We Can't Wait: Obama Administration takes new steps to encourage doctors and hospitals to use health information technology to lower costs, improve quality, create jobs

FOR IMMEDIATE RELEASE.November 30, 2011.U.S. Department of Health and Human Services (HHS).Cleveland, OH —Today, U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius released a report showing that doctors’ adoption of health information technology (IT) doubled in two years.  HHS also announced new actions to speed the use of health IT in doctors’ offices and hospitals nationwide, which will improve health care and create jobs nationwide.

While protecting confidential personal information, health IT can improve access to care, help coordinate treatments, measure outcomes and reduce costs.  The new administrative actions announced today, which were made possible by the HITECH Act, will make it easier for doctors and other health care professionals to receive incentive payments for adopting and meaningfully using health IT.

“When doctors and hospitals use health IT, patients get better care and we save money,” said Secretary Sebelius.  “We’re making great progress, but we can’t wait to do more. Too many doctors and hospitals are still using the same record-keeping technology as Hippocrates. Today, we are making it easier for health care providers to use new technology to improve the health care system for all of us and create more jobs.”

In addition to improving the health care system, data indicate that the national transition to health IT is creating jobs.  Over 50,000 health IT-related jobs have been created since the enactment of the HITECH Ac. According to the Bureau of Labor Statistics, the number of health IT jobs across the country is expected to increase by 20 percent from 2008 to 2018, much faster than the average for all occupations through 2018.

HHS also announced its intent to make it easier to adopt health IT.  Under the current requirements, eligible doctors and hospitals that begin participating in the Medicare EHR (electronic health record) Incentive Programs this year would have to meet new standards for the program in 2013.  If they did not participate in the program until 2012, they could wait to meet these new standards until 2014 and still be eligible for the same incentive payment. To encourage faster adoption, the Secretary announced that HHS intends to allow doctors and hospitals to adopt health IT this year, without meeting the new standards until 2014. Doctors who act quickly can also qualify for incentive payments in 2011 as well as 2012.

These policy changes are accompanied by greater outreach efforts that will provide more information to doctors and hospitals about best practices and to vendors whose products allow health care providers to meaningfully use EHRs.  For example, in communities across the country HHS will target outreach, education and training to Medicare eligible professionals that have registered in the EHR incentive program but have not yet met the requirements for meaningful use.  Meaningful use is the necessary foundation for all impending payment changes involving patient-centered medical homes, accountable care organizations, bundled payments, and value-based purchasing.

These efforts will complement existing outreach efforts to doctors and hospitals including the Obama Administration’s work to create a nationwide network of 62 Regional Extension Centers.  The extension centers are comprised of local nonprofits that provide guidance and resources to help eligible health care providers participate in the Medicare and Medicaid EHR Incentive Programs and meaningfully use health IT.

Also released today, a new Centers for Disease Control and Prevention (CDC) survey found 52 percent of office-based physicians in the U.S. now intend to take advantage of the incentive payments available for doctors and hospitals through the Medicare and Medicaid EHR Incentive Programs.  EHR incentive payments for eligible health care professionals can total as much as $44,000 under the Medicare EHR Incentive Program and $63,750 under the Medicaid EHR Incentive Program.  The CDC data also show the percentage of physicians who have adopted basic electronic health records in their practice has doubled from 17 to 34 percent between 2008 and 2011 (with the percent of primary care doctors using this technology nearly doubling from 20 to 39 percent).

To meet the demand for workers with health IT experience and training, the Obama Administration has launched four workforce development programs that help train the new health IT workforce.  The training is provided through 82 community colleges and nine universities nationwide.  As of October 2011, community colleges have had 5,717 professionals successfully complete their training in health information technology.  Currently there are 10,065 students enrolled in the training programs across the nation.  As of November 2011, universities have graduated over 500 post-graduate and masters-level health IT professionals, with over 1700 expected to graduate by July 2013.

While improving the health care system, health IT can help keep information private and secure.  Federal laws require key persons and organizations that handle health information to have policies and security safeguards in place to protect health information—whether it is stored on paper or electronically.

For more information on how health IT can lead to safer, better, and more efficient care, and for a fact sheet about today’s announcement, visit http://www.healthit.gov/

For more information about the Medicare and Medicaid EHR Incentive Programs, see http://www.cms.gov/EHRIncentivePrograms

For more information on the 2011 CDC survey data referenced above, seehttp://www.cdc.gov/nchs/surveys.htm

For more information about the HHS Recovery Act health IT programs, see http://www.hhs.gov/recovery/announcements/by_topic.html#hit

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Over 100,000 primary care providers sign up to adopt electronic health records through their Regional Extension Centers

November 17, 2011 WASHINGTON, DC – The HHS Office for the National Coordinator for Health Information Technology announced today that more than 100,000 primary care providers are adopting certified Electronic Health Records (EHRs) to help improve their quality of care and ultimately lower health care costs. This commitment by more than one-third of all primary care providers nationwide to work with their Regional Extension Center (REC) to participate in the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs as a way to transition from paper records to certified EHRs, representing a major step toward broader and more meaningful use of health IT.

