Care Coordination and Interoperable Health IT Systems

1. Care Coordination and Interoperable Health IT Systems Unit 7: Policy and Interoperable Health IT Lecture a – Overview of Policy and Interoperable Health IT This material (Comp 22 Unit 7) was developed by Columbia University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number 90WT0004. This work is licensed under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-sa/4.0/.

2. Policy and Interoperable Health ITLearning Objectives • Objective 1: List and discuss the impact of key health interoperability related topics in health care legislation (Lecture a) • Objective 2: Identify and discuss how the Meaningful Use program and the ONC certification programs have impacted interoperable health IT (Lecture b) • Objective 3: Assess and leverage Meaningful Use, ONC certification, and other health IT policy activities to facilitate interoperability (Lecture c)

3. Regulated health IT • Congressional Acts and Federal Regulations have made and continue to make a huge impact on the expansion and shape of health IT and health care interoperability • Health IT is seen as requisite for improving the quality and the cost of health care

4. Regulated health IT (Cont’d – 1) • According to a 2006 Rand Report predating the Meaningful Use program: • “Annual savings from [health IT] efficiency alone could be $77 billion or more” • “The government should act now to overcome obstacles and realize benefits”

5. A quick review of the U.S. government 7.1 Table (Lorenzi, V., 2016) Adapted from https://www.usa.gov/how-laws-are-made.

6. Health IT – related congressional acts • HIPAA: Health Insurance and Portability Act • ARRA: American Recovery and Reinvestment Act • PPACA: Patient Protection and Affordable Care Act • MACRA: Medicare Access & CHIP Reauthorization Act • All of these impact health interoperability, but there are many more bills…

7. Health IT – related regulations • Insurance Reform: Standards for Electronic Transactions • Requires standards for sending claims electronically from providers to CMS • Authorized by HIPAA Act • 2015 Medicare Physician Fee Schedule Final Rule • Includes electronic transmission of quality measures from EHRs to CMS • Included e-prescribing in earlier regulations

8. Key reports that set direction • Better Health Care and Lower Costs: Accelerating Improvement through Systems Engineering (April 2014 for President) • Robust Health Data Infrastructure (April 2014 for AHRQ) • Connecting Health and Care for the Nation: A 10 – Year Vision to Achieve an Interoperable Health IT Infrastructure (2015 by ONC) • Connecting Health and Care for the Nation: A Shared Nationwide Interoperability Roadmap (October 2015 by ONC) • 2016 Interoperability Standards Advisory (November 2015 by ONC) • 2017 Interoperability Standards Advisory (TBD)

9. Other government – related efforts for interoperability • National Institute of Standards and Technology (NIST) involvement • ONC Systems and Interoperability Framework • Interoperability work by the VA, CDC, FDA, and other federal offices • ONC HIE grant opportunities • ONC HIE trust and governance policy advisories

10. In 2009, the “Stimulus Bill” became law • American Recovery and Reinvestment Act (ARRA) • Included a section specific to Health Information Technology, called HITECH (Health Information Technology for Economic and Clinical Health Act) • Included a program to incentivize Meaningful Use of certified health IT • Incentive payments totaling $35 billion since inception (Centers for Medicare and Medicaid Services, 2016) • Goal was not only the adoption of EHRs, but also the “meaningful use” of EHRs

11. The Meaningful Use (MU) Program • This act authorized a series of regulations related to the Certification of Health IT and Meaningful Use of Health IT • Regulations defining MU Stage 1 and ONC 2011 Standards and Certified Technology • Regulations defining MU Stage 2 and ONC 2014 Certified Technology • Regulations defining MU Stage 3 and ONC 2015 Certified Technology

12. The Meaningful Use (MU) Program (Cont’d – 1) • The three main components are: • Use of certified EHR in a meaningful manner • Use of certified EHR technology for electronic exchange of health information to improve quality of health care • Use of certified EHR technology to submit clinical quality measures selected by the Secretary of Health and Human Services

13. MU’s impact for interoperability • Because of Meaningful Use, EHRs are being used in many hospitals and doctors offices across the country • Ninety – six percent of hospitals used certified EHRs in 2015, compared to only nine percent in 2009 • These EHRs are certified to have standards –based interoperability functionality • Providers (hospitals and doctors) meeting MU are required to attest to the use of an interoperability functionality

14. Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) • Contains a section called “Promoting Interoperability of Electronic Health Record Systems” • “Congress declares it a national objective to achieve widespread exchange of health information through interoperable certified EHR technology nationwide by December 31, 2018” • “Preventing blocking the sharing of information” • Requires that Meaningful Users of Health IT attest to “not knowingly and willfully taken action (such as to disable functionality) to limit or restrict the compatibility or interoperability of the certified EHR technology” • Regulation: Merit – based Incentive Payment System (MIPS) • (https://www.congress.gov/bill/114th-congress/house-bill/2/text)

15. Unit 7: Policy and Interoperable Health IT, Summary – Lecture a, Overview of Policy and Interoperable Health IT • Congressional Acts and Federal Regulations have made and continue to make a huge impact on the expansion and shape of health IT and health care interoperability • In addition, there have been recent sentinel reports that have set the direction for interoperability • The Stimulus Bill’s HITECH Act and Meaningful Use Program has impacted interoperability since 2009

16. Policy and Interoperable Health IT References – Lecture a References Centers for Medicare and Medicaid Services. (2016). EHR Incentive Program Summary Report. https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/May2016_SummaryReport.pdf. U.S. Congress. (2015). Medicare Access and CHIP Reauthorization Act of 2015. https://www.congress.gov/bill/114th-congress/house-bill/2/text Office of the National Coordinator for Health Information Technology. (2016). Adoption of Electronic Health Record Systems among U.S. Non-Federal Acute Care Hospitals: 2008-2015. ONC Data Brief #35. https://dashboard.healthit.gov/evaluations/data-briefs/non-federal-acute-care-hospital-ehr-adoption-2008-2015.php RAND. (2006). Health information technology, can HIT lower costs and improve quality? U.S. Government. How laws are made and how to research them. https://www.usa.gov/how-laws-are-made.

17. Policy and Interoperable Health IT References – Lecture a (Cont’d – 1) Charts, Tables, Figures 7.1 Table: Lorenzi, V. (2016). A quick review of the U.S. government. Adapted from https://www.usa.gov/how-laws-are-made.

18. Unit 7: Policy and Interoperable Health IT, Lecture a – Overview of Policy and Interoperable Health IT This material was developed by Columbia University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number 90WT0004.