also investing in better ways to monitor and

identify disparities in health IT adoption. This effort

can enable ONC to measure health IT adoption

disparities and focus resources on areas of greatest

need to mitigate disparities.

HHS is evaluating approaches for using health IT to

collect and analyze data about disparities (on the

bases of race, ethnicity, gender, primary language,

and disability status) in health and health care

provision, and using this data to improve the care of

underserved populations. Beacon Community

grantees are acting as test sites for using health IT

for this purpose. RECs will disseminate best

practices identified by Beacon Communities to

providers and other organizations serving

underserved communities. NIST will provide

technical guidance for EHR design and

development, in order to help prevent the creation

or exacerbation of health care disparities with the

adoption and utilization of EHRs.

Through efforts underway related to the Medicare

and Medicaid EHR Incentive Programs, the

Children’s Health Insurance Program

Reauthorization Act (CHIPRA) of 2009, and other

initiatives authorized by the Affordable Care Act,

HHS is developing electronic clinical quality

measures that enable providers and hospitals to

gauge the health status of their communities. Also,

standards developed to support meaningful use will

strengthen data collection and quality measurement,

enabling quality improvement efforts that reduce

health disparities.

Existing health IT applications such as telehealth can

be used to address gaps in access and quality of

health care services. Telehealth uses electronic

information and telecommunications technologies

such as videoconferencing and wireless

communication to support long-distance care. The

HRSA Health Disparities Collaboratives (HDC)

were created to assist in the transformation of

primary health care practices in order to improve the

care provided to everyone and to eliminate health

disparities. HDC now continues as a private

endeavor. HRSA’s Telehealth Network Grant

Program supports established telehealth networks

that are looking to expand the number of sites that

are receiving clinical services. HRSA’s Telehealth

Resource Program funds Centers of Excellence,

which provide technical assistance on telehealth to

any HRSA grantee in the country. In addition, IHS,

VA, CMS, and USDA all take advantage of

telehealth technologies to meet the needs of

disparate populations. In order to improve access to

quality health care services through telehealth, ONC

is working with states to increase medical licensure

portability by streamlining licensure application and

credentials verification processes so providers can

more easily apply for a license in multiple states.

ONC is also working with HRSA on developing a

report to Congress for the use of health information

technology in underserved communities.

Strategy I.C.3: Support health IT adoption

and information exchange in long-term/

post-acute, behavioral health, and

emergency care settings.

Providers working in long-term and post-acute care

(LTPAC) and behavioral health settings are essential

partners in patient care coordination. ONC, CMS,

and ASPE will collaborate to address quality

measures and evolving clinical decision support

opportunities that will promote appropriate

exchange of health information in LTPAC and

behavioral health care settings for optimal

coordination of care.

Federal Health IT Strategic Plan 20

HHS will build on meaningful use to adopt

electronic standards for the exchange of clinical data

among facilities and community-based LTPAC

settings, including, where available, standards for

messaging and nomenclature. ONC will leverage the

State HIE and Beacon Community grant programs

in demonstrating methods for which the electronic

exchange of information with LTPAC entities can

improve care coordination. In addition, HHS will

identify opportunities in the Affordable Care Act to

support the use of health information exchange

technologies by LTPAC and behavioral health

providers to improve quality of care and care

coordination.

SAMHSA, in collaboration with ONC, will explore

approaches to support adoption of certified EHR

technology within the behavioral health community.

ONC is working with SAMHSA and HRSA to

address the policies and standards concerning the

unique needs of behavioral health IT adoption and

information exchange. This includes work on data

and meta-data standards that can provide additional

clinical context such as patient preferences and

sources of data to help enable data segmentation and

secure exchange of sensitive health information. The

ability to integrate mental health data into the

primary care and related safety net system is essential

for coordinating care.

Recognizing that emergency care settings are

essential places for patient care coordination, ONC

and ASPR will explore ways to address the need for

clinical data to be available in emergency care

situations and identify policies and standards that are

necessary to support these needs.

Federal Health IT Strategic Plan 21

Goal II: Improve Care, Improve Population Health, and

Reduce Health Care Costs through the Use of Health IT

he recently passed Affordable Care Act will

transform American health care from a

system that emphasizes transactions to a

system that emphasizes improved care,

improved population health, and reduced per capita

costs of health care. The widespread adoption and

meaningful use of certified EHR technology is a

necessary interim step in this transformation. It will

be essential to build upon this health IT

infrastructure and use the information made

available by EHRs in order to move toward HHS’

three overarching aims. But while health IT is

necessary to affect such changes, technology by itself

is insufficient. For this reason, federal health IT

investments are being made in lockstep with other

reform efforts, many of which were initiated and

funded by the Affordable Care Act.

Programs underway at ONC and AHRQ are looking

at ways to combine more sophisticated uses of

health IT and clinical care redesign to achieve better

health outcomes and improve health system

performance. The HITRC and REC programs will

make these best practices – such as using clinical

decision support tools,

patient registries, and

reminder systems – a

vailable to providers

throughout the country. The CHIPRA Quality

Demonstration grants are also expected to

demonstrate promising new ways that health IT can

be used to improve pediatric health care. CMS

expects that for future stages of meaningful use, the

financial incentives will encourage providers to use

more sophisticated health IT to achieve higher level

improvement measures. HHS will leverage both

the

Medicare and Medicaid EHR Incentive Programs

and the implementation of administrative

simplification requirements under Section 1104 of

the Affordable Care Act to create cost savings

through increased standardization and automation of

health care administrative functions.

A key part of the Affordable Care Act is the

development of quality and outcome measures. E-

measures can facilitate the electronic capture, reuse

and reporting of health data. E-measures will

support federal and state quality improvement

efforts and enable providers to assess their own

performance with their patients.

Central to both the HITECH Act and the

Affordable Care Act is fostering and learning from

breakthrough examples of health care delivery

system change, which can then serve as models for

more widespread changes. The Beacon Community

grants from the HITECH Act have created 17

demonstration communities in which clinicians,

hospitals, payers, and patients will show how

advanced uses of health IT can achieve

improvement goals in care, efficiency, and

population health. The new CMS Center for

Medicare and Medicaid Innovation will test a range

of innovative payment and service delivery models,

many of which will require advanced uses of health

IT to achieve their objectives. These examples may

employ the latest health IT – remote monitoring,

telehealth, mobile health (mHealth) applications, and

the most advanced means of information exchange –

and could become achievable, sustainable, and

replicable examples of how the government can

build upon the nationwide adoption and meaningful

use of EHRs.

Finally, the Affordable Care Act directs HHS to

develop a national strategy for prevention and health

promotion. Health IT will play a fundamental role in

supporting this national strategy, providing the

necessary infrastructure for disease prevention, early

detection, and condition management before an

illness becomes severe. CDC, in collaboration with

state, local, and other federal public health agencies,

leads federal efforts to provide and improve the core

capacities of the public health IT infrastructure.

Health IT facilitates coordination across public

health entities and other organizations, improves

identification of at-risk populations and their

adherence to public health guidelines, expedites

responses to threats, notifiable conditions, and

adverse population events, and promotes consumer

Federal Health IT Strategic Plan 22

participation in public health by encouraging healthy

behaviors and behaviors that screen for, detect, and

effectively manage disease.

The government has four objectives to “Improve

Care, Improve Population Health, and Reduce

Health Care Costs through the Use of Health IT”:

A. Support more sophisticated uses of EHRs and

other health IT to improve health system

performance

B. Better manage care, efficiency, and

population health through EHR-generated

reporting measures

C. Demonstrate health IT-enabled reform of

payment structures, clinical practices, and

population health management

D. Support new approaches to the use of

health IT in research, public and population

health, and national health security

Spotlight on Health Outcomes

Health IT and information sharing can improve medical decision-making

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.

See endnotes for citations.

Meaningful use of EHRs can result in more effective

management of the risk factors associated with heart disease.

George’s PCP works within a patient-centered medical home

model that provides the organizational infrastructure and

support so that she can best manage George’s care. This

model helps to improve coordination of George’s care by

enabling any specialists George sees and PCP to

electronically access and share critical information to make

better informed, appropriate and timely care decisions.

Through electronic information exchange, all the providers

on George’s care team are able to seamlessly review George’s

most recent blood pressure reading, smoking status, labs,

diagnostic tests, and clinic visit notes. George’s cardiologist is

able to make recommendations using information in real

time, and his PCP can view the care plan in the EHR. All of

these providers can share in the reward for providing better

value health care and keeping George healthy.

While in the hospital, Jane’s physician notices she is slurring

her speech and exhibiting some slight right arm weakness. He

believes she is having a stroke and instructs the care team to

start the appropriate treatment protocol. To confirm the

diagnosis, Jane’s phycian consults her health record that is

shared by all the providers on her care team. He notices that

in a visit with her PCP last week, there is no indication of a

problem with Jane’s speech or strength in either arm, which

suggests these symptoms are new. The physician discusses

with Jane and her family that she is likely having a stroke.

With the patient’s and her family’s consent, the medical team

performs a CT scan of Jane’s head and starts medication

immediately to break up the clot and save Jane from a

potentially

debilitating stroke. Without the shared

information on hand, Jane’s symptoms may not have been

noticed.

Federal Health IT Strategic Plan 23

OBJECTIVE A

Support more sophisticated uses of

HRs and other health IT to improve

health system performance

Strategy II.A.1: Identify and implement best

practices that use EHRs and other health

IT to improve care, efficiency, and

population health.

Goal I of this plan describes the Medicare and

Medicaid EHR Incentive Programs’ payments

available to providers who become meaningful users

– the centerpiece of the government’s health IT

strategy. The success of the meaningful use program

will create the fundamental health IT adoption

within the health system necessary to support the

health reform efforts outlined in the Affordable Care

Act. The Medicare and Medicaid EHR Incentive

Programs, as established by the HITECH Act,

represent a significant step in enhancing the

performance of the health system. The Medicare and

Medicaid EHR Incentive Programs also create a

basic health IT and information exchange

foundation that can support further improvement

interventions that are either not possible or too

difficult and burdensome on providers without this

foundation.

The HITRC program makes tools and best practices

available to providers as they implement clinical care

redesign and more sophisticated health IT into their

offices. HITRC will identify ways to build on EHR

use by changing clinical workflows and integrating

EHR software, patient registries, and medication

reminder systems. The use of these tools can

support better decision-making at the point of care

and increased adherence to treatment regimens,

helping move health care from a reactive system to

one that focuses on prevention and improved care

management.

Clinical decision support (CDS) systems are tools

that leverage EHRs to improve clinical processes.

Broadly, these software systems build off of EHRs,

giving providers helpful information and analytical

support at the point of care. Various clinical decision

support rules can help providers analyze patient

information, supply them with performance reports

against quality measures, and assist them with

diagnoses.

AHRQ and CDC will continue their critical role in

assessing and promoting best practices related to

how health IT can be utilized to improve quality of

care, patient engagement in self-care, management of

chronic diseases, and management of public and

population health.

Promising practices and lessons learned from the

CMS CHIPRA Quality Demonstrations will be

communicated on a regular basis to State Medicaid

and CHIP programs to further promote successful

HIT and EHR initiatives important to vulnerable

populations.

With the establishment of the REC program, the

government now has a way to disseminate tools and

best practices to providers that need the most help

in implementing them into their practices. The RECs

will build on their existing relationships with these

providers to help them achieve improved health

outcomes through more sophisticated uses of EHRs

and other health IT.

Strategy II.A.2: Create administrative

efficiencies to reduce cost and burden for

providers, payers, and government health

programs.

For future stages of meaningful use, HHS expects to

propose measures that simplify administrative

processes and help lower costs in the clinical setting.

In January 2009, HHS adopted modifications to two

HIPAA Administrative Simplification medical data

code set standards for medical diagnosis and

inpatient procedure coding. Under these regulations,

covered entities will be required to transition from

using the International Classification of Diseases,

Ninth Revision, Clinical Modification (ICD-9-CM)

in HIPAA-covered transactions to using the

International Classification of Diseases, Tenth

Revision, Clinical Modification (ICD-10-CM/PCS),

Procedure Coding System in October 2013. ICD-10-

CM/PCS code sets will enable a more granular

understanding of health care treatments and

outcomes, and more complete analyses of treatment

Federal Health IT Strategic Plan 24

costs, ultimately allowing for better disease

management and more efficient health care delivery.

In expanding coverage to as many as 32 million new

Americans, the Affordable Care Act called for some

specific technology-enabled improvements in the

government’s administration of health care. These

include: standards and protocols for streamlining

eligibility and enrollment into federal and state health

and human services programs; a consumer portal for

accessing health insurance information online; and

the creation of new health insurance exchanges by

2014. To fulfill the requirement under Section 1561

of the Affordable Care Act to develop interoperable

and secure standards and protocols to facilitate

enrollment of individuals in federal and state health

and human services programs, ONC organized a

workgroup, under the auspices of the HIT Policy

Committee and HIT Standards Committee, that

produced recommendations to those committees,

which were approved by the full committees to

facilitate more seamless enrollment processes. The

government will incorporate standards and criteria as

a condition for receiving federal grant funding for

these systems, and will employ other mechanisms to

further the development of efficient eligibility and

enrollment systems. ONC will support the

implementation of these health information

technology improvements where mandated by law,

and in all cases will ensure that the Affordable Care

Act technology implementation efforts are

synchronized with federal priorities for meaningful

use and health IT privacy and security. HHS will also

reduce the burden for providers when reporting

required data to federal agencies through use of data

standards and efficient and effective information

exchange planning and design.

OBJECTIVE B

Better manage care, efficiency, and

pulation health through EHR-

generated reporting measures

Strategy II.B.1: Identify specific measures

that align with the National Quality

Strategy.

In March 2011, HHS established the National

Quality Strategy, as required by the Affordable Care

Act. The Plan initially focuses on six priorities that

have great potential for rapidly improving health

outcomes and increasing the effectiveness of care for

all populations. As the National Quality Strategy is

implemented in 2011 and beyond, HHS will work

with stakeholders to create specific quantitative goals

and measures for each of these priorities. A part of

these activities will be the development of e-

measures that can collect and report data through

EHRs. HHS agencies will work together to ensure

the development of e-measures that are aligned

across reporting programs to reduce the burden on

providers and that can be supported by the

implementation of the Medicare and Medicaid EHR

Incentive Programs.

Strategy II.B.2: Establish standards,

specifications, and certification criteria for

collecting and reporting measures through

certified EHR technology.

Based on the measures defined in II.B.1, ONC, in

collaboration with others in HHS, VA, and DoD will

establish standards, specifications, and certification

criteria for EHRs that facilitate the collection and

reporting of e-measures. Using the S&I framework,

these e-measures will be harmonized with other

standards used to support data collection and

information exchange. The development of e-

measures will lead to more cost efficient and timely

assessments of health care performance.

Building e-measures into EHRs will allow providers

to assess and monitor their health care performance.

ONC will make available open source tools that help

providers submit quality measures to government

agencies, better understand their patient populations,

and identify opportunities for improving the health

of their patients.

Federal Health IT Strategic Plan 25

OBJECTIVE C

Demonstrate health IT-

enabled reform

of payment structures, clinical

practices, and population health

management

Strategy II.C.1: Fund and administer

demonstration communities to show how

the advanced use of health IT can achieve

measurable improvements in care,

efficiency, and population health.

ONC is funding 17 Beacon Communities with the

specific mission to identify and show improvement

on care, efficiency, and population health outcomes

through the use of health IT. VA and HRSA are

partnering with ONC to support these Beacon

Communities. By 2014, Beacon communities are

expected to demonstrate that their advanced uses of

health IT, and associated outcome improvements,

are both possible and replicable. By 2015, they are

anticipated to show how these efforts can be

expanded to other communities and how they can

be sustained over time. Key findings from these

communities will be incorporated into guidance for

RECs, State HIE programs, and meaningful use

proposed objectives, and thus, will be expanded to a

national scale.

Strategy II.C.2: Align health IT initiatives

and clinical and payment reform pilots and

demonstrations.

The Affordable Care Act authorized a wide range of

innovative programs using payment reforms to

promote quality, efficiency, and equity of care. These

include bundled payment pilots, medical home

pilots, and others. CMS will have the charge to

quickly and effectively translate knowledge from

these innovative programs into wider CMS policy.

Health IT will be an important tool to support many

of these demonstration projects. The federal

government will work to assure that, when

appropriate, health IT is properly leveraged for these

innovative programs, and that proven outcomes

associated with defined uses of health IT are

encouraged in the wider health care community.

utside of ONC and CMS, there are many other

examples of health IT-enabled reform being

implemented today. Private sector technology

companies, provider networks, payers, and public

providers such as VA, IHS, and DoD, are funding a

wide range of initiatives that experiment with health

IT in clinical settings, including the expanded

potential for open source electronic health record

systems that will complement private sector

proprietary systems. These initiatives offer an

important opportunity for capturing best practices

and applying them to the wider health care system.

The federal government will monitor and study such

efforts around the country and seek to expand on

already-successful programs.

OBJECTIVE D

Support new approaches to t

he use of

health IT in research, public and

population health, and national health

security

Strategy II.D.1: Establish new approaches

to and identify ways health IT can support

national prevention, health promotion,

public health, and national health security.

The Affordable Care Act included significant

resources for improving public health and

prevention. These new strategies will influence the

way public health is administered across the country

and health IT will be a fundamental part of that

change. Public health IT infrastructure investments,

such as those discussed in Strategy II.D.2 below, will

be updated and aligned with these approaches to

public and population health.

The Prevention and Public Health Fund has

supported a new program entitled Strengthening

Public Health Infrastructure for Improved Health

Outcomes, to increase the performance management

capacity of public health departments and ensure

that public health goals are being met. Health IT and

communications infrastructure is one of the four

areas of improvement sought through the program.

In FY 2010, CDC awarded a total of $42.5 million to

Federal Health IT Strategic Plan 26

projects at state and local public health

departments.

