The Office of the National Coordinator for Health Information Technology has adopted a new strategic plan that seeks to keep up the momentum of health IT adoption while taking steps to improve the penetration of information technology beyond hospitals and physician practices.
Under the American Recovery and Reinvestment Act's electronic health-record incentive payment program, which has paid out nearly $25.8 billion since 2011, 94% of eligible hospitals and 79% of eligible physicians have received payment for either purchasing or meaningfully using a tested and certified EHR.
But the program left gaps by not extending payments to behavioral health, long-term care and other providers, said Dr. Karen DeSalvo, head of the ONC. The ONC and other federal agencies are looking at ways to help these excluded providers cover the cost of buying EHRs.
The new plan calls for “emphasizing assistance for healthcare providers serving long-term and post-acute care, behavioral health, community-based, and other populations ineligible to participate in the Medicare and Medicaid EHR incentives.”
“Where I'd like the country to be is where Vermont is,” DeSalvo said, where almost all behavioral health providers in the state are connected to health information exchanges used by general-care hospitals and physicians.
Protecting the privacy and security of health information was one of the plan's objectives under the goal of secure interoperability. Behavioral health information presents a particularly gnarly problem for general-care providers because much of it is covered under a separate federal privacy law more stringent than the Health Insurance Portability and Accountability Act privacy rules.
The latest federal strategic plan calls for “the development of policy, standards and technology to facilitate patients' ability to control the disclosure of specific information that is considered by many to be sensitive in nature (such as information related to substance abuse treatment, reproductive health, mental health or HIV.)”
A strategy to achieve that goal would be “to require and test that certified health IT products incorporate privacy and security standards,” it said.
Currently, software systems to record patient consent and control the flow of their medical records to others are available, but those functions are not required under the testing and certification criteria of the federal EHR incentive payment program.
In June, a privacy and security workgroup that makes recommendations to an ONC advisory panel suggested the ONC should only take “baby steps” and embrace voluntary testing and certification requirements for such privacy protecting technologies—known as data segmentation for privacy, or DS4P.
The ONC has worked with private sector EHR developers, the standards development organization Health Level Seven, and the Substance Abuse and Mental Health Services Administration at HHS on developing and pilot testing the data segmentation technologies.
ONC is looking at ways it could support the capabilities for health information involving substance abuse or mental health treatment, DeSalvo said. “We've heard a lot for questions from consumers and privacy (advocates)” about that, she said.
The 28-page Federal Health IT Strategic Plan (PDF) covers the years 2015 to 2020 and is an update of an earlier five-year plan released by the ONC in 2011.
The ONC is mandated to provide periodic, long-range national health IT plans by the American Recovery and Reinvestment Act of 2009, which created the federal incentive payment program for the adoption of EHRs.
DeSalvo said more than 35 federal agencies, including the federal government's own healthcare delivery giants, the Defense Department's Military Health System and the Veterans Affairs Department's Veterans Health Administration, participated in drafting the plan, which for many of the federal agencies, includes three-year and six-year outcomes milestones.
The strategic plan includes 14 objectives under five broad goals: expanding the adoption of health IT, advancing secure and interoperable health information, strengthening healthcare delivery, advancing the health and wellbeing of individuals and communities, and advancing research, scientific knowledge and innovation.
Promoting health information exchange is the subject of its own detailed federal interoperability plan expected to be released by the ONC early next year.
The ONC's strategic plan is open for public comment through Feb. 6.
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