VI. Key Issues: Financing and Delivery >> A. Health Spending >> Health Cost Containment >> Improve Administration >> Health IT >> Health Information Technology for Economic and Clinical Health (HITECH) Act (last updated 1.17.16)
Lead Editor: Dana Beezley-Smith, Ph.D.
See Health IT for more information on EHRs, Meaningful Use, Data Collection and other Health IT programs
- 1 Overview
- 2 HITECH Requirements
- 2.1 Division A: Title XIII—Health Information Technology
- 2.1.1 Subtitle A—Promotion of Health Information Technology
- 2.1.2 Subtitle B—Testing of Health Information Technology
- 2.1.3 Subtitle C—Grants and Loans Funding
- 2.1.4 Subtitle D—Privacy
- 2.1 Division A: Title XIII—Health Information Technology
- 3 Evaluation of HITECH Programs
- 3.1 Regional Extension Center Program
- 3.2 Health Information Technology Workforce Development Program
- 3.3 State Health Information Exchange Cooperative Agreement Program
- 3.4 Global Assessment Monitoring the National Implementation of HITECH
- 3.5 Beacon Communities Cooperative Agreement Program
- 3.6 Strategic Health Information Technology Research Projects
The Health Information Technology for Economic and Clinical Health (HITECH) Act was enacted as title XIII of division A and title IV of division B of the American Recovery and Reinvestment Act of 2009 (ARRA), Pub. L. No. 111-5, div. A, tit. XIII, 123 Stat. 115, 226-279 and div. B, tit. IV, 123 Stat. 115, 467-496. ARRA contains incentives related to health care information technology in general (e.g. creation of a national health care infrastructure) and contains specific incentives designed to accelerate the adoption of electronic health record (EHR) systems among providers.
The Obama administration held that Health IT funding would “modernize the health care system by catalyzing the adoption of health information technology by 2014. Achieving this goal will reduce health costs for the federal government by over $12 billion over 10 years.”
According to the Department of Health and Human Services, the HITECH Act directed the National Coordinator for Health Information Technology to undertake activities “consistent with the development of a nationwide health information technology infrastructure that allows for the electronic use and exchange of information.” The 2009 Congress envisioned the secure and protected exchange of information over this infrastructure would have these benefits:
- improving quality, reducing errors and health disparities, and advancing patient-centered health care;
- reducing costs resulting from inefficiency, errors, inappropriate or duplicative care, and incomplete information;
- providing information to guide treatments decisions at the point of care;
- improving coordination among hospitals, laboratories, physician offices and other entities;
- improving public health and the rapid response to threats and emergencies, including bioterrorism and infectious disease outbreaks; facilitating research; and,
- promoting a more effective marketplace, greater competition, greater systems analysis, increased consumer choice, and improved health care outcomes.
On July 9, 2010, a final CMS rule was approved to implement the provisions of the HITECH Act that provide incentive payments to eligible professionals (EPs), eligible hospitals and critical access hospitals (CAHs) participating in Medicare and Medicaid programs that adopt and successfully demonstrate Meaningful Use of certified electronic health record (EHR) technology. This final rule specifies: the initial criteria EPs, eligible hospitals, and CAHs must meet in order to qualify for an incentive payment; calculation of the incentive payment amounts; payment adjustments under Medicare for covered professional services and inpatient hospital services provided by EPs, eligible hospitals and CAHs failing to demonstrate meaningful use of certified EHR technology; and other program participation requirements.
Division A: Title XIII—Health Information Technology
Subtitle A—Promotion of Health Information Technology
Part 1—Improving Health Care Quality, Safety, and Efficiency
Part 2—Application and use of adopted health information technology standards; Reports
- 13111 Coordination of federal activities with adopted standards and implementation specifications.
- 13112 Application to private entities.
- 13113 Study and reports.
Subtitle B—Testing of Health Information Technology
- 13201 National Institute for Standards and Technology Testing.
- 13202 Research and development programs.