Health IT is critical in supporting new approaches to

national health security. The use of health IT during

a public health emergency can facilitate continuity of

care for the impacted population by enabling

electronic health information to flow for emergency

care. In the event of a natural disaster, having health

records in an electronic form can help avoid the

impact of destroyed paper records and ensure that

the affected population’s health information can be

accessed in the event of displacement.

Strategy II.D.2: Invest in health IT

infrastructure to support the National

Prevention and Health Promotion Strategy.

CDC, in collaboration with public health agencies at

the federal, state, and local levels, will invest in

public health IT infrastructure to improve a number

of the public health agencies’ core capacities. These

capacities include:

 Anticipating, preventing, and responding to health

threats, reportable diseases, and adverse

population events

 Identifying populations with specific health care

needs (e.g. at risk populations, children, etc.) and

promoting their adherence to public health

guidelines

 Preparing for and responding to emergencies

 Communicating with consumers and encouraging

their participation in public health

For instance, CDC programs support information

exchange across jurisdictional boundaries by

integrating with the Nationwide Health Information

Network, and provide agencies with common tools

for disease detection, monitoring, and real-time

situational awareness. The National Electronic

Disease Surveillance System (NEDSS) advances the

transition to standards-based electronic data

exchange for reportable disease surveillance,

improving agencies’ capabilities in detecting and

responding to reportable diseases. The National

Environmental Public Health Tracking Network

melds data from environmental hazard monitoring

and human exposure and health effect surveillance

into a network of standardized electronic data

systems. Continued investments in these and other

programs will support the National Prevention and

Health Promotion Strategy.

Strategy II.D.3: Ensure a mechanism for

information exchange in support of research

and the translation of research findings

back into clinical practice.

In order to support information exchange vital for

research, information in an EHR, with the

appropriate privacy protections, should be accessible

by researchers, research systems, biorepositories,

registries, and other types of research databases. In

turn, adopted health IT interoperability standards

should be used in research studies – and enhanced to

cover unique research needs – in order to facilitate

both the use of health care data in research and the

translation of research results into clinical practice.

This two-way interaction between research and

clinical care, facilitated by health IT, has the potential

to accelerate the generation of important new

information on medical interventions, personalized

treatments and public health initiatives utilizing

population-based knowledge as well as the

development of new tools for medicine, such as

computerized decision support systems. For

example, the Electronic Medical Records and

Genomics (eMERGE) Network has developed and

applied approaches to research that combine DNA

biorepositories with EHR systems for large-scale,

high-throughput genetic research such as genome-

wide association studies on a variety of diseases. The

consortia, like the NIH-supported Clinical and

Translational Science Award (CTSA) programs, are

maximizing the ability of researchers to leverage the

wealth of existing data to strengthen knowledge

building and evidence creation, and ultimately

improve clinical and preventive care through a more

rapid progression of knowledge from the laboratory

to clinical care implementation. Another example is

The Cancer Biomedical Informatics Grid (caBIG),

an information network sponsored by the National

Cancer Institute (NCI), which provides tools, data,

and services to enable researchers, providers, and

Federal Health IT Strategic Plan 27

patients throughout the oncology community to

collaborate and share expertise and data.

Meaningful use of certified EHR technology in

clinical research presents an opportunity to use data

collected through routine operations in a clinical

practice to generate and test hypotheses about the

relationships among patients, diseases, therapies,

prevention, treatment and recovery, and clinical

outcomes. It can improve the understanding of the

correlations between genotypes and phenotypes and

genomic and epigenetic interactions and

interrelationships, improve the identification and

tracking of medical events such as epidemics and

adverse events related to treatment, and facilitate

surveys of the health of the public at speeds

approaching real time. Data from EHRs are crucial

for patient-centered research and can provide

insights for researchers and benefits for patients and

providers in terms of improved care and

personalized treatments. These efforts will be

consistent with the privacy and security activities

outlined in Goal III of this Plan. Using EHRs may

eliminate redundant data entry, thus improving data

quality and processing speed; may stimulate a

learning health system in which the translation of

research findings into clinical care supports continual

improvement in knowledge, treatment and health;

and may increase opportunities for patients to

participate in research, particularly in underserved

communities and public health settings.

The efficient collection and exchange of EHR data

for research purposes, coupled with the use of

applicable EHR interoperability standards in

research studies, would also ensure that key findings

that lead to improvements in population and

individual health are rapidly translated back into

clinical practice. This will help to create the learning

health system envisioned in Goal V of this Plan.

Federal Health IT Strategic Plan 28

Goal III: Inspire Confidence and Trust in Health IT

rotecting the privacy and security of health

care information, and ensuring the safe use

of health technology, have long been core

responsibilities of the government. These

responsibilities have needed to evolve constantly

with the development of new technologies and the

adoption of new health care practices. Health IT –

with its potentially dramatic impact on the practice

of medicine – requires the government to further

evaluate and update policies and programs in privacy

and security areas over the next five years. In

evaluating and updating its policies and programs,

the government will rely on the Fair Information

Practice Principles

and the Nationwide Privacy and

Security Framework for Electronic Exchange of Individually

Identifiable Health Information

xii

EHRs and other health IT will enhance the quality

and value of health care, but only if there are

appropriate protections in place to keep health

information private and secure. Privacy and security

are the bedrock of building trust, a must-have

component that is essential to achieving meaningful

use and realizing the value of health IT. Patients and

providers must feel confident that laws, policies, and

processes are in place to keep their health

information private and secure, and that they will be

enforced when violations occur.

To that end, the HHS Office for Civil Rights (OCR)

is fulfilling new obligations under the HITECH Act

to modify the Privacy and Security Rules under the

Health Insurance Portability and Accountability Act

of 1996 (HIPAA) to strengthen the privacy and

security protections for health information and the

enforcement of and penalties for violating the

HIPAA rules.

These added privacy and security protections are an

integral piece of the government’s increased efforts

to broaden the use of IT in health care. ONC is also

exploring areas beyond HIPAA that are necessary to

ensure trust in widespread health information

exchange, including governance of the Nationwide

Health Information Network. Through the health IT

certification program and ONC’s partnership with

other federal entities, ONC is working to enhance

privacy and security features in EHRs and to work

with HITECH grantees to make sure appropriate

privacy and security strategies are in place.

ONC is collaborating with OCR on a

comprehensive communications plan to reach out to

providers, consumers, and other stakeholders to

educate and inform them of the importance of

health IT security and ways they can help to keep

protected health information secure.

In addition to added privacy and security

protections, ONC and OCR recognize the

importance of increasing efforts to inform

individuals and providers of patients’ rights with

regard to their protected health information and to

increase public transparency regarding the potential

uses of protected health information. Individuals

must understand their rights, be aware of the federal

government’s efforts to protect those rights, and be

notified of any breaches of unsecured protected

health information that occur.

In addition to the HIPAA Privacy and Security

Rules, which provide a set of national standards for

the protection of certain health information, other

federal laws afford additional protections for

information which may be particularly sensitive, such

as that related to individuals who are treated for

alcohol and/or drug abuse. SAMHSA, working with

ONC and OCR will address issues of behavioral

health privacy and confidentiality in the health IT

environment.

EHRs and other health IT offer tremendous

potential to improve patient safety and to help health

care providers practice safer and more effective care.

ONC took a key first step toward thoroughly

assessing health IT patient safety concerns through

the commission of a report by the Institute of

Medicine (IOM). In addition, ONC is engaged in an

ongoing effort to disseminate best practice resources

to providers to help equip them with the latest

information, so as to avoid common challenges to

safe and effective implementation and use of EHRs

and other health IT.

Federal Health IT Strategic Plan 29

The government’s objectives to “Inspire Confidence

and Trust in Health IT” are:

A. Protect confidentiality, integrity, and availability

of health information

B. Inform individuals of their rights and

increase transparency regarding the uses of

protected health information

C. Improve safety and effectiveness of health

Spotlight on Health Outcomes

Use of health IT can enhance patient trust and care management

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.

Three years ago, George’s PCP’s practice was flooded during

a hurricane. Fortunately, George’s provider had an EHR

system that backed up all of George’s medical information on

a remote, secure server. When George was displaced after the

storm, his new PCP was able to retrieve his entire medical

record, rather than George having to reconstruct his medical

history from memory. George’s provider was able to see

what medications, allergies, coexisting conditions, and risks

she must manage to ensure that George’s care is continued.

When Jane has concerns about her ability to manage her

COPD and especially when she is concerned about

developing an infection, she is able to exchange secure

messages with her PCP to get feedback without requiring a

trip to the provider’s office. When Jane describes to her

provider some early warning signs of an infection, her

provider electronically prescribes antibiotics that she is able

to take immediately to stem the possibility of an infection.

Jane enjoys being able to log into her online portal and show

her children that she is indeed managing her blood pressure

well and can answer their questions regarding what

medications she is taking and her latest lab test results. Jane’s

PCP is able to proactively address Jane’s questions about the

correct dosage of her medications in real time and without

the added delay of having to wait until her next appointment.

Federal Health IT Strategic Plan 30

OBJECTIVE A

Protect confidentiality, integrity, and

ava

ilability of health information

Strategy III.A.1: Promulgate appropriate

and enforceable federal policies to protect

the privacy and security of health

information.

It is HHS’ policy that the privacy and security of

individually identifiable health information should be

protected wherever it is electronically transmitted,

maintained, or received. While the HIPAA Privacy

and Security Rules are key safeguards, they are not

the only means available for affording this

protection. HHS will work with other federal

agencies, states and other stakeholders to ensure that

appropriate policies are in place.

The means for collecting, managing, storing, and

transmitting electronic health information are rapidly

advancing. ONC, along with its federal partners, will

strive to ensure that federal privacy and security

policies, including regulations and guidance, keep

pace with this evolving field.

As a first step, OCR is crafting rules to implement

the modifications to the HIPAA Privacy and

Security Rules as required by the HITECH Act.

Among other changes, these rules will:

 Impose direct liability on business associates for

compliance with certain provisions of the HIPAA

Privacy and Security Rules

 Establish new restrictions on the sale of protected

health information

 Establish stronger restrictions on disclosing health

information for marketing and fundraising

purposes

 Provide increased transparency regarding how

health information is shared

 Strengthen individuals’ rights to access their health

information electronically

OCR has also issued rules required by the HITECH

Act that specify the conditions under which covered

entities must notify individuals, HHS, and in some

cases the media, of breaches of unsecured protected

health information.

HHS has commenced the process of exploring

broader privacy and security policies that may be

necessary to ensure trust in electronic health

information exchange. In exploring these topics,

ONC will be guided by the Nationwide Privacy and

Security Framework for Electronic Exchange of Individually

Identifiable Health Information, a set of privacy and

security principles grounded in the fair information

practice principles (FIPPs) released in 2008. The

process of updating HHS’s approach to privacy and

security policies begins with input from ONC’s

federal advisory committees – the HIT Policy

Committee and HIT Standards Committee – which

identify, assess and recommend solutions to evolving

privacy and security issues. These recommendations

are considered by ONC in light of other policies and

activities and are brought by ONC to an HHS Inter-

Division Task Force that is charged with establishing

policy direction in this area. ONC then gathers

broader Federal feedback through the Federal

Health IT Task Force. The goal is to resolve federal

policy direction on this first set of privacy and

security issues by the end of 2011.

HHS will address, at a minimum, the following key

policy areas:

 Individual choice to participate in health

information exchange

 Access limitations and transparency for electronic

health information exchange

 Security, including provider and patient

authentication and de-identification of personal

health information

 Integrity of health information

 Secondary uses of health information for the

purposes of quality improvement, public health,

and research

 In consultation with the Federal Trade

Commission (FTC), potential regulation models

with respect to personal health records (PHRs)

There are a number of potential levers for instituting

any new privacy and security policies that develop

Federal Health IT Strategic Plan 31

out of this process, including formal rulemaking

where authorized, which would provide the

opportunity for public comment. It is expected that

privacy and security will be components of ONC’s

anticipated regulations to establish a governance

mechanism for the Nationwide Health Information

Network. Concerns with exchanging digital

information over the Internet are not confined to

the health care sphere. ONC is collaborating with

other federal agencies to learn from and implement

consistent approaches to privacy and security. For

example, ONC is working with the Presidential

workgroup formulating the National Strategy for

Trusted Identities in Cyberspace. In addition, as a

participant in the National Science and Technology

Committee’s Subcommittee on Privacy and Internet

Policy, ONC is working with other agencies to

address privacy issues arising from the evolving

means of collecting and analyzing data, including

health information, as it flows over the Internet.

Strategy III.A.2: Enforce existing federal

privacy and security laws and maintain

consistency with federal policy.

In order for providers and patients to have trust in

health IT and information exchange, they must be

confident that privacy and security laws are in place

and will be enforced. OCR is charged with civil

enforcement of the HIPAA Privacy, Security, and

Breach Notification Rules, the primary federal

regulations protecting health information. The

HITECH Act strengthens OCR’s civil enforcement

of the HIPAA Rules by establishing four categories

of violations that reflect increasing levels of

culpability; four corresponding tiers of penalty

amounts that significantly increase the minimum

penalty amount for each violation; and a maximum

penalty amount of $1.5 million for all violations of

an identical provision during a calendar year. OCR

also plans to conduct periodic audits that will assess

covered entities’ and business associates’ compliance

with the HIPAA Privacy and Security Rules. OCR

will employ all of its enforcement tools – including

imposing the increased penalty amounts for HIPAA

violations, conducting compliance reviews, entering

resolution agreements that are satisfactory to HHS

for informally resolving indications of

noncompliance, and conducting periodic audits – to

improve compliance with the Privacy and Security

Rules.

Strategy III.A.3: Encourage the

incorporation of privacy and security

functionality into health IT.

The use of appropriate technology can greatly

enhance the privacy and security of health

information. ONC, working with NIST and other

federal partners, will encourage the incorporation of

privacy and security functions into EHRs and other

health IT. ONC and OCR seek to ensure that

certified EHRs facilitate health care providers’

compliance with the requirements of the HIPAA

Security Rule. ONC’s Final Rule on Standards and

Certification Criteria for EHRs, issued in

conjunction with the Medicare and Medicaid EHR

Incentive Programs’ stage one meaningful use

requirements, requires that certified EHRs be

capable of:

 Encrypting health information to keep it secure

 Establishing access controls that permit only

authorized users to access the system

 Generating audit logs to record certain actions

related to electronic health information

 Automatically logging off a user after a set time of

inactivity

NC will continue to identify additional security

features that may be incorporated into EHR

certification and standards in future stages of

meaningful use.

Strategy III.A.4: Assess technical solutions

that could support more granular patient

choice and data segmentation.

Some individuals may want to give consent for

some, but not all, of their personal health

information to be exchanged (often called “data

segmentation”). For example, an individual may not

want information about his/her substance abuse

treatment shared, but may still want to take

advantage of the benefits of sharing the remainder of

his/her health information electronically. Today,

many EHR systems do not have the capability to

Federal Health IT Strategic Plan 32

support more granular patient consent and data

segmentation. In accordance with the HITECH

Act, ONC is investigating, through research and

potential demonstration projects, innovative means

for protecting the privacy of health information,

such as data segmentation and consent management

tools. ONC will work closely with its SHARP

grantee that is conducting research in this area.

In addition, ONC and SAMHSA are pilot testing the

development of service specifications and reference

models that can segment personal, electronic health

care records into more or less sensitive parts and

share sensitive parts only with appropriate

authorization. This pilot will be broadly applicable,

but particularly useful in the context of exchanging

behavioral health information.

Strategy III.A.5: Identify health IT system

security vulnerabilities and develop strategic

solutions.

ONC will conduct analysis and research to identify

the security vulnerabilities of existing and emerging

health IT systems in order to identify where to best

target its resources. As part of this effort, ONC will

analyze health information breaches that are

reported to HHS in order to identify the most likely

sources of vulnerability. In addition, ONC will

participate in the President’s cybersecurity initiative

and work with other federal partners, including the

Federal CIO Council, to identify large-scale security

threats and to develop strategic solutions. ONC will

also conduct research to identify best practices for

ensuring electronic health information remains

available in the event of a system failure, cyber-

attack, or other emergency event.

ONC is aware of the potential for the use of EHRs

to facilitate fraud and will consider how to address

the potential for fraud through its existing policies

and programs. For example, ONC, following the

leadership of the White House, is developing a

national framework for high assurance physician

identity management. The framework is intended to

provide a simple but highly trustworthy means of

assuring that physicians are who they claim to be in

health information exchange. This framework, which

will be piloted by key federal stakeholders such as

CMS and VA, should have a major impact on

reducing medical identity theft and fraud. In

addition, ONC will support the efforts of other

federal agencies, including CMS and OIG, to explore

a variety of options to improve efforts to combat

fraud.

Strategy III.A.6: Identify health IT privacy

and security requirements and best

practices, and communicate them through

health IT programs.

ONC, OCR, and SAMHSA will seek to ensure that

privacy and security policies and recommended best

practices remain aligned with advancements in

technology. Privacy and security requirements and

priorities will be identified based on analyses of

security incidents and vulnerabilities, and best

practices will be developed and disseminated. Where

necessary, OCR will update guidance to reflect

evolving privacy and security threats, for example

the 2006 guidance on securing remote and mobile

access, which has its basis in OMB memorandum

M-06-16. ONC will work with OCR and SAMHSA

to develop educational and guidance materials on

privacy and security best practices for organizations

implementing health IT. OCR will continue to issue

guidance on complying with the HIPAA Privacy and

Security Rules, and SAMHSA will continue to issue

guidance on complying with 42 CFR Part 2.

Additionally, State HIE Cooperative Agreements,

Beacon Communities grants, and SHARP grants will

demonstrate how privacy and security best practices

can be identified, implemented, and brought to scale.

Similarly, information on these privacy and security

requirements and best practices will be channeled

through the HITRC and the RECs, which offer

opportunities to disseminate best practices to

providers working to achieve meaningful use.

Some stakeholders have identified the variance in

state health privacy laws as an impediment to

exchanging health information among states. ONC

will work with state governments and State HIE

grantees to identify and develop best practices to

exchange health information electronically among

states with varying privacy laws. In addition, ONC is

exploring technology solutions to aid

implementation in a computable format of patient

Federal Health IT Strategic Plan 33

consent and to enable information exchange among

states.

