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Executive Summary | 2015 Update to Congress on the Adoption of Health Information Technology

Context

Health information technology (health IT) is foundational to achieve the nation's health and wellness goals. Since the passage of the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009, adoption and use of health IT by health care providers and hospitals significantly increased across the country. Health IT is now widely used by most hospitals and providers, and the electronic exchange of health information among these providers continues to increase. However, collaborative commitments across government and industry are needed to address remaining challenges for the U.S. to realize the full benefits of a secure, interoperable1 electronic health information infrastructure that seamlessly supports the health system and provides individuals with safe, person-centered care.

This annual report to Congress, required under Section 13113(a) of the American Recovery and Reinvestment Act of 2009, reports on the current state of health IT, discusses critical actions to accelerate progress on a firm path to a digital health care system, and identifies key barriers. HHS recently released the Federal Health IT Strategic Plan (Strategic Plan) and Connecting Health and Care for the Nation: A Shared Nationwide Interoperability Roadmap version 1.0 (Interoperability Roadmap) describing what needs to be achieved, by whom, and by when in order to reach an open and connected community of health IT.

This near-term health IT strategy builds upon the current electronic health information infrastructure and prioritizes government and industry actions that:

In addition to the government's critical actions highlighted in this report, making progress on this near-term health IT strategy will depend on significant actions by the private sector. HHS's plans prioritize industry commitments to:

Critical Actions

Federal Health IT Strategic Plan 2015-2020. The Strategic Plan highlights critical actions that seek to address key challenges to achieve widespread use of health IT and electronic health information to improve health and wellness. The Strategic Plan sets a blueprint for how federal agencies will use their levers to enhance the health IT infrastructure to advance person-centered and self-managed health, transform health care delivery and community health, and to foster research, scientific knowledge, and innovation.

Interoperability Roadmap. The Interoperability Roadmap advances a shared, nationwide interoperability agenda among public and private stakeholders. The Interoperability Roadmap focuses on improving interoperability in the near-term with specific calls to action for the private sector and federal commitments. The Interoperability Roadmap is organized by four critical pathways, (1) improving technical standards and implementation guidance for priority data domains and associated elements; (2) rapidly shifting and aligning federal, state, and commercial payment policies from fee-for-service to value-based models; (3) clarifying and aligning federal and state privacy and security requirements that enable interoperability; and (4) coordinating among stakeholders to promote and align consistent policies and business practices that support interoperability and address those that impede interoperability.

Delivery System Reform Efforts. Electronic sharing of health information is an important element of reforming how care is delivered. Data sharing is necessary in order to enhance consumer access to and control over their health information and for tying payment for care to value. Furthermore, delivery system reform that includes electronic sharing of health information has the potential to change how care is delivered by requiring greater teamwork and integration, more effective coordination of providers across settings, and greater attention by providers to population health. In short, delivery system reform strives to harness the power of information to improve care for patients, spend money more wisely, and ultimately result in healthier people.

Interoperability Standards Advisories. One deliverable from the Interoperability Roadmap was the Interoperability Standards Advisory (ISA). The Office of the National Coordinator for Health IT (ONC) issued an updated final 2016 ISA in December 2015. The ISA represents ONC's assessment of the best available technical standards and implementation specifications for clinical health IT interoperability. Overall, the ISA provides the industry with guidance in a single, public list of the standards and implementation specifications that best enable specific clinical health information interoperability purposes and serves as a means to prompt dialogue and reach consensus among industry stakeholders when more than one standard or implementation specification could be listed as the best available.

