ARRA

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The American Recovery and Reinvestment Act (ARRA) became law on February 17th, 2009 [1]. The ARRA is a $789 billion economic stimulus package, passed by the Office of the National Coordinator for Health Information Technology (ONCHIT or ONC).

Health Information Technology Economy and Clinical Health (HITECH)

The Health Information Technology Economy and Clinical Health Act (HITECH) is part of the ARRA legislation, Division A: title XIII, title XXX; Division B: title IV. HITECH encourages adoption of comprehensive electronic medical records (EMR) systems by physicians and hospitals. The act allocates $19 billion to hospitals and physicians who demonstrate meaningful use of certified electronic medical records.

The Congressional Budget Office estimates that 90 of physicians and 70 percent of hospitals will use these systems by 2020 due to this legislation. The following sections summarize the major points of HITECH.

Establishment of ONCHIT

Within the Department of Health and Human services, the Office of the National Coordinator of Health Information Technology will oversee the development of national health IT infrastructure and its requisite standards. (sections 13101 and 3000-3007) "The National Coordinator shall maintain and frequently update an Internet website on which there is posted information on the work, schedules, reports, recommendations, and other information to ensure transparency in promotion of a nationwide health information infrastructure."

The HIT Policy Committee

Section 3002

The HIT Standards Committee

Section 3003

Defining the Qualified Elctronic Health Record

Such systems contain health information including medical history and problem lists, patient demographics, clinical decision support, physician order entry support, quality reporting support, and data exchange with other electronic sources. Specific criteria for "certification" are to be developed by the National Coordinator in consultation with the Director of the National Institute of Standards and Technology.


Financial Incentives

HITECH provides $20 Billion in potential incentives to physicians and hospitals for "meaningful users" of certified EMR systems. The elibility period runs from 2011-2016. Users (prior to 2014) may receive up to $18k for year one, $12k for year two, $8k for year three, $4k for year four, and $2k for year 5 of eligibility. Incentive is 10% higher in health professions shortage areas. Meaningful use includes electronic prescribing, electronic information exchange, and reporting quality measures. "The eligible professional demonstates to satisfaction of the Secretary (HHS)... ...is using certified EHR technology in a meaningful manner..." $2 Billion is available as grants and loans to support health information technology research and development of a national health IT network (sections 13301 and 3013-3015.)

Financial Penalties

Per section 3006, private entities, including government contractors, are not required to implement meaningful use of certified EMR. However, The National Coordinator may assess a "nominal fee" for the adoption by health care provider of a certified EMR or for provding such technology. For non-users, reimbursement decreases by 1% per year from 2015-2017. If the percentage of EMR users is still >75% of eligible professionals, remibursement decreases by 1% per year, but not may not exceed a 5% reduction. "Significant Hardship" exception to payment adjustments may apply on a case-by-case basis, for up to 5 years, to eligible non-users "such as in the case of an eligible professional who practices in a rural area without sufficient internet access."

Privacy and Security

HITECH gives states' attorneys general the authority to prosecute HIPAA violations (section 13410). HITECH takes into account the HIPAA laws pertaining to health information standards and implementation. Business Associates of Covered Entities are now subject to the same HIPAA security provisions and the business associate agreement must reflect this change. Civil and Criminal penalties now apply to both Covered Entities and their business associates. In the event of a security breach, all individuals with at risk unprotected health information must be notified by the Covered Entity, and Business Associates must notify their respective Covered Entities. All notifications must be made within 60 days from the first discovery of the security breach. Notification may be via certified mail, electronic mail, and/or public anouncement on the Covered Entities website and broadcast/print media. Media notification is required if at least 500 individuals are potentially affected. In that case HHS Secretary is also notified to place a notice on the DHS website.



References

  1. "Public Law 111-5 [2] (retrieved 2/28/2010)
  2. "Title IV-Health Information for Economic and Clinical Health Act" [3] (retrieved 2/28/2010)