State HIE grantees are required to incorporate

privacy and security strategies into their

implementation plans. ONC will work with the

grantees to ensure that these privacy and security

strategies are strong as part of its evaluation of the

states’ overall implementation plans. This work will

be further informed by VA and DoD’s experience

with the VLER program, that facilitates information

exchange of a Veteran’s health record among

different systems and states that may have differing

privacy laws.

Privacy and security are key components in ONC’s

workforce education program as well as the materials

being produced by the workforce curriculum

development centers. ONC will review and evaluate

these materials to help ensure that future health IT

professionals are well educated on privacy and

security requirements and best practices to ensure

compliance with these policies.

OBJECTIVE B

Inform individuals of t

heir rights and

increase transparency regarding the

uses of protected health information

Strategy III.B.1: Inform individuals about

their privacy and security rights and how

their information may be used and shared.

As part of its health IT education and outreach

strategy, HHS will inform providers and individuals

about the privacy and security rights and protections

that are in place to safeguard their electronic health

information. See Strategies I.A.6 and IV.A.2 for a

more detailed discussion of this strategy. To support

the goals of the HITECH Act (Sec. 13403(b),

Education on Health Information Privacy), OCR

and ONC are working in partnership to execute this

education and outreach strategy over a two-year

period in order to inform individuals about how

their information is safeguarded, how their

information may be used and shared, and how

individuals can exercise their rights under the

HIPAA Privacy Rule. This education and outreach

will also inform individuals about best practices that

they can use to protect the privacy of health data

they generate or maintain in consumer health IT

tools. In order to accommodate the needs of non-

English speaking individuals, these campaign

materials will be available in multiple languages.

In an effort to help individuals easily access

information about existing HHS privacy efforts

and the policies supporting them, HHS launched

an online resource center. The site provides

transparency about HHS policies on the

collection, use, and exchange of personally

identifiable health information, and the privacy

and security requirements for entities that collect

and maintain health information.

Strategy III.B.2: Increase transparency

regarding the development of policies and

standards related to uses and sharing of

protected health information.

ONC will engage with a wide range of consumer

organizations and diverse communities in an effort

to increase transparency of privacy and security

issues and to develop policies and standards to

address the consumer organizations and diverse

communities’ interests. The HIT Policy Committee

and the HIT Standards Committee each have a

Privacy and Security Workgroup that holds public

meetings and makes recommendations to its parent

federal advisory committee (FACA) related to

privacy and security requirements, which in turn

considers the workgroup’s advice and may submit

related recommendations to the National

Coordinator. To date, these federal advisory

committees have made recommendations on various

privacy and security issues, including meaningful use

criteria, certification criteria, individual consent,

provider authentication, patient identification and

use of intermediaries or third party service providers

in arrangements to exchange individually identifiable

health information. The Committees will explore

new issues as they arise. ONC will actively seek

public input into the development of these policies

and standards through its federal advisory

committees.

Federal Health IT Strategic Plan 34

Strategy III.B.3: Maintain strong breach

notification requirements.

To maintain consumer trust in EHRs and other

health IT, individuals must be adequately informed

of the use and sharing of their health information

and appropriately notified when their personal health

information has been compromised. OCR has

issued an interim final regulation on breach

notification that improves transparency and acts as

an incentive to the health care industry to improve

privacy and security by requiring HIPAA-covered

entities to promptly notify affected individuals, the

HHS Secretary, and, in some cases, the media, of a

breach of unsecured protected health information, as

well as requiring business associates to notify

covered entities of a breach of unsecured protected

health information. OCR is in the process of issuing

a final breach notification regulation that responds

to comments on the interim final breach notification

rule. Similar breach notification provisions

implemented and enforced by the FTC apply to

non-HIPAA covered entities, such as vendors of

certain PHRs and their third party service providers.

OBJECTIVE C

Improve safety and effectiveness of

alth IT

Strategy III.C.1: Provide implementation

and best practice tools for the effective use

of health IT.

AHRQ’s Health IT Portfolio supports health

services research grants and contracts that create

new knowledge, synthesize and disseminate best

evidence and provide tools for implementation

addressing health IT’s impact on the quality of

health care. Current initiatives address clinical

decision support, patient safety, patient centered

care, quality measurement, and usability and

workflow issues. In addition, ONC is actively

working to make resources available to providers

that allow them to maximize the value of using

health IT by avoiding common challenges and legal

issues associated with adoption, implementation, and

use of EHRs and other health IT. Professional

societies, licensing boards, and continuing education

programs are developing best practice resources

related to issues such as workflow redesign, the need

for ongoing maintenance and upgrades, and legal

concerns related to vendor contract clauses. There

are important legal issues that providers should be

aware of when entering into agreements with EHR

and other health IT vendors. ONC will work to

equip providers with information and help address

potential barriers they may face in achieving

meaningful use, including improved usability of

EHR technology (see Strategy I.A.9). ONC and RECs

will ensure that appropriate best practice resources

about these issues are distributed to the providers

that need them.

Strategy III.C.2: Evaluate safety concerns

and update approach to health IT safety.

ONC has commissioned the Institute of Medicine

(IOM) to conduct a formal study of health IT

patient safety concerns and to recommend additional

actions and strategies to address those concerns, as

well as to define the role of public and private

sectors in ensuring safety of health IT-assisted health

care services.

Strategy III.C.3: Monitor patient safety

issues related to health IT and address

concerns.

While developing an updated overall approach to

health IT safety, HHS agencies are monitoring

patient safety issues and addressing immediate

concerns. ONC is exploring mechanisms to improve

data integrity, including an assessment of existing

and emerging technologies that may allow for

automated resolution of inaccurate or questionable

data in EHRs and PHRs.

AHRQ, in conjunction with FDA and ONC,

developed a new protocol for reporting patient

safety events involving HIT devices. This protocol

was developed as part of the AHRQ Common

Formats for reporting patient safety events and is

available on the AHRQ Web site. AHRQ and FDA

collaborated in order to harmonize HIT event

reporting not only with Common Formats for other

event types but also with FDA’s MedSun system for

reporting adverse events associated with devices. It

is the goal of AHRQ, FDA, and ONC that providers

Federal Health IT Strategic Plan 35

experiencing adverse events involving HIT will be

able to report such events once and have the

information flow to those interested in and

authorized to receive it, e.g., Patient Safety

Organizations, state reporting systems, accrediting

bodies, and the FDA. It is expected that by

providing standardized Formats for reporting HIT

events efficiently, information can be aggregated,

learning accelerated, and care made safer.

Federal Health IT Strategic Plan 36

Goal IV: Empower Individuals with Health IT to

Improve their Health and the Health Care System

ndividual participation is a critical, yet currently

underutilized, component in improving health

and the overall health care system. Health care,

which often means initiating medical solutions after

something has gone wrong, can only go so far in

improving health. Individuals’ behaviors, and the

ways in which communities foster healthy behaviors,

are much more powerful forces for improving

population health. But medical solutions, too, can

become more centered on the individual: by arming

people with knowledge and by giving them and their

loved ones greater control over their own care.

xiii

Health IT, which encompasses a broad category of

tools and services, is critical in both empowering

individuals to manage their health and shifting care

to be more patient-centered so patients can be more

active in health decisions and treatments. Existing

and emerging technologies allow data to flow

directly to and from the individual, wherever the

individual may be. As a result, patient interactions

with the health care system are no longer confined

by the walls of the clinical setting and may occur

frequently in between visits. PHRs allow patients to

capture their own health observations and in some

instances, to access their health information from

providers. Mobile phones with glucometers allow

individuals to track their blood sugar levels through

their mobile devices. Mobile phones and related

applications are also being used to send reminders to

take medications or to send free health tips to help

during a pregnancy. In mental health, mobile apps

are being utilized to track moods and provide

therapeutic interventions with personalized

messages, exercises, and coaching. Using these tools

and others, individuals can become more attuned to

healthy behaviors, monitor their health, make

informed personal health decisions, and receive

preventative care. Patients managing illnesses or

other ailments can use health IT to connect with

other patients that share a similar condition, keep

better track of their health care, receive health care

solutions remotely, and participate in their care

coordination.

However, only 7 percent of Americans have used a

web site to access their health information online.

xiv

For individuals to become empowered they need to

be included in the policymaking process. This means

both understanding the government’s approach to

health IT and being able to shape the direction of

policies and programs. An HHS-led health IT

education and outreach strategy will seek to engage

the public in dialogue about health IT and provide

an opportunity to shape its future and the public’s

own expectations.

Even fewer have used mobile health (mHealth)

applications and remote monitoring technologies.

These low rates are the result of multiple dynamics:

most consumers are not aware of nor able to afford

the technologies, do not have access to their health

information, or do not expect to take as active a role

in their health and health care as they might in other

aspects of their lives. As a result, they have not

created a robust marketplace for technology

innovation. To truly empower consumers and move

the health care system to become more patient-

centered, the government will need to help change

these dynamics.

The single biggest lever to individual empowerment

is access to data. Individual access to data can

augment and improve patient-provider

communications. It is not meant to replace this

relationship, but rather to enhance it. Such data

liquidity will make health IT meaningful for

individuals, promote technological innovation, move

care to center more on the individual, and ultimately

have a direct effect on population health. Right now,

there are too many barriers to individual and

caregiver access to personal health care information.

Engaging individuals with health data is a top

priority of the Medicare and Medicaid EHR

Incentive Programs. Other policies and regulations,

such as the HIPAA Privacy Rule, will work in

concert with meaningful use efforts to facilitate

improved individual access to data. And the

government intends to continue to develop tools

Federal Health IT Strategic Plan 37

and serve as a model for exchanging data with

individuals, as reflected in the Blue Button initiative

at VA, DoD and CMS (see strategy IV.B.2 below for

more information).

Consumer health IT is an emerging industry – it is

new, fast-growing, and on the cutting edge of

technology innovation. While the government will

not lead the innovation that is likely to take place

over the next five years – that is the role of the

private sector – it will remain an active partner to

address a number of key steps to collaborate with

the industry and foster health IT research and

innovation. If the government makes more of the

data it collects available—as well as encouraging

others to do the same--technology companies can

develop applications and business models that make

the information relevant and marketable to

individuals. NIH and other government institutions

directly fund research and development. HHS

launches contests and challenge grants to focus

innovation on specific areas that will benefit health

care and the public good. These strategies to

promote health IT innovation are discussed in more

detail in Goal V Objective B, “Broaden the capacity

of health IT through innovation and research.”

As consumer technologies evolve and become more

prevalent, and as individuals grow more accustomed

to interacting with their health information using

health IT, there will be a need to better integrate

clinical practices with individual use of health IT

outside of the care environment. Through ONC’s

EHR certification program, the government will

facilitate the creation of clinical EHR systems that

can accept information from consumer applications.

The government will also help clinicians empower

individuals with technology, and will encourage

clinical practices to take advantage of consumer-

generated health information, both of which are

steps in achieving the ultimate aim of moving to

more patient-centric care.

The government’s objectives to “Empower

Individuals with Health IT to Improve their Health

and the Health Care System” are:

A. Engage individuals with health IT

B. Accelerate individual and caregiver access to their

electronic health information in a format they can

use and reuse

C. Integrate patient-generated health information

and consumer health IT with clinical applications

to support patient-centered care

Federal Health IT Strategic Plan 38

Spotlight on Health Outcomes

Empowering patients with health IT can improve care management and quality of life

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.

The ability to easily access health information electronically

has spurred innovation in the development of mobile

technology applications and other tools that can help patients

better manage chronic diseases and stay healthy. After

George is diagnosed with chronic heart failure, he and his

PCP decide to use a new mobile health device to help him

track his health status. Using sensors and an easy-to-use

interface on his Smartphone, the device records his exercise

patterns, heart rate, weight and diet. This information is

uploaded to an online site where George sets goals, tracks

progress, and engages in contests with other individuals

managing CHF. Periodically, over the course of a year,

George notices abnormalities in his trends and logs onto his

personal health portal: a site where his personal health

information is stored and both he and his provider have

access to this electronic health information. There he uploads

data from his mobile app, and sends a secure email to his

provider to ask questions about what he is viewing in the

portal. Without having to wait until the next appointment,

the provider is able to tell George that everything looks fine

and to encourage him to keep up the good work. When

George does have his regular in-person visit a year later, his

blood pressure is under control at 128/88 and his LDL is 70.

These results, which George anticipated after noticing

positive trends in his data and feeling better, indicate a

significant improvement in George’s cardiovascular health

and a dramatic decrease in risk of a heart attack.

After her hospitalization, Jane’s family decides they would

like to take care of her at home and are equipped by the

hospital with a remote monitoring system. Remote

monitoring systems may reduce medical complications and

hospitalizations by giving providers more frequent data

readings on their patients. When used by homebound,

chronically ill patients, these systems could be linked to

EHRs to alert providers of a problem and allow the provider

to react more quickly to adjust a medication or troubleshoot

the problem. Jane’s particular device allows her to do weekly

remote visits with a nurse, instead of returning to a medical

facility for these visits. The nurse is able to take readings on

Jane’s blood pressure, glucose levels, and weight, while

interacting with her over video conference to check in on

symptoms and see how Jane is doing with her medications.

Using this device, the nurse is able to answer Jane’s questions

without needing an in-person office visit, and to identify

major problems before they require an emergency room visit.

Jane’s quality of life is greatly improved, and she has been

able to reduce the number of times she and her family have

needed to go to the hospital and spend time in waiting

rooms. These remote monitoring systems have also enabled

Jane from needing to live in an assisted living environment.

Federal Health IT Strategic Plan 39

OBJECTIVE A

Engage individuals with health IT

Strategy IV.A.1: Listen to individuals and

implement health IT policies and programs

to meet their priorities.

The benefits of health IT can only be realized if

individuals are fully involved in the development of

health IT policy and confident that electronic health

information is kept private and secure. When

including individuals in the health IT policymaking

process, the government cannot expect them to

come to Washington, D.C. or to seek out rulemaking

processes. To truly be representative, ONC will seek

to participate in on-going public conversations about

health IT. These conversations are already taking

place, whether it is in online forums serving specific

demographics, community-based faith groups, or

chronic disease advocacy groups. ONC will

participate in these public dialogues with the aim of

learning how health IT policy and programs can

support individual empowerment.

These efforts will be complemented by the primary

formal mechanism established by the HITECH Act

for public input into health IT policy: the federal

advisory committees. As mentioned previously, there

are two committees – the HIT Policy Committee

(HITPC) and the HIT Standards Committee

(HITSC) – and several “sub-committees,” or

workgroups. The HITPC and HITSC make

recommendations to the National Coordinator on

crucial policy and program decisions on an ongoing

basis. While individuals and consumer advocates

have been represented on some of the Committees

already, the federal government will strengthen that

representation going forward.

ONC will also reach out to consumer organizations

directly, both to engage them in its own work and to

encourage them to reach out to their constituents in

the context of their own efforts as well.

Strategy IV.A.2: Communicate with

individuals openly and spread messages

through existing communication networks

and dialogues

The HHS-led education and outreach strategy

discussed in strategies I.A.6 and III.B.1 will engage

consumers as an important audience. Education and

outreach efforts will be aimed at helping people

understand the transition to EHRs, the value of

health IT more broadly and how health IT can be

leveraged to make informed choices and support

behavioral change related to their physical and

behavioral health and care. In order to effectively

reach millions of Americans, HHS intends to

collaborate whenever possible with communication

networks that already exist (such as health care

advocacy groups, faith-based groups, groups aimed

at supporting specific demographics, etc.) and to

take advantage of social media (such as blogs and

online social forums).

ONC has already reached out to numerous

consumer organizations, including those

representing individuals with disabilities, non-

English speaking populations, and people with lower

literacy levels, to involve them in discussions to

shape ONC’s programs and activities.

OBJECTIVE B

Accelerate individual and caregiver

access to their electronic health

information in a format they can use

and reuse

Strategy IV.B.1: Through Medicare and

Medicaid EHR Incentive Programs,

encourage providers to give patients access

to their health information in an electronic

format.

A primary barrier to individual access to information

is the lack of a business case for providers to share

that information. Providers record and store patient

health data in a health record; for them to also share

that information with patients has historically caused

additional administrative burden and cost. While

individuals have a right to access their health

information under the HIPAA Privacy Rule, there

has been little financial incentive for providers to

proactively share a copy of the medical record with

the patient or to minimize the burden for the patient

Federal Health IT Strategic Plan 40

to obtain a copy of the medical record. EHRs,

however, reduce this additional burden and

meaningful use incentive payments help make a

business case for doing so. The first stage of

meaningful use requires providers to send patients a

clinical summary of each office visit and an

electronic copy of their health information within

three days of their request, and includes a menu set

item to identify and provide patient-specific

education resources to patients. We expect that

future stages of meaningful use will build on these

requirements.

ONC is exploring ways to encourage EHR vendors

to add features that would allow patients to access

and download their health information through

consumer e-health tools, such as PHRs and secure

mHealth application on smart phones and other

mobile devices. It is important that personal health

data be not only downloadable, but also available in

a format that can be re-used by other applications

and support interactions between EHRs and external

sources of patient-specific education resources, such

as those available through NIH/NLM’s MedlinePlus

Connect interface.

Strategy IV.B.2: Through federal agencies

that deliver or pay for health care, act as a

model for sharing information with

individuals and make available tools to

do so.

Beyond simple access, better tools and processes are

necessary to make information more useful to

individuals and their caregivers. The government will

be a leader in providing information to individuals.

For example, the Blue Button is a web-based feature

through which patients may easily download a copy

of their health information and share it with health

care providers, caregivers, and others they trust. This

feature is available on the DoD, VA, and CMS

websites for their respective beneficiaries to use.