Designed to jump start EHR adoption, the Health Information Technology Economic and Clinical Health (HITECH) Act of 2009, part of the Recovery Act, created a nationwide network of RECs comprised of local nonprofits, to provide guidance and resources to help eligible professionals make the transition from paper records to certified EHRs. Eligible providers that meet meaningful use of certified EHRs criteria may be eligible for incentive payments under the Recovery Act.

The 62 RECs focus on assisting primary care providers and those providers serving traditionally medically underserved populations as they take part in the Medicare and Medicaid EHR Incentive Programs and meaningfully use EHRs in ways that can reduce health care costs, increase patient safety, and improve the overall quality of patient care. These providers face challenges in EHR adoption including tight budgets, over-stretched health information technology staff, and limited broadband access.

“The RECs are playing an integral role in helping providers on the path to EHR adoption,” said Farzad Mostashari, MD, ScM, the Office of National Coordinator for Health Information Technology. “This compelling milestone demonstrates strong interest in adoption and meaningful use among community health centers, small practices, and rural providers that can lead to improvements in health and healthcare.”

One-half of the providers committed to making the transition to certified EHRs are in small group practices or consortia of small group practices. The remaining providers focus on the underserved with 18 percent in community health centers, 11 percent in public hospitals, and 21 percent in other underserved settings, such as critical access hospitals, rural health clinics, and practices in medically underserved areas.

RECs serve the majority of primary care providers in small practices in rural areas. Today’s figures include over half of the targeted 1,776 critical access and rural hospitals in 41 states and throughout Indian Country.

A complete listing of REC grant recipients and additional information about Regional Extension Centers may be found at http://www.HealthIT.hhs.gov/REC/.

For more information about how health IT can lead to safer, better, and more efficient health care, visit http://www.healthit.gov/.

For information about the Medicare and Medicaid EHR Incentive Programs, see http://www.cms.gov/EHRIncentivePrograms.

For information about HHS Recovery Act health IT programs, see http://www.hhs.gov/recovery/announcements/by_topic.html#hit.

Integrating Large-Scale Genomic Information into Clinical Practice - Workshop Summary

Sequencing technology has evolved at such a rapid pace in the decade since the human genome was first sequenced that what initially took 13 years to accomplish can now be done in a matter of days. With these technological advances and the comparable decline in cost, genomics technologies are beginning to be incorporated into clinic practice. 

Already, genetic and genomic tests are used to assess the risk of breast and ovarian cancer, diagnose diseases such as cystic fibrosis and Proteus syndrome, and identify the best treatment options for various cancers, and it is expected that the number of healthcare applications will only continue to grow. Given the rapid technological advances, the potential effect on patients’ lives, and the increasing use of genomic information in clinical care, it is important to evaluate how genomics data can best be integrated into the clinical setting in order to maximize patient benefit.

On July 19, 2011, the IOM’s Roundtable on Translating Genomic-Based Research for Health hosted a workshop to highlight and identify the challenges and opportunities in integrating large-scale genomic information into clinical practice. Challenges range from the analysis, interpretation, and delivery of genetic information to associated workforce, ethical, and legal issues. Additionally, many patients and providers have yet to realize the broad effect genomic discoveries are likely to have on treatment and health. The main objective of the workshop was to start a discussion on what needs to be done to prepare the necessary infrastructure and to address the various challenges for realizing genomic medicine. This document summarizes the workshop.

Released: November 11, 2011.Type: Workshop Summary.Topics: Biomedical and Health Research, Public Health.Activity: Roundtable on Translating Genomic-Based Research for Health. Board: Board on Health Sciences Policy

Integrating Large-Scale Genomic Information into Clinical Practice - Workshop Summary

Health IT and Patient Safety: Building Safer Systems for Better Care

In their continuous efforts to improve health care, both the public and private sectors have invested—and continue to invest—heavily in health information technologies, collectively referred to as health IT. When designed and used appropriately, health IT is expected to help improve the performance of health professionals, reduce operational and administrative costs, and enhance patient safety.

However, some products have begun being associated with increased safety risks for patients. The Office of the National Coordinator for Health Information Technology (ONC), the unit within the Department of Health and Human Services (HHS) that is responsible for coordinating the development of a national health IT infrastructure and promoting the use of health IT, asked the Institute of Medicine (IOM) to evaluate safety concerns and to identify actions that both government and the private sector can take to alleviate those actions. The IOM appointed a study committee, which interpreted its charge as recommending ways to make patient care safer using health IT so that the nation will be in a better position to realize its potential benefits.

