Monday, March 28, 2011

The Federal Health IT Strategic Plan

On Friday, March 25, ONC released the Federal Healthcare IT Strategic Plan 2011-2015.

Here's an outline of the five goals and a bit of commentary:

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

A.  Accelerate adoption of electronic health records
*Provide financial incentive payments for the adoption and meaningful use of certified EHR technology.
*Provide implementation support to health care providers to help them adopt, implement, and use certified EHR technology.
*Support the development of a trained workforce to implement and use health IT technologies.
*Encourage the inclusion of meaningful use in professional certification and medical education.
*Establish criteria and a process to certify EHR technology that can support meaningful use criteria.
*Communicate the value of EHRs and the benefits of achieving meaningful use.
*Align federal programs and services with the adoption and meaningful use of certified EHR technology.
*Work with private sector payers and provider groups to encourage providers to achieve meaningful use.
*Encourage and facilitate improved usability of EHR technology.

B.  Facilitate information exchange to support meaningful use of electronic health records
*Foster business models that create health information exchange.
*Monitor health information exchange options and fill the gaps for providers that do not have viable options.
*Ensure that health information exchange takes place across individual exchange models, and advance health systems and data interoperability.

C.  Support health IT adoption and information exchange for public health and populations with unique needs
*Ensure public health agencies are able to receive and share information with providers using certified EHR technology.
*Track health disparities and promote health IT that reduces them.
*Support health IT adoption and information exchange in long-term/post-acute, behavioral health, and emergency care settings.

Goal II: 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
*Identify and implement best practices that use EHRs and other health IT to improve care, efficiency, and population health.
*Create administrative efficiencies to reduce cost and burden for providers, payers, and government health programs.

B.  Better manage care, efficiency, and population health through EHR-generated reporting measures
*Identify specific measures that align with the National Health Care Quality Strategy and Plan.
*Establish standards, specifications, and certification criteria for collecting and reporting measures through certified EHR technology.

C.  Demonstrate health IT-enabled reform of payment structures, clinical practices, and population health management
*Fund and administer demonstration communities to show how the advanced use of health IT can achieve measurable improvements in care, efficiency, and population health.
*Align health IT initiatives and clinical and payment reform pilots and demonstrations.

D.  Support new approaches to the use of health IT in research, public and population health, and national health security
*Establish new approaches to and identify ways health IT can support national prevention, health promotion, public health, and national health security.
*Invest in health IT infrastructure to support the National Prevention and Health Promotion Strategy.
*Ensure a mechanism for information exchange in support of research and the translation of research findings back into clinical practice.

Goal III: Inspire Confidence and Trust in Health IT

A.  Protect confidentiality, integrity, and availability of health information
*Promulgate appropriate and enforceable federal policies to protect the privacy and security of health information.
*Enforce existing federal privacy and security laws and maintain consistency with federal confidentiality, policy.
*Encourage the incorporation of privacy and security functionality into health IT.
*Identify health IT system security vulnerabilities and develop strategic solutions.
*Identify health IT privacy and security requirements and best practices, and communicate them through health IT programs.

B.  Inform individuals of their rights and increase transparency regarding the uses of protected health information
*Inform individuals about their privacy and security rights and how their information may be used and shared.
*Increase transparency regarding the development of policies and standards related to uses and sharing of protected health information.
*Require easy to understand reporting of breach notifications.

C.  Improve safety and effectiveness of health IT
*Provide implementation and best practice tools for the effective use of health IT.
*Evaluate safety concerns and update approach to health IT safety.
*Monitor patient safety issues related to health IT and address concerns.

Goal IV: Empower Individuals with Health IT to Improve their Health and the Health Care System

A.  Engage individuals with health IT
*Listen to individuals and implement health IT policies and programs to meet their interests.
* Communicate with individuals openly and spread messages through existing communication networks and dialogues.

B.  Accelerate individual and caregiver access to their electronic health information in a format they can use and reuse
*Through Medicare and Medicaid EHR Incentive Programs, encourage providers to give patients access to their health information in an electronic format.
*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.
*Establish public policies that foster individual and caregiver access to their health information while protecting privacy and security.

C.  Integrate patient-generated health information and consumer health IT with clinical applications to support patient-centered care
*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.
*Solicit and integrate patient-generated health information into EHRs and quality measurements.
*Encourage the use of consumer health IT to move toward patient-centered care.

Goal V: Achieve Rapid Learning and Technological Advancement

A.  Lead the creation of a learning health system to support quality, research, and public/population health
*Establish an initial group of learning health system participants.
*Develop standards, policies, and technologies to connect individual participants within the learning health system.
*Engage patients, providers, researchers, and institutions to exchange information through the learning health system.
*Grow the learning health system by adding more members and expanding policies and
population standards as needed.

B.  Broaden the capacity of health IT through innovation and research
*Liberate health data to enable health IT innovation.
*Make targeted investments in health IT research.
*Employ government programs and services as test beds for innovative health IT.
*Monitor and promote industry innovation.
*Provide clear direction to the health IT industry regarding government roles and policies for protecting individuals while not stifling innovation.

As I read the report, there were a few paragraphs I found particularly interesting.   I believe they suggest important directions to watch:

*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.

*For providers ineligible for incentive payments (for example, long-term and post-acute care facilities, community mental health centers, or substance use disorder treatment providers), the government is developing technology and policy solutions that build on meaningful use and fit their unique needs.

*The health information exchange strategy in Goal I focuses on first fostering exchange that is already happening today, supporting exchange where it is not taking place, and creating means for exchange between local initiatives.

*Goal IV recognizes the importance of engaging and empowering individuals with electronic health information in order to move to patient-centered care, and proposes strategies for doing so.

*Goal V includes a clear vision and path forward for building a “learning health system" that will become increasingly prominent over the next several years.

Of note, ICD-10 is mentioned only once (page 24) and X12 5010 is not mentioned at all.   The justification for work on ICD-10 is "ICD-10-CM/PCS code sets will enable a more granular understanding of health care treatments and outcomes, and more complete analyses of treatment costs, ultimately allowing for better disease management and more efficient health care delivery."    My personal opinion is that we should defer the work on ICD-10 while we're navigating meaningful use stage 1, 2 and 3.    Accurate coding requires comprehensive clinical documentation on the front end including adoption of clinical vocabularies such as SNOMED-CT.   Let's enhance our front end documentation before thinking about the back end coding.

Overall the Federal Strategic plan is a winner - it melds Meaningful Use, Certification, Health Information Exchange, PCAST, and the Institute of Medicine work on creating a learning healthcare system.

The next National Coordinator will have the benefit of a great strategic plan - David Blumenthal's parting gift.


Unknown said...

Nice post John. We should all be grateful for Dr. Blumenthal's exceptional work during the past two years. The only concern I have is the presentation of IT security as a goal - it is a foundational element of health IT transformation. Without security no other goals are possible. I welcome you and others to read my blog post on this issue: Thanks.

Stanley Nachimson said...

John, I am struck by your comments on the lack of mention of X12/5010 and the small reference to ICD-10. In reviewing the plan, there is only a passing reference to demonstration projects for funding. What this implies to me is the continued "disconnect" between the efforts to improve clinical HIT (EHRs) and the efforts to improve administrative HIT. These two should be closely linked in any HIT strategic plan.

Regarding ICD-10, I believe we should continue our efforts to implement this initiative as it will provide further incentive for the adoption of EHRs as a documentation tool. By providing payment based on ICD-10, providers will have a greater interest in documenting to the greater specificity the code set requires.