This model is a key step forward in privately and

securely sharing information with individuals, which

will be enhanced over time. Using the Blue Button in

combination with PHRs and other consumer health

IT, individuals will be able to collect, aggregate, and

analyze their health care information. Over the next

five years, the government will consider more

advanced features of health information sharing with

individuals, including data subscriptions,

standardized code sets, standards for consumer

health IT applications, and applications that enable

information to be exchanged through mobile

devices.

The Nationwide Health Information Network has

already demonstrated sharing of patient-health

information between the VA, DoD, SSA, and many

private sector partners. Extending the Nationwide

Health Information Network specifications with

additional building blocks such as the Direct

specifications will include protocols for provider-

patient secure messaging, which is a major step

towards patient-centered care.

The Federal Health IT Taskforce has recognized

individual access to data as a primary objective. As

done with the Blue Button initiative, it will continue

to seek ways to align government investments with

methods for giving individuals useful and reusable

copies of their own data.

Strategy IV.B.3: Establish public policies

that foster individual and caregiver access to

their health information while protecting

privacy and security.

While the Medicare and Medicaid EHR Incentive

Programs provide incentives for individual and

caregiver access to health information, there remain

policy opportunities and barriers that the

government will address outside of this program.

For instance, CMS and OCR are looking at ways to

enable individuals to request access to their test

results directly from laboratories. CMS has also

issued guidance to laboratories to clarify this issue.

OCR has proposed to revise the HIPAA regulations

such that a covered entity health plan would be

required to provide an enrollee access to the

enrollee’s electronic claims data in the electronic

form and format requested by the enrollee, if it is

readily producible in such form and format. These

policy issues may evolve over the next five years, but

HHS will support approaches that:

 Feature a transparent, understandable, and easy to

use online process that enables consumers to

download and reuse their data

Federal Health IT Strategic Plan 41

 Accommodate the range of user capabilities,

languages and access considerations, including

effective strategies for ensuring accessibility and

usability of electronic health information for

people with disabilities and meaningful access to

such information for individuals with limited

English proficiency

 Provide strong privacy and security protections

Some of HHS’ priority policy work related to

individual access to information has been discussed

in Goal III, including: modifications to HIPAA as

stipulated in the HITECH Act, individual consent to

participate in health information exchange, and

authorization and authentication.

OBJECTIVE C

Integrate pa

tient-generated health

information and consumer health IT

with clinical applications to support

patient-centered care

Strategy IV.C.1: Support the development of

standards and tools that make EHR

technology capable of interacting with

consumer health IT and build these

requirements for the use of standards and

tools into EHR certification.

There are a number of compelling examples of

technologies that enable individuals to manage their

own health and care, and capture more complete

information about themselves. EHRs should be able

to interact with these devices, so that a provider can

access information that a patient using health IT

chooses to share with him or her. ONC, in

partnership with FDA and other federal agencies,

will promote standards to enable integration,

including standards for devices and EHR

interoperability, standards for data integration, such

as glucometer measurements and unique device

identifiers (UDI), for identifying the source of the

device generated data. Through the adoption of

certification criteria, ONC could encourage the use

of these standards and tools that may enable EHRs

to receive information from any consumer health IT

device that also uses similar standards and tools.

Strategy IV.C.2: Solicit and integrate

patient-generated health information into

EHRs and quality measurements.

There are two main types of patient-generated health

information - both of which could help achieve the

goal of improved care, improved population health,

and reduced per capita costs of health care:

1. “Patient-generated insights” are individual’s

observations and perceptions about their own

health or care. These observations of daily living

could come in the form of surveys, health journal

entries, online blog entries, or any number of

other media

2. “Device-generated data” is data captured by

medical devices or other consumer health IT.

hile we acknowledge there are policy questions

that need to be examined related to the integration

of patient-generated health information into EHRs,

this information can be valuable to providers in

adjusting treatment regimens, valuable to individuals

in understanding and improving their health choices,

and valuable to the health system in measuring and

rewarding for health care quality. As part of its

health care quality activities, HHS is studying

opportunities to encourage providers to solicit and

report patient-generated information on physical and

behavioral health. This includes ensuring that this

information could be captured and integrated into

EHRs as part of meaningful use, and exploring

standards and specifications that will enable that

integration.

Strategy IV.C.3: Encourage the use of

consumer health IT to move toward patient-

centered care.

Today, eighty percent of people on the Internet use

it to search for health information.

Online

resources, including advice from peers, are a

significant source of health information. Many

people use the Internet to seek advice and to share

their experience, but far fewer have gone online to

review test results, used a PHR, or emailed their

doctor.

xvi

Consumers have expressed interest in the

use of health IT tools to make sure their health

record is correct, review test results, email providers,

Federal Health IT Strategic Plan 42

schedule appointments online, and refill

prescriptions online, all of which lend themselves to

more patient-centered care.

xvii

To further the use of consumer health IT, ONC and

CDC are working with two Beacon communities to

design tools that aim to help patients better manage

their diabetes. This program is modeled after

Text4Baby, a free text messaging service for

pregnant women and new moms that delivers timely

and practical tips customized for each stage of a

woman’s pregnancy or her baby’s age. Text4Baby is

the result of a public-private partnership with HHS,

the White House Office of Science and Technology

Policy and many private sector partners.

For care to truly become more patient-centered,

providers will need to adopt new processes and uses

of health IT that empower individuals in

understanding and directing their care. HHS’

primary approach to encouraging changes in

provider behavior is through the implementation of

quality measures and the attachment of incentives or

penalties to improving on these measures. To this

end, the National Quality Strategy, the National

Prevention and Health Promotion Strategy and the

Medicare and Medicaid EHR Incentive Programs

will work in concert to promote the integration of

consumer technologies and patient provided health

information into clinical workflows to improve

physical and behavioral health and care.

There are four domains of quality improvement that

can help lead to patient-centered care:

1. Self-management/activation refers to

measures of quality improvement that assess the

degree to which patients understand the role they

are meant to play in their care process, and the

degree to which patients have the knowledge,

skills, confidence, and self management

resources/support to move forward in this role.

2. Honoring patient preferences and shared

decision making refers to measures of quality

improvement that assess the degree to which

patients have the knowledge to make informed

decisions about their care. It also encompasses

measures that assess the quality of decision

making, patient connectedness to resources,

patient preferences, and care provider adherence

to patient preferences.

3. Patient health outcomes refers to measures of

quality improvement that assess the degree to

which the care provided affects disease/disability,

health risk, and functional health status at the

individual patient and population level.

4. Community resources coordination /

connection refers to measures of quality

improvement that assess if, and to what extent,

patients are connected to community resources.

ertain consumer health IT applications, when used

by consumers and providers in concert, enable

improvement in these domains. Future quality

measures and meaningful use requirements will help

to realize these benefits.

Federal Health IT Strategic Plan 43

Goal V: Achieve Rapid Learning and Technological

Advancement

eaningful use of certified EHR

technology will help the health care

system “catch up” with proven

technology and process changes that have been

available for years. Technology is not in stasis – it is

a dynamic industry prone to innovation which,

though at times disruptive, can yield enormous

benefits. There are two areas where the government

is working in concert with the framework of

meaningful use and the Affordable Care Act to

prepare for a future that is hard to predict:

1) enabling health IT innovation and research, and

2) leading the creation of a learning health system.

Health IT Innovation and Research

The future of health IT rests in innovation. The

government will embrace ongoing technology

advancements whether they are incremental or

fundamental. This means both adapting government

strategy to advances in technology, and continuing

to encourage rapid industry innovation.

Though there have been great leaps in health IT in

the past few years, the most remarkable gains are

likely still ahead of us. Possibilities include new ways

of engaging individuals with their health

information, new ways of aggregating and analyzing

data, new ways of connecting the clinical setting

more directly with individuals’ everyday lives, and

new ways of protecting privacy and ensuring the

security of health information. The government’s

first step to enabling innovation is liberating data

that is useful to consumers, providers, and

innovators. But the government will also invest

directly in research and development, use

government mechanisms as levers for fostering

adoption of innovative technology, and encourage

collaboration and targeted innovation in the health

IT industry.

The Learning Health System

A nation of providers who are meaningful users of

health IT will create very large amounts of clinical

information that is captured and stored in electronic,

computable form, and represented using defined

standards. Developing effective privacy policies and

technologies that can de-identify personally

identifiable health information will be challenging,

yet is essential to ensuring public trust and

safeguarding sensitive information. Through

carefully designed and trusted mechanisms, this data

will be able to flow securely from the system that

collected it to other systems, such as research

consortia, registries, and biorepositories, with an

authorized use for it. The secondary use and

population level analysis of this information holds

great promise for many forms of biomedical

research, public and population health, such as

tracking and management of epidemics, and

improving quality and efficiency of prevention and

care.

The government’s vision for realizing the value of

this information is a learning health system – an

environment where a vast array of health care data

can be appropriately aggregated and analyzed,

turning data into knowledge that can be put to

immediate use. A learning health system can shorten

the gap between the creation of new knowledge and

its widespread adoption in health care from the

often-quoted 17 years to 17 months, or even 17

weeks. Through a learning health system, the right

information will be available to support a given

decision, whether it is about the efficacy of a

treatment or medication for an individual patient,

predicting a national pandemic, or deciding whether

to proceed with the research and development for a

potential new treatment.

xviii

The learning health system will benefit from the

potential of Medicare and Medicaid EHR Incentive

Programs payments and payment reforms initiated

by the Affordable Care Act to motivate demand for

health care information, and to create the policies

and infrastructure for information exchange. The

government’s strategy to promote health

information exchange is described in Goal I, and

focuses on fostering exchange at the local level

Federal Health IT Strategic Plan 44

where there are existing business models for

information exchange. We expect future stages of

meaningful use to require more rigorous information

exchange requirements and will work in concert with

the Affordable Care Act to create demand for health

care information throughout the health care system.

Drivers for information exchange will be coupled

with federal leadership on national standards, privacy

and security requirements, and infrastructure that

supports information exchange.

The learning health system will use the policies,

requirements, and infrastructure created to support

meaningful use of certified EHRs, and will build on

them to support more sophisticated modes of

information exchange necessary for a system that

can “learn.” ONC commissioned the Institute of

Medicine (IOM) to convene national private and

public sector leaders in health care for a workshop

series on The Electronic Infrastructure to Support a

Learning Healthcare System. The report resulting from

these workshops series describes how lessons from

current smaller-scale examples of learning health

care systems, can be put into a policy framework that

could be implemented on a national scale.

xix

After soliciting input from the private sector, ONC

will work with federal partners to establish an initial

group to ascertain how to structure a learning health

system. Initial efforts will focus on creating a

federated model for the learning health system that

bridges disparate systems. Additional efforts will

focus on expanding the learning health system to

include additional public and private sector entities.

The government’s objectives to “Achieve Rapid

Learning and Technological Advancement” are:

A. Lead the creation of a learning health system to

support quality, research, and public and

population health

B. Broaden the capacity of health IT through

innovation and research

Spotlight on Health Outcomes

A learning health system can lead to earlier detection and better risk management

The use of health IT can enable a learning health

system to help prevent and monitor adverse events

caused by new drugs. As George begins therapy

using a new drug, information about his health can

be captured in the EHR and findings may be

automatically transmitted from the EHRs in which

they are collected and reported in aggregate via a

standard format to oversight agencies, such as the

FDA, or to the company which manufactures the

drug. By making this information available quickly in

the learning health system, population-level data

could be aggregated for earlier signaling of possible

adverse reactions to new drugs. If a potential adverse

reaction is identified, EHRs can serve another role in

helping providers to quickly identify each of their

patients taking a certain medication and notify the

patients via their preferred communication channel

about the potential risks.

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.

The nationwide adoption and meaningful use of EHRs could

facilitate the collection of clinical and research data from disparate

sources including hospital systems, provider offices, laboratories,

biorepositories, registries, and other research databases. Some

stakeholders within the health care industry – such as researchers –

are currently on the cutting edge of analyzing EHR-generated data

to identify patient populations that are at-risk for preventable

hospitalizations. EHR-generated data combined with analytical

systems can be a boon to predictive modeling and knowledge

generation. As an elderly woman with multiple medical conditions,

Jane is part of an at-risk population. As these populations are

identified earlier and risk factors are better understood, the learning

health system could also enable resources, such as disease

management and case management, to be deployed earlier to help

avoid preventable hospitalizations.

Currently, good clinical

information regarding patient-centered outcomes on the best

treatment options for patients with multiple diagnoses is lacking.

In the long-term, EHR-generated data could be used to translate

research findings to better inform preventive approaches, establish

correlations, identify risks, and develop a deeper understanding of

disease in patients with multiple conditions.

Federal Health IT Strategic Plan 45

OBJECTIVE A

Lead the creation of a learning health

system to support quality, research,

and public and population health

Strategy V.A.1: Establish an initial group of

learning health system participants.

The learning health system’s success will depend in

part on the participation of a select number of

institutions that collect and use large amounts of

health care data. ONC recognizes this initial group

of participants is only a sub-set of a broader set of

activities occurring in the public and private sectors,

and plans to engage both sectors early in the process

and expand participation in the learning health

system over time (see Strategy V.A.4).

Several federal organizations are already fostering

learning health systems scaled to their own agencies,

and some of these agencies will be key initial

members of this group. The efforts of these agencies

provide a base of experience on which to build the

system at a larger scale. FDA’s Sentinel Initiative is a

national electronic system that is currently being

designed to enhance FDA’s ability to track the safety

of drugs, vaccines, biologics, and medical devices

after they reach the market. CDC’s programs are

supporting a national surveillance network through

which health care organizations, public health

entities, health information exchanges, and others

are able to contribute to the picture of the health of

the nation. Its goal is to be able to provide

nationwide and regional situational awareness for all-

hazard health-related threats and to support national,

state, and local responses to those threats. CDC also

has the National Environmental Public Health

Tracking Network, which integrates health,

exposure, and hazard data from a variety of national,

state, and local sources. It offers new understanding

of how hazardous substances can contribute to

illness and potentially be prevented.

Strategy V.A.2: Develop standards, policies,

and technologies to connect participants

within the learning health system.

In order to make the learning health system a reality

on a national scale, standards, policies, and mutually

reinforcing technologies must be put in place to

ensure that data collected at the point of care can be

de-identified, aggregated, queried and analyzed for

population health studies and quality improvement.

Data used in these studies must be represented

compatibly across participating organizations. Many

of these can be built upon already-existing standards,

policies, and technologies stemming from

meaningful use and the State HIE, Beacon

Community and SHARP grantees, but new

standards, policies and technologies will also be

needed.

To begin identifying specific standards, policies, and

technologies needed for the learning health system,

the Institute of Medicine (IOM) convened, with

ONC support, an Electronic Infrastructure to Support a

Learning Healthcare System workshop series in 2010.

The report stemming from the workshop series,

Digital Infrastructure for the Learning Health System: The

Foundation for Continuous Improvement in Health and

Health Care – Workshop Series Summary,

takes lessons

from current examples of learning health care

systems, including those in the private sector, and

broadens them to propose technologies and policies

that could be implemented on a national scale. It

provides the federal government a path forward to

implement such a framework, and makes

recommendations to address the policy and technical

barriers that will need to be addressed.

xxi

Strategy V.A.3: Engage patients, providers,

researchers, and institutions to exchange

information through the learning health

system.

ONC is

working to ensure that its ongoing efforts related to

standards, certification, and governance of

nationwide health information exchange will align

with the vision for a learning health system.

The learning health system will only be as valuable as

the information that is exchanged. As more

organizations and members participate in the

learning health system, more knowledge will reach

more entities to make a positive impact on clinical

and research practices. ONC will engage the sources

of critical information – patients and providers – so

Federal Health IT Strategic Plan 46

that they understand the learning health system, its

relation to and interaction with research, and the

benefits of such research to inform the learning

health system. Increasing the engagement and

understanding of patients and providers may

increase their willingness to participate in

information sharing that they trust and that is private

and secure, including for secondary uses of EHR

data in research. Consumers stand to directly benefit

from more information flowing into the learning

health system which would allow for a better

understanding of which subgroups may respond

better to certain medications or treatments.

Consumers are also likely to benefit from the

availability of population level data in interacting

with their clinicians about what treatment is right for

them. Work to engage patients and providers will be

done directly and through representative consumer

and provider groups, as well as in public health

settings in underserved communities.

Strategy V.A.4: Grow the learning health

system by adding more members and

expanding policies and standards as

needed.

The government will seek to expand participation in

the learning health system early in the process,

beyond the initial group of federal partners, to add

private sector partners. Future participants could

include public and private provider groups, Health

Information Exchanges, payers, small community

medical and behavioral health practices, registries

and additional federal agencies. Incentives to join

this group will include the positive results of the

initial exchange activities and the possibility of

reciprocal benefit. The private sector is already

coming together to share data and knowledge via

various consortiums, and ONC will continue to

coordinate and learn from these efforts. As

standards and policies are expanded to support

system growth, the learning health system will

engage the private sector and will also support

government efforts at the state, local, and tribal

levels. Over the next five years, the government will

expand on the findings of the IOM study (see

strategy V.A.2) and continue evolving the federal

plan for the learning health system.

OBJECTIVE B

Broaden the capacity of health IT

thr

ough innovation and research

Strategy V.B.1: Liberate health data to

enable health IT innovation.

Facilitating access to health data, in accordance with

privacy and security protections, is a key mechanism

of the government to encourage innovation in the

industry and demonstrate to the public the value of

health IT. Rich and high quality data are the starting

point for building applications that provide value to

individuals and care providers. For instance, PHRs

become much more interesting if they can use the

patient’s entire medical history to provide advice on

how to reach personal health goals. Huge quantities

of data exist already, but in forms that are not easily

usable for those that could benefit from the data.

The government is working on multiple fronts to

correct this.

The first priority is giving individuals timely access to

their electronic personal health information. The

government is working to facilitate the ability for

users to successfully access, retrieve, process, and act

on the data easily and efficiently. This approach is

discussed at length in Goal IV Objective B. In

addition, the government is also seeking innovative

means for protecting users’ personal health

information, including effective techniques to de-

identify and segment data, and to facilitate informed

choice. As individuals become empowered with their

health data, demand for consumer health IT

applications will likely accelerate.