Medicare and Medicaid EHR Incentive Programs. The Centers for Medicare & Medicaid Services (CMS) issued the Medicare and Medicaid Programs; Electronic Health Record Incentive (EHR) Program - Stage 3 and Modifications to Meaningful Use in 2015 Through 2017; Final Rule (2015 EHR Incentive Programs Final Rule)2 in October 2015. The 2015 EHR Incentive Programs Final Rule establishes requirements for Stage 3, which aims to reduce provider burden and focus health IT implentation efforts on 8 high-priority objectives. Stage 3 will become the only stage that providers must meet beginning in 2018 (providers also have the option to begin Stage 3 in 2017). In addition, the final rule modifies Stage 1 and Stage 2 for 2015 through 2017 to align with Stage 3. Notably, CMS announced a 60-day public comment period for certain provisions of the final rule in order to gather additional feedback about the future of the EHR Incentive Programs, particularly in light of the transition to the new Merit-based Incentive Payment System created by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). HHS expects to issue rulemaking to implement MACRA in the spring of 2016.

Stage 3 focuses on the advanced use of certified EHR technology to support health information exchange and interoperability; advance quality measurement and care improvement; and support patient and family engagement. Stage 3 also promotes the use of application programming interfaces (API) that enable the development of new functionalities to build bridges across systems and provide increased data access. This will help patients have access to their health records, empowering individuals to make key health decisions. Finally, Stage 3 increases flexibility for providers and reduces overall reporting burden by, among other things: (1) aligning the clinical quality measure reporting requirements of the Medicare and Medicaid EHR Incentive Programs (EHR Incentive Programs) with other CMS quality reporting programs; (2) establishing a single, aligned reporting period for all providers; and (3) giving providers additional flexibility in how they report to an objective, which allows providers to focus efforts on activities most applicable to their practice.

2015 Edition Final Rule. In the 2015 Edition final rule3, the Secretary adopted standards, implementation specifications, and certification criteria that, among other things, focus on interoperability. The 2015 Edition final rule also updates the ONC Health IT Certification Program to continue to support the EHR Incentive Programs and to make the program more open and accessible to other types of health IT and settings, such as long-term and post-acute care and behavioral health. As compared to the proposed rule, the final rule reduces developer burden by finalizing fewer certification criteria while still advancing key provisions that benefit the providers and patients they serve. The 2015 Edition final rule includes, among other things: (1) a new 2015 Edition Base EHR definition and a common clinical data set of foundational health IT capabilities that support the interoperable exchange of health information; (2) modifications to the ONC Health IT Certification Program to support transparency and improve reliability of certified health IT; and (3) provisions related to the use of APIs, which support improved patient access to their health information and allow developers to implement APIs that are most helpful to the customers they serve.

Report to Congress on Health Information Blocking. ONC is aggressively pursuing all available administrative avenues to help target and address information blocking (defined as knowingly and unreasonably interfering with information sharing). Many of these actions are detailed in ONC's Report to Congress on Health Information Blocking, released in April 2015, including new certification criteria that require health IT developers to disclose any additional types of costs that a customer might incur to implement or use certified health IT; require developers to disclose, in plain language, any limitations, including contractual and technical impediments, that could prevent users from successfully implementing and using certified health IT; require developers to publicly indicate whether they take the Transparency Pledge; facilitate the publication of comparative information about health IT products by consumer research organizations for the benefit of purchasers and users; require surveillance of health IT products and capabilities in the clinical environment and not just in an artificial testing environment; require surveillance at random and in response to user complaints; subject health IT developers and/or products that fail to meet requirements to mandatory corrective action; and require publication of the corrective action information on the publicly available ONC Certified Health IT Products List (CHPL).

Patient Safety Roadmap. An ONC contractor, RTI International, developed and released the Health IT Safety Center Roadmap (Patient Safety Roadmap) proposing for a national Health IT Safety Collaborative, drawing on input from a diverse array of experts. This Patient Safety Roadmap envisions a Health IT Safety Collaborative as a trusted convener of public and private stakeholders in order to most efficiently and effectively identify, correct, and prevent patient safety issues in health IT - one of many steps ONC is taking to advance patient safety. The non-regulatory, multi-stakeholder format envisioned for the Health IT Safety Collaborative would promote the disclosure of more safety-enhancing content and serve as a center of collaboration and shared purpose for patient safety issues.