Subtitle C—Grants and Loans Funding
- 13301 Grant, loan, and demonstration programs.
- 13400 Definitions: Breach Business Associate Covered Entity Disclose Electronic Health RecordHealth Care Operations Health Care Provider Health Plan National Coordinator (head of the Office of the National Coordinator for Health Information Technology) Payment Personal Health Record Protected Health Information Secretary Security State Treatment Use Vendor of Personal Health Records
Part 1—Improved Privacy Protections and Security Provisions
- 13401 Application of security provisions and penalties to business associates of covered entities; annual guidance on security provisions.
- 13402 Notification in the case of breach.
- 13403 Education on health information privacy.
- 13404 Application of privacy provisions and penalties to business associates of covered entities.
- 13405 Restrictions on certain disclosures and sales of health information; accounting of certain protected health information disclosures; access to certain information in electronic format.
- 13406 Conditions on certain contacts as part of health care operations.
- 13407 Temporary breach notification requirement for vendors of personal health records and other non-HIPAA covered entities.
- 13408 Business associate contracts required for certain entities.
- 13409 Clarification of application of wrongful disclosures criminal penalties.
- 13410 Improved enforcement.
- 13411 Audits.
Part 2—Relationship to Other Laws; Regulatory References; Effective Dates; Reports
- 13421 Relationship to other laws.
- 13422 Regulatory references.
- 13423 Effective date.
- 13424 Studies, reports, guidance.
Evaluation of HITECH Programs
Evaluating HITECH: Successes, Barriers, and Future Opportunities. Robert Wood Johnson Foundation (2015). “The HITECH Act of 2009 provided unprecedented financial and technical assistance to health professionals implementing EHRs, grants to states to establish or advance the electronic exchange of health information, and authorized the creation of programs designed to train and certify HIT professionals. As required by HITECH, ONC funded an independent evaluation of each cooperative agreement program to identify challenges, disseminate findings and inform future health policy.
Regional Extension Center Program
- Objective: The Regional Extension Center (REC) program was tasked with providing technical assistance to 100,000 small practices and health professionals serving vulnerable communities. RECs were modeled after the U.S. Department of Agriculture’s Cooperative State Research, Education, and Extension Service, with the goal of providing “boots on the ground” technical assistance to geographically defined regions of the country. Staffing included both clinical and technical experts to support a range of services, including vendor selection, EHR implementation, attestation assistance, and quality improvement activities. A total of 62 cooperative agreements were awarded to entities covering non-overlapping geographic regions defined primarily by state boundaries. Many RECs established partnerships with other entities including fellow RECs, other HITECH grantees, and state and local health departments.
- Outcome: Over 90 percent of all health professionals who sought technical assistance from an REC were successful in adopting a certified EHR system; however, less than three quarters of these entities could effectively demonstrate the meaningful use of their EHR by August 2015.
Health Information Technology Workforce Development Program
- Objective: The HIT Workforce Development Program employed a hybrid national and local approach in its design of four inter-related programs seeking to increase the number of professionals with HIT training. These programs included the development of a curriculum and supporting resources, the establishment of two training programs, and the creation of a competency exam. At the national level, ONC convened national experts to delineate a set of 12 distinct “roles” to ensure a well-rounded HIT workforce.
- Outcome: The Workforce program was generally successful in achieving its primary targets. As a result of the HITECH funding, ONC was able to publicly release a comprehensive curriculum developed by leading experts. As of March 2013, over 180,000 individuals had downloaded curriculum material from a public website. Approximately 20,000 students completed all requirements for a HIT program at one of the HITECH-funded community colleges, exceeding the programmatic goal by nearly 200 percent…In spite of these national achievements, success varied across the country…For example, among the 4,700 students who enrolled in a program at one of the eight colleges within the Northwest Community College Consortia, over 80 percent successfully completed all requirements. In contrast, the Southern Community Consortia, comprised of a total of 21 individual colleges, successfully recruited over 10,000 students; however, less than half competed the six-month program.