Outside of individual health information, the

government is a leading generator of health care

data. HHS maintains valuable information about the

health care system’s performance (e.g., the safety and

efficacy of treatments, disease surveillance).

Although much of this data is already public, it has

historically been stored in disparate datasets that are

largely inaccessible or unusable for developers. HHS

is now taking an active role in getting this data in the

hands of developers to activate innovation. This

includes the launch of

HHS.gov/Open, a website

tailored to providing the public more transparency

Federal Health IT Strategic Plan 47

into HHS’ administration, and the Community

Health Data Initiative (CHDI), a public-private

partnership committed to innovation through the

use of public data. CHDI is making many large data

sets, and tools that make those data sets useful,

readily downloadable from the CHDI website. It has

also organized contests and challenges to ignite

innovation using this data, such as the Health 2.0

Developer Challenge. In that ongoing contest,

anyone interested in submitting a challenge can do

so. Technology companies, health care companies,

and government agencies work together to both

identify specific market needs, and develop software

solutions using data to meet those needs. Dozens of

compelling applications have already been built as a

result of this challenge.

Strategy V.B.2: Make targeted investments

in health IT research.

The federal government is committed to investing

directly in health IT research and development in

areas that hold great promise for improving the

health of individuals and populations. NIH and

ARHQ, in particular, are funding dozens of research

projects related to the development of health IT.

Through the HITECH Act, ONC established the

Strategic Health IT Advanced Research Projects

(SHARP) Program, a four-year program funding

research in health IT security, patient-centered

cognitive support, health care applications and

network platform architectures, and secondary use

of EHR data. The progress made by grantees will

assist in developing best practices which can be

applied nationwide, possibly through meaningful use

requirements. AHRQ sponsors projects focused on

best practices and integration of health IT into the

practice of medicine. Focus topics include usability

of EHRs, clinical decision support, consumer health

IT, health information exchanges, and telehealth.

The Networking and Information Technology

Research and Development (NITRD) Program

coordinates federal research and development

investments in computing, networking, and software.

As required under the HITECH Act, NITRD is

developing a program and strategic plan to

coordinate research and development relating to

health IT. This work will make the pursuit of

important opportunities for technology

breakthroughs through coordinated inter-agency

initiatives possible, and will ensure that programs of

different agencies are non-redundant and mutually

reinforcing. In December 2010, PCAST issued a

report on all NITRD activities called Designing a

Digital Future: Federally Funded Research and Development

in Networking and Information Technology, which

emphasizes the importance of research to improve

health IT.

xxii

Strategy V.B.3: Employ government

programs and services as test beds for

innovative health IT.

Government agencies are leaders in adopting

innovative health IT into provider and payer

settings. Applying advanced health IT to the

government’s own health care practices and payment

administration creates a large market for

technologies, helps to prove their value, and creates

best practices for wider adoption.

VA’s Care Coordination Services uses health

informatics, e-care, and disease management

technologies to avoid unnecessary admission to

long-term institutional care facilities. Technologies

include videophones, messaging devices, biometric

devices, digital cameras, and remote monitoring

devices. VHA also has an award-winning PHR, “My

HealtheVet,” which gives its patients access to their

health information along with other VA information

and services. DoD’s MiCare portal enables its

patients to manage their medical information

through a PHR of their choice. IHS is in the process

of developing a PHR for its patients which will

support meaningful use requirements.

CMS is piloting free PHR options for Medicare

recipients. “Medicare PHR Choice” gives people

living in Arizona and Utah a choice among four

vendors’ PHRs, and automatically updates their

online record with Part A and Part B claims. “My

Personal Health Record South Carolina” allows

participants to see their medical history based on the

past two years of claims. Additional information can

be added manually, and the PHR provides helpful

resources to understand diagnoses, conditions, and

procedures.

Federal Health IT Strategic Plan 48

Strategy V.B.4: Monitor and promote

industry innovation.

The government facilitates and monitors the health

IT industry and stays abreast of innovation’s impact

on federal policies and programs in order to further

promote innovation within the industry. Such

activity is conducted primarily through panels,

conferences, white papers, and similar outreach

efforts. The government also plans to promote

innovation through open innovation prizes and

challenge grants focused on specific health IT

problems. Potential focus areas include helping to

ensure privacy and security in the digital health

infrastructure, increasing the usability of health

information systems to enhance provider

interactions, the creation of new analytical

techniques to inform improved care, and the

development of more efficient methods of data

compression and communication through modalities

such as mobile health.

Strategy V.B.5: Provide clear direction to the

health IT industry regarding government

roles and policies for protecting individuals

while not stifling innovation.

ONC commissioned the Institute of Medicine

(IOM) to thoroughly evaluate health IT patient

safety concerns and to recommend additional

actions and strategies to address those concerns, as

well as to define the role of public and private

sectors in ensuring the safety of health IT-assisted

health care services. Over the next two years, ONC,

in collaboration with federal partners, will develop a

consistent approach to health IT that protects

individuals without stifling innovation. The

government is committed to being as open and

transparent as possible in formulating its approach.

Federal Health IT Strategic Plan 49

Appendix A: Performance Measures

The performance measures below reflect key aspects of progress towards achieving the goals in this Federal Health

IT Strategic Plan for 2011-2015, and the overarching goal that all Americans will benefit from EHRs. These

performance measures are not intended to be a complete set, but a subset of key indicators in assessing progress.

Supporting information for these performance measures is contained in ONC’s Annual Performance Plan and

Report, which is integrated into the annual Congressional Budget Justification, which is available on the HHS

website. The most recent assessment about the status of meeting each goal is also included to provide a baseline

from which ONC aims to improve performance.

Goal Performance Measures

Most Recent

Assessment of

Performance Data Sources

I. Achieve

Adoption and

Information

Exchange

through

Meaningful Use

of Health IT



Increase the percentage of

eligible professionals receiving

Medicare and Medicaid EHR

Incentive Programs payments



N/A

Baseline TBD

(FY 2011)



Centers for Medicare &

Medicaid Services (CMS)

Meaningful Use Registration

and Attestation System

Better performance in hospitals:

 Increase the percentage of

eligible hospitals receiving

Medicare and Medicaid EHR

Incentive Programs payments

 Increase the percentage of

hospitals that have adopted

electronic health records

 N/A

Baseline TBD

(FY 2011)

 12% (CY 2009)

 CMS Meaningful Use

Registration and Attestation

System

 American Hospital Association

(AHA) Annual Survey of

Hospitals, IT Supplement

Better performance for physicians:

 Increase the percentage of

eligible primary care

professionals receiving

meaningful use incentive

payments

 Increase the percentage of

Federally Qualified Health

Centers (FQHCs) that are

affiliated with providers that

receive Medicare and Medicaid

EHR Incentive Programs

payments

 Increase the percentage of

office-based physicians who

have adopted electronic health

records

 Increase the percentage of

office-based primary care

physicians who have adopted

 N/A Baseline

TBD (FY 2011)

 N/A Baseline

TBD (FY 2011)

 21% (CY 2009)

 20% (CY 2009)

 CMS Meaningful Use

Registration and Attestation

System

 TBD

 CDC National Ambulatory

Medical Care Survey, IT

Supplement

 Centers for Disease Control

and Prevention (CDC),

National Ambulatory Medical

Federal Health IT Strategic Plan 50

Goal Performance Measures

Most Recent

Assessment of

Performance Data Sources

electronic health records

Care Survey, IT Supplement



Increase the percentage of

community pharmacies in the

U.S. that are capable of

exchanging health information

electronically



85% (CY 2009)



Surescripts National Progress

Report on E-Prescribing

II. Improve Care,

Improve

Population

Health, and

Reduce Health

Care Costs

through the Use

of Health IT



Proportion of eligible providers

in Beacon Communities that

receive Medicare and Medicaid

EHR Incentive Programs

payments



N/A

Baseline TBD

(FY 2011)



ONC Office of State and

Community Programs,

Beacon Division



Number of providers

participating in Beacon

Community interventions



N/A

Baseline TBD

(FY 2011)



ONC Office of State and

Community Programs,

Beacon Division

III. Inspire

Confidence

and Trust in

Health IT



Decrease the percentage of

Americans who are very

concerned about the security of

electronic health records



N/A

Baseline TBD

(FY 2011)



ONC Privacy and Security

Attitudes Survey

IV. Empower

Individuals with

Health IT to

Improve their

Health and the

Health Care

System



Increase the percentage of

Americans who have been given

electronic access to any part of

their health care record



N/A

Baseline TBD

(FY 2011)



ONC Privacy and Security

Attitudes Survey

V. Achieve Rapid

Learning and

Technological

Advancement



Measure TBD



N/A

Baseline TBD



Data Source TBD

Federal Health IT Strategic Plan 51

Appendix B: Programs, Initiatives, and Federal

Engagement

 Department of Agriculture (USDA) improves agricultural productivity and competitiveness and contributes

to the national economy and the public health. The Recovery Act appropriated funds to the Department of

Agriculture’s Rural Utilities Service (RUS) and the Department of Commerce’s National Telecommunications

Information Administration (NTIA) to expand broadband access and adoption in communities across the U.S.,

to increase jobs, spur investments in technology and infrastructure, and provide long-term economic benefits.

 Department of Commerce (DoC) has cross-cutting responsibilities in the areas of trade, technology,

entrepreneurship, economic development, environmental stewardship, statistical research, and analysis. Its

involvement with health IT has been evident through one of its agencies, the National Institute for Standards

and Technology.

– National Institute of Standards and Technology (NIST) is a non-regulatory federal agency whose

mission is to promote U.S. innovation and industrial competitiveness by advancing measurement

science, standards, and technology in ways that enhance economic security and improve quality of life.

 NIST collaborates with HHS/ONC in realizing the health IT goals of the Administration and

Congress. This relationship allows ONC to draw upon NIST expertise in applying IT to health

care through standards, conformance measurement, prototype implementation, security, and

usability, and in consulting on the Nationwide Health Information Network, standards, and

certification processes.

 NIST has funded a grant on the “Relationship Between Health IT Usability and Patient Safety:

A Human Factors Engineering Framework for Action.” This grant will develop a framework

explaining how the multiple facets of usability may be linked to different aspects of patient

safety.

 Department of Defense (DoD) provides health care to all U.S. military personnel worldwide through the

Military Health System (MHS) and is supported by a robust EHR system.

– Armed Forces Health Longitudinal Technology Application, (AHLTA) the military’s EHR, is an

enterprise-wide medical and dental information management system that provides secure online access

to Military Health System (MHS) beneficiaries’ records. It is used by medical clinicians in all fixed and

deployed Military Treatment Facilities (MTFs) worldwide. This centralized EHR allows health care

personnel worldwide to access complete, accurate health data to make informed patient care decisions.

– Virtual Lifetime Electronic Record, (VLER) will permit information vital to health care, benefits

and services to be available to the DoD and the VA from the moment a service member enters the

military until the death of the service member or veteran. Both the DoD and VA have begun to work

together to define and build a seamless system of integration that will provide a framework to ensure

that health care providers have all the information they need to deliver high-quality health care, while

reducing medical errors. VLER is intended to be a lifetime, personal record that ensures a seamless

continuum of care and benefits. VLER leverages the work of CONNECT and the Nationwide Health

Information Network in service to military and veteran personnel.

– Electronic Health Record (EHR) Way Ahead is a proposed Major Automated Information System

(MAIS) program designed to replace/sunset the current portfolio of systems providing initial EHR

capability, primarily AHLTA and Composite Health Care System (CHCS). EHR Way Ahead will

Federal Health IT Strategic Plan 52

establish a comprehensive, longitudinal, electronic health record that is available anytime and anywhere

for the lifetime of every patient. This longitudinal electronic health record will support a virtual lifetime

electronic record (VLER) for a service member by being a source system for health care information to

be shared via VLER.

– “Blue Button” is a web-based portal enabling individuals to download their personal health

information and share this information with health care providers, caregivers, and others they trust. It

provides consumers with a standardized and reusable copy of their health information through a simple

download function on DoD, VA and CMS’ websites.

 Department of Health and Human Services (HHS) is the principal agency responsible for protecting the

health of all Americans and has many agencies and initiatives that work towards advancing health IT within the

U.S. and implementing various aspects of the Affordable Care Act and the HITECH Act.

– Text4Baby is a free mobile information service designed to promote maternal and child health by

connecting women to prenatal and infant care services, as well as providing tips on what women need

to know during pregnancy and the baby’s first year. Text4baby is made possible through a broad,

public-private partnership that includes government agencies, corporations, academic institutions,

professional associations and non-profit organizations.

– Section 2041 of the Affordable Care Act authorizes the Secretary of HHS to make grants to long-term

care facilities for the purpose of assisting such entities in offsetting the costs related to the purchasing,

leasing, developing, and implementing of certified EHR technology.

– Agency for Healthcare Research and Quality (AHRQ)

is the lead federal agency charged with

improving the quality, safety, efficiency, and effectiveness of health care for all Americans. AHRQ

supports health services research that seeks to continuously improve the quality of health care and

promote evidence-based decision-making.

 AHRQ’s Health IT Portfolio has supported health services research grants and contracts that

create new knowledge, synthesize and disseminate best evidence and provide tools for

implementation addressing health IT’s impact on the quality of health care since 2004. Current

initiatives address clinical decision support, patient safety, patient centered care, quality

measurement, and usability and workflow issues. Examples like treating chronic illness in an

effective and efficient manner using telemedicine through Project ECHO in New Mexico,

texting diabetic patients in Colorado to incorporate their blood sugar readings into an EHR, or

using health IT to reduce the incidence and impact of pressure ulcers in long term care

facilities in Utah, demonstrate the power of health IT to revolutionize the health care system.

In this portfolio, AHRQ has developed a publically available web site, United States Health

Information Knowledgebase (USHIK.ahrq.gov) where information (metadata: such as name,

definition, how they are represented) about the data elements from the HHS Secretary’s

National Interoperability Standards (HIPAA transactions, Consolidated Health Informatics,

Health Information Technology Standards Panel, and others) is related to the data elements’

use cases and the standards from which they come. This site promotes understandable health

information exchange and the uniformity of data used for health research and decision-making.

 AHRQ’s Patient-Centered Health Research/Effective Health Care Portfolio supports projects

that develop the information infrastructure needed to conduct patient--centered health

research and enable a learning health care system. Current initiatives are supporting

infrastructure development projects, EHC distributed data research networks and enhanced

clinical registries, and methods work to support them. The Portfolio includes efforts like the

Federal Health IT Strategic Plan 53

Safe Surgery Project at the University of Washington, which has implemented a standardized

surgical checklist statewide to improve safety.

– Assistant Secretary for Preparedness and Response (ASPR)

serves as the Secretary’s principal

advisor on matters related to bioterrorism and other public heath emergencies.

 ASPR is looking to health IT, EHRs, and Joint Patient Tracking Systems (JPTS) to assist in

addressing various functions, including Identifying at Risk Individuals, Strategic National

Stockpiling, City Readiness Initiative, Medical Reserve Corps coordination, Emergency System

Management for Advance Registration of Volunteer Health Professionals, Hospital

Preparedness, and National Disaster Medical Management.

– Assistant Secretary for Planning and Evaluation (ASPE) is the principal advisor to the HHS

Secretary on policy development, and is responsible for major activities in policy coordination,

legislation development, strategic planning, policy research, evaluation, and economic analysis and is

currently building a multi-payer, multi-claim database to support patient-centered research using

Medicare, Medicaid, and private payer claims data.

 ASPE is leading the Department’s research initiatives and focus on health IT adoption by post-

acute and long-term care providers, including identifying health IT standards to advance

interoperable health information by post-acute and long-term care providers, and producing

the HITECH required Report to Congress in which the Secretary is to determine the extent to

which and manner in which incentives and other funding for using certified EHRs should be

made available to providers who are not eligible for incentives or other funding for such

purposes.

– Centers for Disease Control and Prevention (CDC)

collaborates to create the expertise,

information, and tools that people and communities need to protect their health – through health

promotion, prevention of disease, injury and disability, and preparedness for new health threats.

 The Public Health Information Network (PHIN) is a national initiative to increase the

capacity of public health to exchange data and information electronically across organizational

and jurisdictional boundaries by promoting the use of standards and defining functional and

technical requirements. PHIN strives to improve public health by enhancing research and

practice through best practices related to efficient, effective, and interoperable public health

information systems.

 The National Healthcare Safety Network (NHSN) is a voluntary, secure, Internet-based

surveillance system that integrates patient and health care personnel safety surveillance systems

and has the capacity for health care facilities to share data in a timely manner between health

care facilities and with other entities.

 The National Electronic Disease Surveillance System (NEDSS), a major component of

PHIN, advances the transition to standards-based electronic data exchange for reportable

disease surveillance to improve local/state/territorial capacity to detect and respond to

reportable diseases and the nation’s ability to support the revised International Health

Regulations.

 BioSense is a national program to improve capabilities for rapid disease detection, monitoring,

and real-time situational awareness through access to existing data from health care

organizations. BioSense enables local and state public health departments to share and access

Federal Health IT Strategic Plan 54

data, providing a more complete picture of potential and actual health events both locally and

across jurisdictional boundaries.

 The National Environmental Public Health Tracking Network integrates health,

exposure, and hazard data from a variety of national, state, and city sources and offers a new

understanding of how hazardous substances can contribute to illness.

 National Center for Health Statistics, as the Nation’s principal health statistics agency,

provides statistical information that will guide actions and policies to improve the health of the

American people. NCHS collects data from birth and death records, medical records, interview

surveys, and through direct physical exams and laboratory testing. NCHS is a key element of

the national public health infrastructure, providing important surveillance information that

helps identify and address critical health problems.

 “Strengthening Public Health Infrastructure for Improved Health Outcomes” is funded

within the Prevention and Public Health Fund under the Affordable Care Act and is designed

to advance any or all of the key areas for infrastructure investment and to help ensure

successful implementation of the Affordable Care Act, specifically by: improving the public

health workforce, developing information systems to support adoption and implementation of

rules and regulations, reengineering of infrastructure to improve networking and coordination,

implementing best health care practices and impact evaluation, improving information and

data system capacity, and improving organizational capacity. The new program is seeking to

increase the performance management capacity of public health departments and ensure that

public health goals are being met.

