Policy Communication: HITECH ACT Health policy communication: HITECH Act

Policy description

Part of the 2009 U.S. Recovery and Reinvestment Act (ARRA) are the provisions of HITECH (Health Information Technology for Economic and Clinical Health), a major overhaul of the 1996 Health Insurance Portability and Accountability Act (HIPAA). Under HITECH, monetary incentives are delivered to healthcare providers and schemes, for employing electronic health records (EHRs); the target is to ensure EHR implementation in every single U.S. health facility by the year 2014. Further, HITECH adds stricter privacy rules, which include overseeing business partners for healthcare plans, clearinghouses and providers, notification prerequisites and further penalties for noncompliance. The requirements take effect on different dates, further complicating the process of compliance (HITECH, 2009).

HITECH laid down civil financial penalties, criminal penalties, and mandatory federal reporting requirements for security breach that caused patient privacy loss. Additionally, it offered financial support to compliance audits. The Office of Civil Rights (OCR) is in charge of handling security breach cases; more than 500 cases are reported on OCR's website. At one time, confidentiality dealt with therapeutic relationship under state supervision, but now, the concept is associated with federal supervision and rules. This affects all written, oral, and electronic interactions between clients and marriage and family therapists (MFTs), as well as discussions about clients (Hecker & Edwards, 2014).

Health-related information, under HIPAA cannot be divulged without acquiring patient permission/agreement, unless information release is imperative to administering healthcare, benefits or payment. Moreover, healthcare providers should explain privacy systems to patients on a regular basis; information should also be disclosed by patients/clients to the U.S. Department of Health and Human Services (DHHS) (Horowitz, 2011). Privacy breach penalties are now harsher than ever, under HITECH: companies may be fined no less than 250,000 dollars for patient information breach. Health program manager at Verizon's ICSA Labs, Amit Trivedi states that HITECH broadened privacy protection's scope under HIPAA, following criticisms about strict adherence to the privacy regulations. ICSA analyses EHRs for compliance with federal rules on meaningful usage. Business confederates (i.e., third-party cloud providers or billing companies) have to abide by HIPAA privacy rules, through patient information protection and reporting of any breach (Horowitz, 2011).

Role of state in policy development and implementation

HITECH posed numerous ramifications for states; it calls for leadership in two chief areas, namely, supervision of health information exchange (HIE) planning and execution, which encompasses application for and management of grant funds (which may, in part, be assigned to any state-chosen agency) and Medicaid incentive-pay management, to entitled recipients (such as providers). State governors are responsible for appointing an agency/individual in their respective states for the purpose of receiving HIE development and execution grants. HIE execution grants can only be given to state-assigned entities having a set, DHHS-approved plan; guidelines with regard to state plan's minimum requirements, and procedure of application for HIE planning grants, are available (Ellis, 2009).

HITECH's enactment integrated state government technology policies into health policy; state chief information officers (CIOs) have a central part to play in development and execution of HIE. States are bringing stakeholders together, establishing a base for implementation plan, as well as carrying out resource-connected environmental scans. The CIOs need to prove themselves as important stakeholders, for enabling them to facilitate with creation of policies, which will impact their offices. State CIOs may have direct and longstanding influence (in relation to HIE) in four broad fields: Design, Governance, Policy and Funding/Sustainability. Each of these fields is accompanied by its own distinct challenges; however, the four are correlated and dependent upon each other when it comes to deciding their individual outcomes. This major undertaking implies that the CIOs at state level need to cope with persisting critical questions, which are tricky and have complex solutions that may not be apparent (Ellis, 2009; Vinson, 2011).

The state planning phase of health information technology (HIT) after HITECH's promulgation has begun despite wide variations in individual states' HIE/HIT planning progress. Rapidly advancing states owe their progress to pioneers who started early efforts for laying the foundation of HIT/HIE, with an aim to propel their state towards the forefront of the HIT domain. A number of states are reviewing original HIE plans and evaluating their HITECH grant eligibility independently. HITECH delegated a considerable number of new duties to states, in terms of HIE supervision and HIE planning and execution grants. In the initial phase of planning, state CIOs have to secure a place for themselves as major stakeholders, in addition to identifying strengths and ascertaining weaknesses which need to be resolved in their respective offices, in relation to HIE/HIT planning across the state. CIOs should look into their...