State Health Information Exchange Cooperative Agreement Program
- Objective: In March 2010, ONC awarded cooperative agreements to a total of 56 states, eligible territories, and qualified State Designated Entities (SDEs) to support the establishment or expansion of HIE efforts [ONC 2014a]. Grantees were given several options for governing HIE activities to carry out their core duties: administrative coordination, managing progress toward technical program goals, and convening all relevant stakeholders to support the program.
- Outcome: There is general public consensus that the State HIE program encountered a number of both anticipated and unforeseen challenges which hampered its efforts in ensuring access to electronic information exchange for all eligible health professionals. While successes were realized in several states, wide variation in the governance, funding and technical implementation of HIEs produced mixed results in the program as a whole…In addition to legislation to support HIE, many states established an “opt-out” consent model (which automatically includes patient data in the health information exchange unless s/he explicitly opts out of participation) to increase patient participation in the exchange.
Global Assessment Monitoring the National Implementation of HITECH
- Objective: The Global Assessment Monitoring the National Implementation of HITECH was established to help ONC and policymakers better understand the national impact of HITECH, as well as the interdependencies of its multiple components and potential areas for future focus, including those outside the purview of the HITECH-funded programs.
- Outcome: The products of the Global Assessment, including quarterly reports, focused research, and case studies, helped to provide an in-depth conceptualization of the multiple components of the HITECH Act and their key dependencies, as well as delineating challenges that were not directly under the control of the collective HITECH programs but would likely impact the ability to realize the HITECH objectives. A quarterly report produced as part of the Global Assessment provided ONC with a synthesis of selected statistics, activities and publicly reported information relevant to various facets of the Act and its overall impact. Focused research on a select number of “special topics” helped to provide a more in-depth understanding of issues which had the potential to significantly impact HITECH’s ultimate success, while case studies conducted at the community level helped to better assess the impact of local context on health professionals’ incentives and capacity to achieve meaningful use as well as to understand variation in program implementation.
Beacon Communities Cooperative Agreement Program
- Objective: While not mandated under HITECH, the Beacon Communities Cooperative Agreement program, identified as a White House priority, was designed to complement the mandated HITECH programs, and, as such, was included in the collection of evaluations funded by ONC. As a result, 17 regionally based communities received funding to ensure the representation of a diverse population, unique health professional characteristics and innovative approaches to the use of technology.
- Outcome: The work of the Beacon Communities is an ongoing process which will likely continue to yield valuable insights into the effective use of HIT and its potential to enhance community health and care coordination. Unfortunately, aggregate data on the impact of these investments on population health across the targeted communities is not available. Perhaps the greatest insights gained from evaluations of the Beacon Communities to date have been an enhanced understanding of the challenges that must be overcome to realize the program’s goals of building a HIT infrastructure, fostering innovation, and leveraging these efforts to improve population health, reduce costs and improve quality.
Strategic Health Information Technology Research Projects
- Objective: While not an explicit component of HITECH, the Strategic HIT Research Projects (SHARP) established a set of discrete projects overseen at the local level with an emphasis on national dissemination of project findings. Each of the grantees was tasked with exploring one of four narrowly defined challenges related to optimizing the use of HIT: issues related to privacy and security; the need for patient-centered tools; HIT product usability; and using HIT to improve clinical quality. Each grantee established multidisciplinary teams led by nationally recognized academic or medical research institutions.
- Outcome: While all SHARP grantees experienced challenges related to coordination across internal partners as well as with external stakeholders, each also encountered its own unique barriers. The team working on issues related to privacy and security reported difficulty acquiring datasets to validate their findings while the team focused on enhancing usability-reported challenges related to securing participation by commercial vendors. The SHARP team tasked with establishing patient-centered applications and tools reported difficulty gaining buy-in from the HIT community, and the team working to advance clinical knowledge found that their clinical element models could not be universally applied, requiring ongoing refinements.”