 CDC’s Public Health Informatics and Technology Program Office (PHITPO) at the Office of

Surveillance, Epidemiology and Laboratory Services (OSELS) is leading the development of

public health standards that align with certified EHR technology. As with clinical data, public

health departments require public health standards and may benefit from certified public

health information systems to effectively exchange information.

– Centers for Medicare & Medicaid Services (CMS) is the federal agency that oversees the Medicare

and Medicaid EHR Incentive Programs, thus playing a key role in the overall direction of the health

care system. The HITECH Act established the incentive programs to provide payments for the

meaningful use of certified EHR technology. The Medicare and Medicaid EHR Incentive Programs

provide payments to eligible professionals and hospitals who meet meaningful use requirements. These

incentive programs are designed to instill the use of EHRs in a meaningful way to support the nation in

improving care, efficiency, and population health.

 The Center for Medicare and Medicaid Innovation (Center for Innovation or CMMI)

was established to test innovative payment and service delivery models to reduce program

expenditures under the applicable titles while preserving or enhancing the quality of care.

 My Personal Health Record South Carolina (MYPRSC) is a Personal Health Record

(PHR) pilot conducted by CMS that provides an online PHR to Medicare beneficiaries who

reside in South Carolina and have original (fee-for-service) Medicare.

 Medicare PHR Choice, a PHR pilot conducted by CMS, for people with original (fee-for-

service) Medicare residing in Utah and Arizona.

 Under the Children’s Health Insurance Program Reauthorization Act of 2009

(CHIPRA), CMS has awarded ten Quality Demonstration grants in a total of 18 States to

Federal Health IT Strategic Plan 55

implement and evaluate provider performance measures, utilize health information

technologies such as pediatric electronic health records, and test the effectiveness of provider

delivery models such as medical homes.

 The Affordable Care Act also provides $300 million dollars for the development and

implementation of a voluntary Medicaid Adult Health Quality Measures Program -

including quality measures that can be collected via electronic health records.

 “Blue Button” is a web-based portal enabling individuals to manage their personal health

information and provide access to health care providers, caregivers, and others they trust. The

Blue Button feature allows individuals to access and download information into a text file (or

an enhanced PDF) that can be read, printed, or saved on any computer. The download can be

broken out by data class or data range. Blue Button allows control of information without

special software – and enables individuals the ability to share data with their health care

providers, caregivers, or people they trust. It provides consumers with a standardized and

reusable copy of their health information through a simple download function on DoD, VA

and CMS’ websites.

– Food and Drug Administration (FDA)

is the primary federal agency responsible for protecting the

public health by assuring the safety, efficacy, and security of human and veterinary drugs, biological

products, and medical devices, and providing oversight of the nation’s food supply, cosmetics, products

that emit radiation, and tobacco products. FDA also promotes the public health by promptly and

efficiently reviewing clinical research and taking timely and appropriate action on the marketing of

regulated products. The agency’s actions support innovations that make medical products more

effective and safer. FDA also helps the public obtain the accurate, science-based information they need

to use medical products and appropriately consume foods to improve their health. FDA’s Center for

Devices and Radiological Health (CDRH) is responsible for assuring the safety and effectiveness of

medical devices. CDRH will continue to monitor health IT patient safety concerns using its existing

programs and initiatives.

 Medwatch-Plus provides electronic capability for receiving adverse event data, processing,

storing and analyzing adverse event reports and other safety information for human drugs,

medical devices, vaccines and other biologics, dietary supplements, and cosmetics. Alerts

issued based on this data contain useful information.

 FDA Adverse Event Reporting System (FAERS) is a program within MedWatch Plus.

FAERS will provide a back-end database for processing, storing and analyzing post-market

adverse event reports and other safety information for FDA-regulated drug, biologic, and

medical device products.

 The Sentinel Initiative is building a national electronic system, the Sentinel System, to

enhance FDA’s ability to track the safety of drugs, vaccines, biologics, and medical devices

once they reach the market. The Sentinel Initiative aims to develop and implement an active

surveillance system that will augment existing systems that the FDA has in place to track

reports of adverse events linked to the use of its regulated products.

 Structured Product Labeling (SPL) is an electronic document markup standard approved

by Health Level Seven (HL7) and adopted by FDA as a mechanism for exchanging product

information. SPL is also used by FDA and NLM DailyMed initiative, which provides

information on human drugs and biologics in electronic format in an effort to improve

patient safety.

Federal Health IT Strategic Plan 56

– Health Resources and Services Administration (HRSA)

is the primary federal agency for

improving access to health care services for people who are uninsured, isolated or medically vulnerable.

In an effort to use health IT to extend access to health care, HRSA is working to identify, disseminate

and provide technical assistance to health centers and other HRSA grantees in adopting model practices

and technologies. HRSA is also working collaboratively with foundations, national organizations, the

private sector, and other government agencies to help HRSA grantees adopt health IT.

 The HRSA Health Disparities Collaborative (HDC) was created to assist in the

transformation of primary health care practices to improve the health care provided to

everyone and to eliminate health disparities. This initiative was originally funded by HRSA but

now continues as a public-private endeavor.

 HRSA’s Telehealth Network Grant Program supports established telehealth networks that

are looking to expand the number of sites receiving clinical services.

 HRSA’s Telehealth Resource Program funds Centers of Excellence that provide technical

assistance on telehealth to any HRSA grantee in the country.

 Telehealth Services for Children and Youth with Epilepsy grants fund initiatives to

demonstrate ways to improve the system of services for children and youth with epilepsy

through the use of telehealth/telemedicine.

 Health Center Controlled Networks (HCCNs) improve operational effectiveness and

clinical quality in health centers through the provision of management, financial, technology

and clinical support services. An overwhelming number of community health centers who

have signed on with an HCCN have successfully adopted an EHR system.

 Health IT Toolboxes provide a compilation of resources to help community health centers,

safety net providers and ambulatory care providers implement health IT and better understand

meaningful use.

 The National Health Service Corps (NHSC), through scholarship and loan repayment

programs, helps Health Professional Shortage Areas (HPSAs) in the U.S. get the medical,

dental, and mental health providers they need to meet their tremendous need for health care.

 The Rural Health Network Development Planning Grant Program (Network Planning)

expands access to, coordinates and improves the quality of essential health care services and

enhances the delivery of health care, in rural areas. The program provides one-year grants to

rural entities to plan and develop a formal health care network.

 HRSA Pediatric Primary Care Electronic Health Record (EHR) Network for

Comparative Effectiveness Research (CER). The CER study is testing, via a cluster

randomized trial, a point-of-care clinical decision support system linked to electronic health

records in improving the quality of care for a chronic pediatric condition.

 The Community Health Applied Research Network (CHARN) is a consortia of

researchers based at community health centers funded under the 2009 Recovery Act. The

CHARN will demonstrate that a well conceived and fully operational data infrastructure can be

put in place to support patient-centered outcomes research (PCOR) on diverse populations

and patient subgroups that are often underrepresented in health outcomes research. The

CHARN will actively disseminate research results to patients and clinicians in safety net

treatment settings.

Federal Health IT Strategic Plan 57

 Integrating Child Health Information Systems through health information exchange funds

allows states to develop an interoperable system of collecting and exchanging information

including immunizations, vital statistics, and newborn screening. States and public health

departments are implementing systems that enhance communication and facilitate the

exchange of information between multiple partners including clinicians, laboratorians, public

health agencies, researchers and various community support services.

– Indian Health Service (IHS) is responsible for providing federal health services to American Indians

and Alaska Natives. The IHS is the principal federal health care provider and health advocate for Indian

people and its goal is to raise their health status to the highest possible level. The IHS provides a

comprehensive health service delivery system for approximately 1.9 million American Indians and

Alaska Natives who belong to 564 federally recognized tribes in 35 states. The IHS has long leveraged

health IT to serve its populations, some of whom are located in the most remote areas of the country.

Indian Health Service, along with its Tribal and Urban Program partners, have developed and deployed

a comprehensive suite of software applications to support the provision of quality services and the

secure management of health information.

 IHS Resource and Patient Management System (RPMS) is the suite of health IT

applications that support health care delivery throughout the IHS. The RPMS includes an

EHR, population management tools, clinical decision support, quality reporting, integrated

behavioral health, electronic dental record, practice management, patient registration and

management, and other integrated applications. In April 2011, IHS became the first federal

agency to have part of its health information system certified for stage one meaningful use.

The IHS RPMS Suite is certified as a Complete EHR for both inpatient and ambulatory

settings. Part of the EHR system development included creation of a personal health record

(PHR) portal to support meaningful use requirements related to engaging patients and their

families in their health care.

 IHS Population Health Management (iCare) is the IHS’ population management tool that

enables providers to easily identify groups of patients (populations) that share similar

characteristics. It presents diverse patient data in a user-friendly view by retrieving patient

information from the various underlying components of the RPMS database and bringing it

together under a single interface. User-defined patient lists (panels) are easily created, sorted

and filtered in a variety of ways to form the core functionality of iCare. The Care Management

Event Tracking (CMET) electronically tracks and manages certain pre-defined events related to

breast, cervical, colon, and skeletal health from screening through completion. “Anonymous

Community Alerts” related to CDC Nationally Notifiable Diseases and Suicidal Behavior are

mined on a nightly basis and displayed in a variety of locations to promote early awareness and

allow for prompt intervention.

 IHS Patient Wellness Handout (PWH) is a paper-based report for patients that combines

information from their medical records along with an explanation of their results. It can be

used to provide patients with a listing of the recommended health maintenance services that

are due, serve as a tool to promote health communication, or as a portable record of selected

health information. The PWH can be generated on demand by anyone who is providing care

services to the patient.

 IHS National Patient Information Reporting System (NPIRS) is the national data

warehouse for the IHS. The NPIRS maintains historical data from RPMS and other sources to

Federal Health IT Strategic Plan 58

provide information on health trends, cost and quality reporting, and individual data marts for

specific chronic health care challenges, such as diabetes.

 IHS Infrastructure, Office Automation, and Telecommunications (IOAT) is the

foundational network of hardware, software and services that support RPMS, NPIRS and the

operations of the IHS. The IOAT enables information exchange for RPMS and security for all

IHS operations.

– The Office of Minority Health (OMH)

has developed and supports the National Health Information

Technology (NHIT) Collaborative that works to bridge gaps between coordinating and implementing

health IT within underserved communities, helping to educate health care providers and advocate

within these communities concerning the use and application of health IT, and advising other federal,

state and local agencies of how to best coordinate the use of health IT within underserved communities

of color.

– National Institutes of Health (NIH) is the primary federal agency for the support and conduct of

biomedical and behavioral research. Its mission is to seek fundamental knowledge about the nature and

behavior of living systems and apply it to enhance health, lengthen life, and reduce the burdens of

illness and disability. In terms of health IT, NIH supports and conducts research and standards

development to advance the meaningful use of certified EHR technology in research and clinical

practice. Given the unprecedented opportunities to answer new and important research questions using

the information contained in EHRs, NIH is working assiduously to facilitate appropriate access and

exchange of data for research purposes. Health IT is of interest and relevance to all of the NIH

Institutes and Centers. A few examples of relevant NIH activities include the following:

 The National Library of Medicine (NLM) has a lead role in federal health IT policy as the

central coordinating body for clinical terminology standards within HHS. NLM supports,

develops, and disseminates key health data standards that are designated to enable certain users

to achieve meaningful use of the certified EHRs. NLM supports and conducts research and

development related to health IT, including clinical terminologies, clinical decision support,

personally controlled EHRs, health information exchange, syndrome surveillance, anatomical

image databases, natural language processing, information retrieval, advanced

telecommunications, and information infrastructure for emergency response. NLM also

manages the ClinicalTrials.gov databank which contains public information and data on clinical

trials. NLM also supports the training of health IT professionals through academic biomedical

informatics research training centers.

 Cancer Biomedical Informatics Grid (caBIG®) is an information network supported by

the National Cancer Institute (NCI) enabling members of the cancer community – researchers,

providers, and patients – to collect, manage, and analyze large volumes of biomedical and

clinical data. The components of caBIG® are widely applicable beyond cancer as well.

 The Electronic Medical Records and Genomics (eMERGE) Network, an initiative of the

National Human Genome Research Institute (NHGRI), is developing, disseminating, and

applying approaches to research that combine DNA biorepositories with electronic medical

record (EMR) systems for large-scale, high-throughput genetic research.

 NHGRI and NCI have collaborated with the Office of the Surgeon General and the Office of

the Secretary to develop standards and tools for the collection, storage and dissemination of

family history information. The U.S. Surgeon General’s My Family Health Portrait (MFHP)

has been a centerpiece of these activities to date. It is a free web-based tool for family history

Federal Health IT Strategic Plan 59

collection that is standards-based and potentially interoperable with EHR systems. Recently an

inter-agency NIH working group has been established to address future governance of MFHP.

Future activities include the development of clinical decision support tools for common

heritable conditions that are compatible with MFHP.

 The National Institute of Biomedical Imaging and Bioengineering’s Radiological

Society of North America RadLex Ontology Project provides uniform terms and concepts

for indexing and retrieving imaging research databases, educational materials, and clinical

imaging reports in an EHR. The project develops and deploys radiology reporting templates

for EHR software.

 The NIH Clinical Center, in association with a number of NIH Institutes, developed the

Biomedical Translational Research Information System (BTRIS), a repository of clinical

research data that facilitates the conduct of intramural clinical trials. BTRIS is also addressing

important questions related to the standardization and aggregation of EHR data that will be

relevant to other national efforts involving EHR data reuse.

– Office for Civil Rights (OCR)

administers and enforces four key privacy and security laws: 1) the

HIPAA Privacy Rule, which protects the privacy of individually identifiable health information; 2) the

HIPAA Security Rule, which sets national standards for the security of electronic health information;

and 3) the HIPAA Breach Notification Rule, which requires HIPAA covered entities to notify

individuals, HHS, and in some cases the media of impermissible uses and disclosures of health

information that compromise the privacy and security of such information; and 4) the confidentiality

provisions of the Patient Safety Rule, which protect identifiable information being used to analyze

patient safety events and improve patient safety. Together, ONC and OCR are the lead HHS offices for

health-IT-related privacy and security policy.

 OCR also enforces federal civil rights laws protecting individuals from discrimination on the

basis of race, color, national origin, gender, age, and disability and works with ONC to ensure

that health information technology benefits all individuals, including those who are protected

by these laws.

– Office of the National Coordinator for Health IT (ONC)

is at the forefront of the administration’s

health IT efforts and is a resource to the entire health system to support the adoption of health IT and

the promotion of nationwide health information exchange. ONC is the principal federal entity charged

with coordinating nationwide efforts to implement and advance the use of health IT and promote the

electronic exchange of health information.

 The Health Information Technology Extension Program (Regional Extension Centers

or RECs) offers technical assistance, guidance and information on best practices to support

and accelerate health care providers’ efforts to become meaningful users of certified EHR

technology.

 The Health Information Technology Research Center (HITRC) helps support the RECs

by gathering information on effective practices and helping the RECs collaborate with one

another and with relevant stakeholders to identify and share best practices in EHR adoption,

meaningful use, and provider support.

 The State Health Information Exchange Cooperative Agreement Program supports

states or state designated entities in building health information exchange capacity for

exchanging health information electronically across the health care system both within and

across states.

Federal Health IT Strategic Plan 60

 The Beacon Community Cooperative Agreement Program supports communities at the

cutting edge of EHR adoption and health information exchange to build and strengthen their

health IT infrastructure and exchange capabilities to push them to achieve new levels of

sustainable health care quality and efficiency. These communities will focus on demonstrating

measurable improvements in care, efficiency, and population health.

 The Health IT Workforce Development Program focuses on several key resources needed

to rapidly expand the availability of skilled health IT professionals who will support broad

adoption and use of health IT in the provider community.

 The Strategic Health IT Advanced Research Projects (SHARP) Program funds research

focused on achieving breakthrough advances to address well-documented problems that have

impeded adoption of health IT. The knowledge generated from this program will help

accelerate progress towards meaningful use of health IT and a high performing, adaptive,

nationwide health care system.

 The Nationwide Health Information Network is a set of standards, services and policies

that enable secure health information exchange over the Internet. The Nationwide Health

Information Network will provide a foundation for the exchange of health information across

diverse entities, within communities, and across the country.

 The Federal Health Architecture (FHA) is an E-Government Line of Business initiative

managed by the Office of the National Coordinator for Health Information Technology. FHA

was formed to coordinate health IT activities among federal agencies that provide health and

health care services to citizens.

 The CONNECT project is an E-government initiative managed by ONC. CONNECT was

formed as a consortium of interested federal agencies to develop software based on the

Nationwide Health Information Network specifications to support standards-based exchange.

The CONNECT software is available through an open source license and is used by both

federal and private sector organizations.

– Substance Abuse and Mental Health Services Administration (SAMHSA) is the lead agency

within the Department of Health and Human Services charged with Behavioral Health Services

integration into community and existing provider-based prevention and treatment systems at

community, State and national levels. The role of health IT in SAMHSA is incorporated into a broad

range of activities that include but are not limited to:

 Working with the VA and DOD on Suicide Prevention National Lifeline activities to expand

and strengthen use of the VA model for EHR with a “flag” protocol to identify and coordinate

interventions and services for those at high risk of suicide, or with a past history of attempts.

 Working with the VA’s Virtual Lifetime Electronic Record (VLER) initiative to demonstrate

privacy protected exchange of sensitive clinical records between community-based behavioral

health programs and VA health centers.

 Working with several State behavioral health and Medicaid agencies to develop open source

EHRs and HIE services that integrate behavioral health within community-based health

homes and State Health and Human Service programs.