Critical Knowledge Gaps and Barriers

In its report, Health IT and Patient Safety: Building Safer Systems for Better Care, the committee examines the safety of health IT products and their effects on patient safety. Overall, the committee finds the literature about health IT and patient safety to be inconclusive. Some health IT applications are definitively successful at improving medication safety. For example, the number of patients who receive the correct medication in hospitals increases when these hospitals implement well-planned, robust computerized prescribing mechanisms and use barcoding systems. But even in these instances, the ability to generalize the results across the health care system may be limited. For other products— including electronic health records, which are being employed with more and more frequency— some studies find improvements in patient safety, while other studies find no effect.

More worrisome, some case reports suggest that poorly designed health IT can create new hazards in the already complex delivery of care. Although the magnitude of the risk associated with health IT is not known, some examples illustrate the concerns. Dosing errors, failure to detect life-threatening illnesses, and delaying treatment due to poor human–computer interactions or loss of data have led to serious injury and death.

Fostering a Systems Approach

In looking for ways to make health IT–assisted care safer, it is important to recognize that the products are not used in isolation. Rather, they are part of a larger sociotechnical system that also includes people—such as clinicians or patients— organizations, processes, and the external environment. Safety emerges from the interactions of these factors. Comprehensive safety analyses, therefore, should not look for a single “root cause” of problems but should consider the system as a whole in looking for ways to reduce the likelihood that any given patient will experience an adverse health event.

Creating safer systems begins with usercentered design principles and includes adequate testing and quality assurance assessments conducted in actual or simulated clinical environments, or both. Designers and users of health IT should work together to develop, implement, optimize, and maintain health IT products. For most end users, an effective health IT product will provide easy retrieval of accurate, timely, and reliable data; incorporate simple and intuitive data displays; and yield evidence at the point of care to inform decisions. Among other improvements, the product will

• enhance workflow, perhaps by automating mundane tasks or streamlining work, without increasing physical or cognitive workloads;
• allow easy transfer of information to and from other organizations and providers; and
• cause no unanticipated downtime.

Promoting Sharing of Safety Data

While the private sector, including health IT vendors, users, patients, and professional societies, must play a major role in improving safety, the government can help in various ways. As one step, HHS should ensure that vendors support users in freely exchanging information about health IT experiences and issues, including details relating to patient safety. The ability to generate, develop, and share details of safety risks is essential to a properly functioning market in which health care providers have the ability to choose products that best suit their needs. Currently, many contracts with vendors include clauses that could impede efforts to improve patient safety. For example, nondisclosure clauses can discourage users from sharing information, and limited liability clauses can essentially shift liability from the vendor to the users when an adverse event occurs.

The ONC also should work with the private sector to make comparative user experiences publicly available. In other industries, public product reviews allow users to rate their experiences with products and share lessons learned. A consumer guide for health IT safety could help identify safety concerns, increasing system transparency.

Improving Standards, Measures, and Criteria for Safe Use

HHS also should take steps to help improve information gathering and analysis. This includes promoting the development of new measures for reliably assessing the current state of health IT safety and monitoring for improvements. Currently, no entity is developing such measures. To lead, HHS should fund a new Health IT Safety Council, within an existing voluntary consensus standards organization, that would evaluate criteria for judging the safe use of health IT and the use of health IT to enhance safety.

Promoting Transparency and Accountability

In addition, HHS should establish a mechanism for both vendors and users to report health IT– related deaths, serious injuries, or unsafe conditions. This effort would supplement current private-sector efforts and help quantify patient safety risks. Reporting should be mandatory for vendors, while reporting by users should be voluntary, confidential, and nonpunitive. Strategies also should be developed to encourage reporting; such efforts might include removing any perceptual, contractual, legal, and logistical barriers to reporting.

While improving reporting of patient safety incidents is critical, it is only one part of a larger solution to maximize the safety of health IT– assisted care. Another part is ensuring the ability to learn from and act on this information. To this end, HHS should recommend that Congress establish an independent federal entity—similar to the National Transportation Safety Board—that would perform the needed analytic and investigative functions in a transparent, nonpunitive manner. The entity would make nonbinding recommendations to the Secretary of HHS, providing flexibility and allowing HHS, health care organizations, vendors, and external experts to collectively determine the best course forward.

These and other recommendations would comprise the first stage for action, greatly advancing current understanding of the threats to patient safety. However, because the private sector has not taken substantive action on its own, the committee further recommends that HHS monitor and publicly report on the progress of health IT safety annually, beginning in 2012. If progress is not sufficient, HHS should direct the Food and Drug Administration (FDA) to exercise its authority to regulate health IT. To be effective, the FDA will need to commit sufficient resources and add capacity and expertise to carry this out.

Conclusion

To achieve better health care, a robust infrastructure that supports learning and improving the safety of health IT is essential. Proactive steps must be taken to ensure that health IT is developed and implemented with safety as a primary focus. If appropriately implemented, health IT can help improve health care providers’ performance, better communication between patients and providers, and enhance patient safety, which ultimately may lead to better care for Americans.

Health IT and Patient Safety: Building Safer Systems for Better Care