Health IT Progress Update

This section of the report primarily uses the most recently available data to provide a snapshot of the nation's health IT environment through 2014. The data reported is collected through annual surveys, resulting in a lag time between data collection and data reporting.

Health IT Adoption. Many measures exist for the adoption of EHRs. According to survey data, EHR adoption among hospitals and physicians continued to increase. In 2014, nearly all hospitals (97 percent) reported possessing certified EHR technology. Three-quarters of physicians report possessing a certified EHR.

Health Information Exchange. According to survey data, three-quarters of hospitals electronically exchange health information with outside providers, an increase of 23 percent between 2013 and 2014. Health information exchange among physicians increased during this period, but remains relatively low. In 2014, 42 percent of physicians report sharing patient health information electronically, and one-quarter (26 percent) report sharing patient health information electronically with outside providers.

Individual Access and Use of Personal Health Information. According to survey data, in 2014, nearly four in ten Americans were offered electronic access to their medical record. The proportion of Americans offered online access to their medical records rose by more than a third between 2013 and 2014. In 2014, 55 percent of individuals who were offered access viewed their information at least once within a 12-month period.

Health Information Exchange among Public Health Entities. As a result of HHS's health IT efforts, significant public health progress has occurred. According to survey data, in 2014, 90 percent of eligible professionals participating in Stage 2 of the Medicare EHR Incentive Program electronically reported immunizations to local registries and 72 percent of participating Medicare professionals who vaccinate reported electronically to an Immunization Information Services (IIS).

Key Barriers

Increasing Heath IT Adoption Across the Care Continuum. Despite substantial gains in EHR adoption, significant barriers remain for the nation to realize the full benefits of electronic health information and health IT use. Health IT adoption for providers that are not eligible for the EHR Incentive Programs lags behind. Evidence from national surveys illustrates that hospitals and ambulatory physicians have lower rates of electronic exchange with providers in these settings.

Ensuring that Electronic Health Information is Appropriately Available, Easily Transferable, and Readily Usable by the Individuals, Providers, Payers, Researchers, and Others. Widespread interoperability is another significant challenge. Currently, there is insufficient specificity when it comes to standards implementation and not enough industry-wide testing of standards prior to nationwide deployment. There is also significant variation in how health IT stakeholders interpret and implement government policies and legal requirements. Health IT stakeholders are also reluctant to embrace supportive business practices that can reinforce and expand collaborative data use arrangements and foster meaningful consumer engagement and action.

Improving the Safety and Usability of Health IT. Ensuring the safety and usability of health IT remains a key priority for stakeholders across the health care system. There is clear and emerging evidence that the broad scale implementation of health IT has augmented the general safety of health care, but there are still best practices to be agreed upon and more broadly and consistently implemented across the spectrum of health care providers and entities.

Expose and Discourage Health Information Blocking. Information blocking occurs when persons or entities knowingly and unreasonably interfere with the exchange or use of electronic health information. These practices undermine efforts to advance the use of information and technology to improve health and health care. Evidence and experience suggest that information blocking is occurring and may become even more prevalent as technical and other challenges of sharing electronic health information are reduced.

HHS Efforts to Gather and Use Recommendations

In 2015, HHS issued two documents - the Strategic Plan and the Interoperability Roadmap - that contain planned strategies, actions, and recommendations on a path forward to make electronic health information available when and where it matters most. Further, the actions described in this report augment these plans to help make secure electronic health information accessible to achieve better care, smarter spending, and healthier people. Additionally, agencies within HHS use the annual budget requests (i.e., Congressional Justification of Estimates for Appropriations Committees) to make formal recommendations to Congress to advance health IT adoption and use across the health care delivery system. This report covers efforts by HHS to gather and use recommendations to advance nationwide use of health IT and electronic health information.

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