 Testing the usability and feasibility of smartphone-based applications and patient links to

clinical services, including, but not limited to a recovery tool called Addiction

Comprehensive Health Enhancement Support System (A-Chess) – an online peer

Federal Health IT Strategic Plan 61

support group and clinical counselors, a GPS feature that sends an alert when the user gets

near an area of previous drug or alcohol activity, real-time video counseling, and a “panic

button” that allows the user to place an immediate call for help with cravings or triggers.

 Open Behavioral Health Information Technology Architecture (OBHITA) supports the

creation of a behavioral health EHR reference model information technology architecture.

OBHITA will also build on privacy protection standards developed over the past five years.

 The SAMHSA Health Information Network (SHIN) includes the National Clearinghouse

for Alcohol and Drug Information (NCADI) and the National Mental Health Information

Center (NMHIC). SHIN connects the behavioral health workforce and the general public to

the latest information on the prevention and treatment of mental and substance use disorders.

The NMHIC was developed to provide information about organizations dedicated to treating

and preventing medical illness, as well as information about federal grants, conferences, and

events.

 Exploring the use of pharmacy and medical provider information from individual State

Prescription Drug Monitoring Programs and the National All Schedules Prescription

Electronic Reporting Act, or NASPER, to inform state and community treatment and

prevention programs, including community coalitions that will be using the Strategic Planning

Framework to identify and provide local, real time information regarding questionable

prescription drug abuse.

 Providing Grants to Expand Substance Abuse Treatment in Targeted Areas of Need -

Technology Assisted Care (TCE - TAC). The purpose of this program is to enhance and/or

expand the capacity of substance abuse treatment providers to serve clients who have been

underserved because of lack of access to treatment in their immediate community due to

transportation concerns, an inadequate number of substance abuse treatment providers in their

community, and/or financial constraints, through the use of therapeutic techniques that

involve innovative, creative and cost-effective advanced technology. This approach includes

the use of various technological modalities such as Internet, tele-behavioral health, chatlines,

videocams, etc.

 Regulating 1230 opioid treatment programs that dispense the treatment medications

methadone and buprenorphine to 288,824 patients nationwide. Through an interactive online

“Extranet,” providers extract patient health information from medical records, and submit an

electronic form that is evaluated concurrently by Federal and State regulatory authorities. The

system addresses exemptions from certain Federal and State regulatory requirements.

 Working with the field to develop a digital access to medication (DAT-M) system. This Web-

based system would concentrate selected patient health information, including dose levels, into

an interoperable data base that could be securely accessed by providers throughout the

country. DAT-M is being developed to address opioid dependent patients to continue care

after being displaced by various disasters.

 Providing U.S. public health statistics on the use of alcohol, illegal drugs, prescription drugs

and mental health issues through the Center for Behavioral Health Statistics and Quality. This

Center also provides information on substance use disorder treatment episodes. It also

publishes brief reports based on the National Survey on Drug Use and Health, the Drug

Abuse Warning Network, and the Treatment Episode Data set.

Federal Health IT Strategic Plan 62

 Request for Application (RFA) for Supplemental Funds for Health IT Infrastructure

Development. Two new RFAs were announced that are specifically designed for the following

entities: 1) current Primary and Behavioral Health Care Integration (PBHCI) grantees ($11.2

million); and 2) State-Designated-Entities (SDEs), including for technical assistance to States

and grantees ($3.8 million). The purpose of the PBHCI program is to improve the physical

health status of people with serious mental illnesses, including individuals with co-occurring

substance use disorders, by supporting communities to coordinate and integrate primary care

services into publicly funded community mental health and other community-based behavioral

health settings. The overarching goal for the supplemental funding for HIT is to integrate care

across and among providers via the appropriate use of certified EHR technology.

 Department of Veterans Affairs (VA) provides Veterans with health benefits and uses EHR systems to better

their service and accelerate consumer use.

– Veterans Health Information Systems and Technology Architecture (VistA) is an enterprise-wide

information system built around an EHR, used throughout the VA medical system which is known as

the Veterans Health Administration (VHA). VistA is one of the most widely used EHRs in the world.

– Virtual Lifetime Electronic Record, (VLER) will permit information vital to health care, benefits

and services to be available to the DoD and the VA from the moment a service member enters the

military until the service member or veteran’s death. Both the DoD and VA have begun to work

together to define and build a seamless system of integration that will provide a framework to ensure

that health care providers have the information they need to deliver high-quality health care, while

reducing medical errors. VLER is intended to be a lifetime, personal record that ensures a seamless

continuum of care and benefits. VLER leverages the work of CONNECT and the Nationwide Health

Information Network in service to military and veteran personnel.

– “Blue Button” is a web-based portal enabling individuals to manage their personal health information

and provide access to health care providers, caregivers, and others they trust. It provides consumers

with a standardized and reusable copy of their health information through a simple download function

on DoD, VA and CMS’ websites.

– My Health

Vet is VA’s e–health website, which offers Veterans, active duty service members, their

dependents, and caregivers access anywhere, anytime via the Internet to VA health care information

and services. My HealtheVet is a free, online PHR that empowers Veterans to become informed

partners in their health care by allowing access to trusted, secure, and current health and benefits

information, as well as the ability to record, track and store important health and military history

information.

– Care Coordination/Home Telehealth (CCHT) is the national program the VHA uses to coordinate

the care of veteran patients with chronic conditions. CCHT involves the systematic use of health

informatics, e-care, and disease management technologies to avoid unnecessary admission to long-term

institutional care facilities. Technologies include videophones, messaging devices, biometric devices,

digital cameras, and remote monitoring devices. E-care is an appropriate and cost-effective way to

manage chronic care patients in urban and rural settings and enables patients to live independently at

home.

– Healthcare Associated Infection & Influenza Surveillance System, (HAIISS) is a national VA IT

initiative that will allow VA healthcare providers to detect the development of healthcare acquired

infections in near real time; perform syndromic surveillance and track microbiological organisms of

epidemiologic significance, including automated reporting of infectious diseases to local public health

Federal Health IT Strategic Plan 63

agencies and CDC; and provide tools for tracking multidrug resistant organisms and monitoring

antimicrobial utilization in VA medical centers to improve the quality of care for Veterans. VA and

DoD are also working together to build a bi-directional biosurveillance system that will provide

improved situational awareness for public health related events.

 Federal advisory committees are established or authorized by statute to provide advice or recommendations

to federal officials on issues or policies that are within the purview of the federal government. These committees

include groups from outside the federal government that afford an expertise or perspective not available within

the Department of other federal agencies. They provide a mechanism for public input into health IT policy.

– National Committee on Vital and Health Statistics (NCVHS) advises the HHS Secretary in the

area of health data, statistics, and national health information policy and the Department’s strategy to

best address those issues.

– HIT Policy Committee (HITPC) was created by the HITECH Act to make recommendations to the

National Coordinator for Health IT on a policy framework for the development and adoption of a

nationwide health information infrastructure, including standards for the electronic exchange and use of

patient medical information.

– HIT Standards Committee (HITSC) was created by the HITECH Act to make recommendations to

the National Coordinator for Health IT on standards, implementation specifications, and certification

criteria for the electronic exchange and use of health information.

 Federal Communications Commission (FCC) is the federal agency responsible for regulating interstate and

international communications, and is actively involved in efforts to build the communications infrastructure

necessary to facilitate information exchange. FCC’s investments are helping to connect rural health communities

and improve access to health IT for more Americans.

– The Rural Health Care Pilot Program facilitated the creation of a nationwide broadband network

dedicated to health care and connecting public and private non-profit health care providers in rural and

urban locations.

– The Expanding Investment in Broadband Health Care Technology program will invest $400

million annually to enable doctors, nurses, hospitals and clinics to deliver, through communications

technology, world-class health care to patients no matter where they live. It is one of four programs in

the Universal Service Fund administered by the FCC.

 Federal Health IT Taskforce serves as the overall government coordination body for policy development,

coordination and implementation of federal health IT activities. This Taskforce also aims to improve

transparency of federal government activities related to health IT and communication among federal agencies as

they execute federal health IT policy. The Taskforce is chaired by the National Coordinator, with OMB’s Health

Program Associate Director and the federal government’s Chief Information Officer and Chief Technology

Officer serving as vice chairs. Agency participants include senior policy officials from HHS (and its relevant

offices and operating divisions), DoD, VA, SSA, USDA, OPM, and Commerce.

 Federal Trade Commission (FTC) advances consumers’ interests by sharing its expertise with federal and

state legislatures and U.S. and international government agencies. The Commission has been actively involved in

enforcing competition in health care markets. Alongside ONC and OCR, the FTC continues to analyze and

update breach notification policies and procedures to ensure they protect individuals’ rights and meet their

needs.

Federal Health IT Strategic Plan 64

 Office of Personnel Management (OPM) provides comprehensive human resource services to all federal

agencies and employees. It continues to develop plans to encourage health insurance plans purchased by the

government to support meaningful use among their network of providers.

 Social Security Administration (SSA) administers the Social Security Act, which provides benefits for

retirement, disabilities, and survivors. SSA is an important partner and early adopter of the Nationwide Health

Information Network. In partnership with MedVirginia, SSA uses the Nationwide Health Information Network

to obtain electronic medical records in disability cases, and is working with ONC and other Nationwide Health

Information Network cooperative members to expand this effort.

 White House Office of Science and Technology Policy (OSTP) leads interagency efforts to develop and

implement sound science and technology policies and to work with the private sector, state and local

governments, the science and higher education communities, and other nations toward this end.

Federal Health IT Strategic Plan 65

Appendix C: HIT Standards and HIT Policy Committees

Information Flow

Figure 2; Flow of recommendations through the HIT Policy and Standards Committees, ONC, and

the HHS Secretary

Federal Health IT Strategic Plan 66

Appendix D: Process Approach

In creating the Federal Health IT Strategic Plan, several methods and key sources were utilized and incorporated in

order to achieve the final document. The process for obtaining input included working collaboratively with both

the public and private sectors, as well as gathering input from current policy and regulations.

At its core, the plan leverages the work of the Strategic Plan workgroup of the HIT Policy Committee. Beginning

in January 2010, the workgroup met regularly to devise a strategic plan framework that was submitted to the

Health IT Policy Committee which in turn submitted its recommended approach for consideration to the National

Coordinator. This framework served as a key input for consideration as ONC wrote the Federal Health IT

Strategic Plan. The framework was developed by members of the Workgroup which included health IT leaders

from across both the public and private sectors, and also incorporated feedback from the public gathered during

public meetings and a listening session.

Due to the diverse scope and multi-agency nature of the plan, it was essential to engage the federal health

community in various ways during the plan’s development and refinement. ONC conducted interviews and

conversations with representatives from key federal agencies and offices in order to create a cohesive and

integrated health IT plan across the federal government. After the meetings and discussions were held, ONC

looked to these federal agencies and leaders for valuable feedback on drafts of the plan, and intends to continue

this collaboration as the plan advances in the future.

ONC actively sought public input into the plan via its Health IT Blog and hosted a consumer working group

discussion with health IT leaders in the public and private sectors to gather input in developing its consumer

strategy (Goal IV).

The Federal Health IT Strategic Plan was developed with the crucial understanding that several policies and

regulations have critical implications pertaining to the current and future state of health IT (See Appendix E). The

Plan has also undergone a public comment period and has been updated to reflect input gathered from the public

during this process.

Federal Health IT Strategic Plan 67

Appendix E: Statutes and Regulations

Statutes

American Recovery and Reinvestment Act of 2009 (The Recovery Act)

On February 17, 2009, the President signed the Recovery Act. This statute includes the Health Information

Technology for Economic and Clinical Health Act (the HITECH Act) (see below) which establishes the Medicare

and Medicaid EHR Incentive Programs that encourage meaningful use of certified EHRs and other health

information technology (IT) to improve quality of care.

Health Information Technology for Economic and Clinical Health Act of 2009

(The HITECH Act)

The Health Information Technology for Economic and Clinical Health (HITECH) Act, passed as part of the

Recovery Act, allocated billions of dollars for the health care system to adopt and meaningfully use health IT to

improve health. A number of provisions in the HITECH Act strengthen the privacy and security protections for

health information established under the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

Health Insurance Portability and Accountability Act of 1996 (HIPAA)

HIPAA called for the establishment of standards and requirements for transmitting certain health information to

improve the efficiency and effectiveness of the health care system while protecting patient privacy. The

Administrative Simplification Regulations have been developed to implement the Administrative Simplification

provisions of HIPAA.

The Patient Protection and Affordable Care Act of 2010 (the Affordable Care Act)

On March 23, 2010, the President signed the Patient Protection and Affordable Care Act of 2010, later amended

by the Health Care and Education Reconciliation Act of 2010 (collectively, the Affordable Care Act), which,

among other things, is estimated to expand health care coverage to 32 million currently uninsured Americans by

2019. The Affordable Care Act builds on the HITECH Act and recognizes health IT as a critical enabler to broad

transformations in health care.

Regulations

Medicare and Medicaid Programs: Electronic Health Record Incentive Programs Final Rule

This rule implements the Recovery Act provisions that provide incentive payments to eligible professionals and

eligible hospitals that adopt and use certified EHR technology in a meaningful way. The programs seek to help

improve care, efficiency, and population health. This rule also specifies the initial criteria that eligible providers

must meet to qualify for the Medicare and Medicaid EHR incentive payments, and it includes other incentive

programs participation requirements.

Health Information Technology: Initial Set of Standards, Implementation Specifications, and

Certification Criteria for Electronic Health Record Technology Interim Final and Final Rules

Under these rules, the Secretary has adopted the initial set of standards, implementation specifications and

certification criteria that are required for the certification of EHR technology. These rules have been aligned to

support the achievement of meaningful use stage one by eligible professionals, eligible hospitals, and critical access

hospitals under the Medicare and Medicaid EHR Incentive Programs.

Federal Health IT Strategic Plan 68

Establishment of the Temporary Certification Program for Health Information Technology

Final Rule

This final rule establishes a temporary certification program for the purposes of testing and certifying health IT,

thereby ensuring the availability of Certified EHR Technology for eligible health care providers seeking incentive

payments available under the Medicare and Medicaid EHR Incentive Programs. This final rule is issued under the

authority granted to the National Coordinator by section 3001(c)(5) of the Public Health Service Act (PHSA), as

added by the HITECH Act. Under the temporary certification program, the National Coordinator will authorize

qualified organizations that meet specified requirements to conduct the testing and certification of Complete

EHRs and/or EHR Modules.

Establishment of the Permanent Certification Program for Health Information Technology

Final Rule

This final rule establishes a permanent certification program for the purpose of certifying health IT. This final rule

is issued pursuant to the authority granted to the National Coordinator for Health Information Technology (the

National Coordinator) by section 3001(c)(5) of the PHSA, as added by the HITECH Act. The permanent

certification program will eventually replace the temporary certification program that was previously established by

a final rule. The National Coordinator will use the permanent certification program to authorize qualified

organizations to certify certain types of EHR technology, such as Complete EHRs and/or EHR Modules. The

permanent certification program could also be expanded to include the certification of other types of health IT.

Breach Notification for Unsecured Protected Health Information Interim Final Rule

This rule implemented section 13402 of the HITECH Act by requiring HIPAA covered entities to provide

notification following a breach of unsecured protected health information to individuals, HHS, and in some

cases the media. This rule also requires business associates to notify covered entities following a breach of

unsecured protected health information.

HIPAA Privacy and Security Rules

The HIPAA Privacy Rule provides federal protections for individually identifiable health information held by

covered entities and gives patients an array of rights with respect to that information. At the same time, the Privacy

Rule is balanced so that it permits the disclosure of protected health information needed for patient care and other

important purposes. The HIPAA Security Rule specifies a series of administrative, physical, and technical

safeguards for covered entities to implement to assure the confidentiality, integrity, and availability of electronic

protected health information.

Modifications to the HIPAA Privacy, Security, and Enforcement Rules Under the HITECH Act

Proposed Rule

This rule proposes a number of provisions that would implement certain parts of the HITECH Act that are

designed to strengthen the privacy and security protections for health information established under HIPAA. In

addition to seeking to implement these HITECH Act provisions, this rule proposes a number of modifications to

improve the HIPAA Rules, which are not mandated in the HITECH Act. The Department issued this proposed

rule in 2010 and expects to finalize it in 2011.

HIPAA Privacy Rule Accounting of Disclosures Under the HITECH Act Proposed Rule

This rule proposes modifications to the HIPAA standard for accounting of disclosures of protected health

information. The modifications in part would implement the statutory requirement under the HITECH Act to

require covered entities and business associates to account for disclosures of protected health information to carry

out treatment, payment, and health care operations if such disclosures are through an electronic health record. The

Federal Health IT Strategic Plan 69

rule also proposes to expand the accounting provision to provide individuals with the right to receive an access

report indicating who has accessed electronic protected health information in a designated record set.

Federal Health IT Strategic Plan 70

Appendix F: Goals, Objectives, and Strategies

Goal I: Achieve Adoption and Information Exchange through Meaningful Use of Health IT

Objectives Strategies

I.A. Accelerate adoption

of electronic health

records

I.A.1. Provide financial incentive payments for the adoption and meaningful use of

certified EHR technology.

I.A.2. Provide implementation support to health care providers to help them adopt,

implement, and use certified EHR technology.

I.A.3. Support the development of a trained workforce to implement and use health

IT technologies.

I.A.4. Encourage the inclusion of meaningful use in professional certification and

medical education.

I.A.5.

Establish criteria and a process to certify EHR technology that can support

meaningful use criteria.

I.A.6. Communicate the value of EHRs and the benefits of achieving meaningful use.

I.A.7.

Align federal programs and services with the adoption and meaningful use

of certified EHR technology.

I.A.8. Work with private sector payers and provider groups to encourage providers to

achieve meaningful use.

I.A.9. Encourage and facilitate improved usability of EHR technology.

I.B. Facilitate

information

exchange to support

meaningful use of

electronic health

records

I.B.1. Foster business models that create health information exchange.

I.B.2. Monitor health information exchange options and fill the gaps for providers

that do not have viable options.

I.B.3. Ensure that health information exchange takes place across individual exchange

models, and advance health systems and data interoperability.