HITECH's enactment has aborted some such efforts, or they may potentially alter or get restructured for suiting the new, mandated frameworks and upcoming standards. State-level CIOs can participate in statewide HIE planning and assist their states in becoming eligible for grants in following ways (Vinson, 2011; Hecker & Edwards, 2014):
Organize and participate in environmental scanning of current enterprise-wide health legacy structures, which may require replacement or upgrading. Investigate state's HIT assets to help decide which assets must be leveraged upon reaching competitive grant stage.

Team up with organizational stakeholders and get in touch with Medicaid leaders, healthcare policy, and public health counselors to state governors. Identify the HIT spokesperson, as well as the individual (if any) selected as overall state leader for HIT/HIE. State CIOs should comprehend the scale of participating stakeholders and determine the main parties with whom relationships need to be cultivated.

Recognize and ascertain the different federal agencies, chiefly via the DHHS (Office of the National Coordinator (ONC) for HIT, Centers for Medicare & Medicaid Services (CMS), AHRQ, Centers for Disease Control and Prevention (CDC), IHS, Health Resources and Services Administration (HRSA)), which will finance state-HIT. Furthermore, HIT-financing streams will affect the federal Veteran Affairs Department (VA), Defense, Agricultural and Commercial Departments, Social Security Administration (SSA), and NIST (National Institute of Standards and Technology), and percolate to states.

Detect and get involved with currently available opportunities. Different state-level work groups and agencies may develop, brought into existence by the state-governor-assigned HIE/HIT leader. Involvement of state CIOs in the right places is crucial (Heckerr & Edwards, 2014; Vinson, 2011; Horowitz, 2011).

Role of the legislative committee

President Barack Obama signed HITECH on the 17th of February, 2009, under the ARRA. HITECH is overseen by Office of the National Coordinator (ONC), and includes specific incentives devised for hastening HIT implementation by the healthcare sector, providers, patients, and consumers. HITECH aims at facilitating care quality enhancements, fostering affordability, and improving U.S. healthcare outcomes. The chief federal authority responsible for managing countrywide HIT/HIE adoption efforts is the ONC. One of the provisions of the ARRA was institution of HIT Standards and HIT Policy Committees, under FACA-patronage (Federal Advisory Committee Act) (Nicholls, 2010; Hecker & Edwards, 2014).

The aforementioned bodies were assigned the following roles and functions: a) The HIT Policy Committee was made responsible for advising the National HIT Coordinator with regards to a policy structure for formulating and executing a countrywide HIT infrastructure, including HIE standards, and b) The HIT Standards Committee was allotted the duty of advising the National HIT Coordinator on standards, HIE certification criteria and HIT implementation stipulations; in the early stages, this body would concentrate on the HIT Policy Committee's framed policies. Both committees would, at the outset, concentrate their efforts on outlining parameters dealing with defining "meaningful use" about EHR utilization by physician. The HIT Standards Committee builds upon earlier works of the HIT-SP (Standards Panel); a preliminary collection of privacy and security standards in line with ARRA prerequisites was approved in July 2009 (Vinson, 2011; Nicholls, 2010).

The HIT Policy Committee was made responsible for advising the National HIT Coordinator with regards to a policy structure for formulating and executing a countrywide HIT infrastructure, including HIE standards. ARRA stipulates that the HIT Policy Committee must, at any rate, advice the National HIT Coordinator on fields wherein standards, certification conditions, and implementation stipulations are required in 8 distinct domains. The HIT Standards Committee was allotted the duty of advising the National HIT Coordinator on standards, HIE certification criteria, and HIT implementation stipulations. Initially, the emphasis of HIT Standards Committee will be on policies developed in the above eight domains. In three months of ARRA's enactment, the HIT Standards Committee is required to create an agenda for policy-recommendation assessment (formulated by the HIT Policy Committee); this requires updating on a yearly basis. Moreover, the HIT Standards Committee, while creating, standardizing, or acknowledging implementation conditions and standards, will provide for NIST-administered testing for the above conditions and standards (Nicholls, 2010; Horowitz, 2011).

Affected population

Health schemes, healthcare providers, or clearinghouses can be covered entities (CEs). Healthcare providers can only be categorized as CEs if they pass-on electronic healthcare data in relation to DHHS-standardized transactions. These encompass providers like healthcare centers or clinics, physicians, pharmacies, dentists, mental health therapists,…