I.C. Support health IT

adoption and

information

exchange for

public health and

populations with

unique needs.

I.C.1. Ensure public health agencies are able to receive and share information with

providers using certified EHR technology.

I.C.2. Track health disparities and promote health IT that reduces them.

I.C.3. Support health IT adoption and information exchange in long-term/post-acute,

behavioral health, and emergency care settings.

Federal Health IT Strategic Plan 71

Goal II: Improve Care, Improve Population Health, and Reduce

Health Care Costs through the Use of Health IT

Objectives Strategies

II.A. Support more

sophisticated uses

of EHRs and other

health IT to

improve health

system performance

II.A.1. Identify and implement best practices that use EHRs and other health IT to

improve care, efficiency, and population health.

II.A.2. Create administrative efficiencies to reduce cost and burden for providers,

payers, and government health programs.

II.B. Better manage care,

efficiency, and

population health

through EHR-

generated reporting

measures

II.B.1. Identify specific measures that align with the National Quality Strategy.

II.B.2. Establish standards, specifications, and certification criteria for collecting and

reporting measures through certified EHR technology.

II.C. Demonstrate health

IT-enabled reform

of payment

structures, clinical

practices, and

population health

management

II.C.1. Fund and administer demonstration communities to show how the advanced

use of health IT can achieve measurable improvements in care, efficiency, and

population health.

II.C.2. Align health IT initiatives and clinical and payment reform pilots and

demonstrations.

II.D. Support new

approaches to the

use of health IT in

research, public and

population health,

and national health

security

II.D.1: Establish new approaches to and identify ways health IT can support national

prevention, health promotion, public health, and national health security.

II.D.2: Invest in health IT infrastructure to support the National Prevention and

Health Promotion Strategy.

II.D.3: Ensure a mechanism for information exchange in support of research and the

translation of research findings back into clinical practice.

Federal Health IT Strategic Plan 72

Goal III: Inspire Confidence and Trust in Health IT

Objectives Strategies

III.A. Protect

confidentiality,

integrity, and

availability of health

information

III.A.1. Promulgate appropriate and enforceable federal policies to protect the

privacy and security of health information.

III.A.2. Enforce existing federal privacy and security laws and maintain consistency

with federal policy.

III.A.3. Encourage the incorporation of privacy and security functionality into

health IT.

III.A.4. Assess technical solutions that could support more granular patient choice

and data segmentation.

III.A.5. Identify health IT system security vulnerabilities and develop strategic

solutions.

III.A.6. Identify health IT privacy and security requirements and best practices, and

communicate them through health IT programs.

III.B. Inform individuals

of their rights and

increase

transparency

regarding the uses

of protected health

information

III.B.1. Inform individuals about their privacy and security rights and how their

information may be used and shared.

III.B.2. Increase transparency regarding the development of policies and standards

related to uses and sharing of protected health information.

III.B.3. Maintain strong breach notification requirements.

III.C. Improve safety and

effectiveness of

health IT

III.C.1. Provide implementation and best practice tools for the effective use of

health IT.

III.C.2. Evaluate safety concerns and update approach to health IT safety.

III.C.3. Monitor patient safety issues related to health IT and address concerns.

Federal Health IT Strategic Plan 73

Goal IV: Empower Individuals with Health IT to Improve

their Health and the Health Care System

Objectives Strategies

IV.A. Engage individuals

with health IT

IV.A.1. Listen to individuals and implement health IT policies and programs to

meet their priorities.

IV.A.2. Communicate with individuals openly and spread messages through existing

communication networks and dialogues.

IV.B. Accelerate

individual and

caregiver access to

their electronic

health information

in a format they can

use and reuse

IV.B.1. Through Medicare and Medicaid EHR Incentive Programs, encourage

providers to give patients access to their health information in an electronic format.

IV.B.2. Through federal agencies that deliver or pay for health care, act as a model

for sharing information with individuals and make available tools to do so.

IV.B.3. Establish public policies that foster individual and caregiver access to their

health information while protecting privacy and security.

IV.C. Integrate patient-

generated health

information and

consumer health IT

with clinical

applications to

support patient-

centered care

IV.C.1. Support the development of standards and tools that make EHR technology

capable of interacting with consumer health IT and build these requirements for the

use of standards and tools into EHR certification.

IV.C.2. Solicit and integrate patient-generated health information into EHRs and

quality measurements.

IV.C.3. Encourage the use of consumer health IT to move toward patient-centered

care.

Goal V: Achieve Rapid Learning and Technological Advancement

Objectives Strategies

V.A. Lead the creation of

a learning health

system to support

quality, research,

and public and

population health

V.A.1. Establish an initial group of learning health system participants.

V.A.2. Develop standards, policies, and technologies to connect participants within

the learning health system.

V.A.3. Engage patients, providers, researchers, and institutions to exchange

information through the learning health system.

V.A.4. Grow the learning health system by adding more members and expanding

policies and standards as needed.

V.B. Broaden the

capacity of health IT

through innovation

and research

V.B.1. Liberate health data to enable health IT innovation.

V.B.2. Make targeted investments in health IT research.

V.B.3. Employ government programs and services as test beds for innovative

health IT.

V.B.4. Monitor and promote industry innovation.

V.B.5. Provide clear direction to the health IT industry regarding government roles

and policies for protecting individuals while not stifling innovation.

Federal Health IT Strategic Plan 74

Appendix G: Acronyms

Term/Acronym Description

AHLTA

Armed Forces Health Longitudinal Technology Application

AHRQ

Agency for Healthcare Research and Quality

ASPE

Office of the Assistant Secretary for Planning and Evaluation (HHS)

ASPR

Office of the Assistant Secretary for Preparedness and Response (HHS)

caBIG

The Cancer Biomedical Informatics Grid

caGrid

Infrastructure that supports caBIG

CDC

Centers for Disease Control and Prevention

CDS

Clinical Decision Support

CHDI

Community Health Data Initiative

CMS

Centers for Medicare & Medicaid Services

DHS

U.S. Department of Homeland Security

DoD

U.S. Department of Defense

DoEd

U.S. Department of Education

DoL

U.S. Department of Labor

DURSA

Data Use and Reciprocal Support Agreement

EHR

Electronic Health Record

FACA

Federal Advisory Committee Act

FCC

Federal Communications Commission

FDA

U.S. Food and Drug Administration

FHA

Federal Health Architecture

FTC

Federal Trade Commission

HDC

Health Disparities Collaborative (HRSA)

Health IT

Health Information Technology

HHS

U.S. Department of Health and Human Services

HHS/OS

U.S. Department of Health and Human Services, Office of the Secretary

HIE

Health Information Exchange

HIPAA

Health Insurance Portability and Accountability Act of 1996

HITECH ACT

Health Information Technology for Economic and Clinical Health Act

HITPC

HIT Policy Committee

HITRC

Health Information Technology Research Center

Federal Health IT Strategic Plan 75

Term/Acronym Description

HITSC

HIT Standards Committee

HITSP

Healthcare Information Technology Standards Panel

HRSA

Health Resources and Services Administration

IHS

Indian Health Service

IOM

Institute of Medicine

LTPAC

Long-term and post-acute care

mHealth

Mobile health

NAMS

National Ambulatory Medical Survey

NEDSS

National Electronic Disease Surveillance System

NIH

National Institutes of Health

NIST

National Institute of Standards and Technology

NITRD

Networking and Information Technology Research and Development Program

NLM

National Library of Medicine

NPRM

Notice of Proposed Rulemaking

NQF

National Quality Forum

NRC

The National Resource Center for Health Information Technology

OCR

Office for Civil Rights

OGC

Office of the General Counsel

OPM

Office of Personnel Management

ONC-ATCB

Office of the National Coordinator for Health IT – Authorized Testing and

Certification Body

ONC

Office of the National Coordinator for Health Information Technology

OPP

ONC’s Office of Policy and Planning

OSI

ONC’s Office of Standards and Interoperability

OSTP

The White House Office of Science and Technology Policy

PCAST

President’s Council of Advisors on Science and Technology

PHR

Personal Health Record

REC

Regional Extension Center

RPMS

Resource and Patient Management System (Indian Health Service’s Electronic

Health Record)

SAMHSA

Substance Abuse and Mental Health Services Administration

SDO

Standards Development Organizations

SSA

U.S. Social Security Administration

Federal Health IT Strategic Plan 76

Term/Acronym Description

State HIE

State Health Information Exchange Cooperative Agreement Program

SHARP

Strategic Health IT Advanced Research Projects

S&I

Standards and Interoperability

USDA

U.S. Department of Agriculture

U.S. Department of Veterans Affairs

VHA

Veterans Health Administration

VistA

Veterans Health Information Systems and Technology Architecture

(VA’s Electronic Health Record)

Federal Health IT Strategic Plan 77

ONC

Office of the National Coordinator for Health Information Technology

200 Independence Avenue SW

Washington, DC 20201

Acknowledgements

The Office of the National Coordinator is deeply grateful to the leaders and key staff from each federal agency

involved with the development of this document.

Development of this plan was supported under contract HHSP23320095633WC by professional staff from

Deloitte Consulting LLP. The Office of the National Coordinator gratefully acknowledges Deloitte’s contributions

to this document.

Federal Health IT Strategic Plan 78

Notes

The National Ambulatory Medical Care Survey (NAMCS). American Hospital Association IT Supplement 2010.

http://www.hhs.gov/news/press/2011pres/01/20110113a.html. These estimates refer to the proportion of office-based physicians and non-

federal acute care hospitals that have achieved a “basic” level of electronic health record adoption. For more information about these measures, visit

http://healthit.hhs.gov/budget and view the Online Performance Appendix to the Fiscal Year 2012 President’s Budget Request to Congressional

Appropriations Committees.

Consumers and Health Information Technology: A National Survey; April 2010, California HealthCare Foundation.

http://www.chcf.org/publications/2010/04/consumers-and-health-information-technology-a-national-survey

iii

Friedman, Charles P., Adam K. Wong, and David Blumenthal. "Achieving a Nationwide Learning Health System." Science Translational Medicine,

10 Nov. 2010. Vol 2.

The “Meaningful Use” Regulation of Electronic Health Records. David Blumenthal and Marilyn Tavenner, August 5, 2010, New England

Journal of Medicine. http://www.nejm.org/doi/full/10.1056/NEJMp1006114

HHS Strategic Plan FY 2010-2015. US Department of Health and Human Services.

http://www.hhs.gov/secretary/about/priorities/priorities.html and the National Strategy for Quality Improvement in Health Care. US

Department of Health and Human Services, May 2011.

http://www.healthcare.gov/center/reports/quality03212011a.html

Health IT Workforce Development Program. http://healthit.hhs.gov/portal/server.pt?open=512&objID=1432&mode=2.

vii

HHS/OMB Memorandum: Federal Agency Coordination on Health Information Technology (HIT), February 19, 2010.

http://www.whitehouse.gov/sites/default/files/omb/assets/memoranda_2010/m10-10.pdf.

viii

Stimulating the Adoption of Health Information Technology. David Blumenthal, M.D., M.P.P. N Engl J Med 2009; 360:1477-1479. April 9,

2009.

http://www.nejm.org/doi/full/10.1056/NEJMp0901592 .

ix Medicare Shared Savings Program: Accountable Care Organizations Proposed Rule published in the Federal Register on April 7, 2011

(76 FR 19528, 19652)

Sebelius Announces $42.5 Million for Public Health Improvement Programs through the Affordable Care Act.

http://www.cdc.gov/media/pressrel/2010/r100920.htm.

Fair Information Practice Principles; Federal Trade Commission, June 25, 2007. http://www.ftc.gov/reports/privacy3/fairinfo.shtm.

xii

Nationwide Privacy and Security Framework for Electronic Exchange of Individually Identifiable Health Information; December 15,

2008.

http://healthit.hhs.gov/portal/server.pt/community/healthit_hhs_gov__privacy___security_framework/1173.

xiii

Accelerating Health Care Innovation to Achieve System-Wide Impact; Donald Berwick at the Brookings Institutions, October 18, 2010.

http://www.brookings.edu/~/media/Files/events/2010/1018_health_innovation/20101018_health_innovation_keynote.pdf.

xiv

Consumers and Health Information Technology: A National Survey; April 2010, California HealthCare Foundation.

http://www.chcf.org/publications/2010/04/consumers-and-health-information-technology-a-national-survey.

xv The Social Life of Health Information, 2011. Susannah Fox. Pew Research Center, May 2011,

http://www.pewinternet.org/Reports/2011/Social-Life-of-Health-Info.aspx

xvi Consumers and Health Information Technology: A National Survey; April 2010, California HealthCare Foundation.

http://www.chcf.org/publications/2010/04/consumers-and-health-information-technology-a-national-survey

xvii

Consumers and Health Information Technology: A National Survey, California Healthcare Foundation, April 2010.

http://www.chcf.org/publications/2010/04/consumers-and-health-information-technology-a-national-survey.

xviii

Achieving a Nationwide Learning Health System; Charles Friedman, Adam Wong, and David Blumenthal, Science Translational Medicine,

November 2010.

xix

The Digital Infrastructure for a Learning Health System: Foundation for Continuous Improvement in Health and Health Care -

Workshop Summary, Institute of Medicine, December 20, 2010.

Grossman Claudia, Powers, Brian and McGinnis J. Michael, Digital Infrastructure for the Learning Health System the Foundation for Continuous Improvement in

Health and Health Care Series Summary, Roundtable on Values and Science-Driven Health Care, The Institute of Medicine’s Board on Studies under the

IOM Executive Office, Released May 23, 2011

Federal Health IT Strategic Plan 79

xxi

The Digital Infrastructure for a Learning Health System: Foundation for Continuous Improvement in Health and Health Care -

Workshop Summary, Institute of Medicine, December 20, 2010.

xxii

Designing a Digital Future: Federally Funded Research and Development Networking and Information Technology, President’s Council

of Advisors on Science and Technology, December 2010.

“Spotlight on Health Outcomes” Citations

Goal I: Use of EHRs provides information that can contribute to reducing heart attacks

1. P

ersell SD, Kho AN, Thompson JA, Baker DW. Improving hypertension quality measurement using electronic health records. Med Care.

2009 Apr;47(4):388-94.

2. Persell SD, Dunne AP, Lloyd-Jones DM, Baker DW. Electronic health record-based cardiac risk assessment and identification of unmet

preventive needs. Med Care. 2009 Apr;47(4):418-24.

oal I: Use of EHRs to perform medication reconciliation can contribute to reducing preventable hospitalizations

1. Br

ownstein JS, Murphy SN, Goldfine AB, Grant RW, Sordo M, Gainer V, Colecchi JA, Dubey A, Nathan DM, Glaser JP, Kohane

IS.Brownstein, et. al. Rapid Identification. Rapid identification of myocardial infarction risk associated with diabetes medications using

electronic medical records. Diabetes Care. 2010 Mar;33(3):526-31. Epub 2009 Dec 15.

oal II: Health IT can help enable information sharing to contribute to improving care coordination and reducing heart attacks

1. P

ersell SD, Kaiser D, Dolan NC, Andrews B, Levi S, Khandekar J, Gavagan T, Thompson JA, Friesema EM, Baker DW. Changes in

Performance After Implementation of a Multifaceted Electronic-Health-Record-Based Quality Improvement System.Persell Article. Med

Care. 2011 Feb;49(2):117-125.

oal II: Health IT can help provide information to enhance clinical decision making and can contribute to reducing preventable

hospitalizations

1. Be

rtoni AG, Bonds DE, Chen H, Hogan P, Crago L, Rosenberger E, Barham AH, Clinch CR, Goff DC Jr. Impact of a multifaceted

intervention on cholesterol management in primary care practices: guideline adherence for heart health randomized trial. Arch Intern Med.

2009 Apr 13;169(7):678-86.

2. Amarasingham R, et al. An automated model to identify heart failure patients at risk for 30-day readmission or death using electronic medical

record data. Med Care. 2010 Nov;48(11):981-8.

oal IV: Empowering patients with health IT can contribute to reducing heart attacks

1. Scalvini S, Capomolla S, Zanelli E, Benigno M, Domenighini D, Paletta L, Glisenti F, Giordano A. Effect of home-based telecardiology on

chronic heart failure: costs and outcomes. J Telemed Telecare. 2005;11 Suppl 1:16-8.

oal IV: Empowering patients with health IT can contribute to reducing preventable hospitalizations

1. S

calvini S, Capomolla S, Zanelli E, Benigno M, Domenighini D, Paletta L, Glisenti F, Giordano A. Effect of home-based telecardiology on

chronic heart failure: costs and outcomes. J Telemed Telecare. 2005;11 Suppl 1:16-8.

2. Crossley GH, Boyle A, Vitense H, Chang Y, Mead RH; CONNECT Investigators. The CONNECT (Clinical Evaluation of Remote

Notification to Reduce Time to Clinical Decision) Trial The Value of Wireless Remote Monitoring With Automatic Clinician Alerts. J Am

Coll Cardiol. 2011 Jan 14.

oal V: A “learning health system” can contribute to reducing heart attacks

1. C

oloma PM, Schuemie MJ, Trifirò G, Gini R, Herings R, Hippisley-Cox J, Mazzaglia G, Giaquinto C, Corrao G, Pedersen L, van der Lei J,

Sturkenboom M; EU-ADR Consortium. Combining electronic healthcare databases in Europe to allow for large-scale drug safety monitoring:

the EU-ADR Project. Pharmacoepidemiol Drug Saf. 2011 Jan;20(1):1-11. doi: 10.1002/pds.2053. Epub 2010 Nov 8.

oal V: A “learning health system” can contribute to reducing preventable hospitalizations

1. A

marasingham R, et al. An automated model to identify heart failure patients at risk for 30-day readmission or death using electronic medical

record data. Med Care. 2010 Nov;48(11):981-8.

Federal Health IT Strategic Plan 80

2. Friedman, Charles P., Adam K. Wong, and David Blumenthal. "Achieving a Nationwide Learning Health System." Science Translational

Medicine, 10 Nov. 2010. Vol 2.