Office of the National Coordinator for Health Information Technology
The Office of the National Coordinator for Health Information Technology is a staff division of the Office of the Secretary, within the U.S. Department of Health and Human Services. ONC leads national health IT efforts, charged as the principal federal entity to coordinate nationwide efforts to implement and use the most advanced health information technology and the electronic exchange of health information.
President George W. Bush created the position of National Coordinator on April 27, 2004 through. Congress later mandated ONC in the Health Information Technology for Economic and Clinical Health Act provisions of the American Recovery and Reinvestment Act of 2009, under the Obama Administration.
Mission
With the passage of the HITECH Act, the Office of the National Coordinator for Health Information Technology is charged with building an interoperable, private and secure nationwide health information system and supporting the widespread, meaningful use of health information technology.ONC's mission is looking ahead as it begins its second decade in 2014.
ONC is working to improve these five areas:
- Adoption: increase end user adoption of electronic health records and health IT to capture and use the information
- Standards: establish standards so the various technologies can speak to each other
- Incentives: provide the right incentives for the market to drive financial and clinical advances
- Privacy and security: make sure protected health information remains private and secure
- Governance: provide governance and structure for the exchange of health information
The mission of ONC is to optimize the paths to reach these five health IT goals along with interoperability to support the Triple Aim. Widely adopted by the healthcare sector, the Triple Aim was developed by the Institute for Healthcare Improvement to 1) improve patient experience of care, 2) improve the health of populations, and 3) reduce per capita costs of healthcare.
The Federal Health IT Strategic Plan from 2011-2015 had set these five goals
- Achieve adoption and information exchange through meaningful use of health IT
- Improve care, improve population health, and reduce healthcare costs through the use of health IT
- Inspire confidence and trust in health IT
- Empower individuals with health IT to improve their health and the health care system
- Achieve rapid learning and technological advancement
- Evolve from ARRA structure of the ONC
- Federal HIT Strategic Plan
- Develop national consensus agenda
- Health information exchange, use and infrastructure a priority focus
- Meaningful use
- Advance health IT tools in support of the Triple Aim
- Promoting development of a nationwide HIT infrastructure that allows for electronic use and exchange of information that:
- *Ensures secure and protected patient health information
- *Improves health care quality
- *Reduces health care costs
- *Informs medical decisions at the time/place of care
- *Includes meaningful public input in infrastructure development
- *Improves coordination of care and information among hospitals, labs, physicians, etc.
- *Improves public health activities and facilitates early identification/rapid response to public health emergencies
- *Facilitates health and clinical research
- *Promotes early detection, prevention, and management of chronic diseases
- *Promotes a more effective marketplace
- *Improves efforts to reduce health disparities
- Providing leadership in the development, recognition, and implementation of standards and the certification of HIT products;
- Health IT policy coordination;
- Strategic planning for HIT adoption and health information exchange; and
- Establishing governance for the Nationwide Health Information Network.
Leadership
National Coordinators
; Donald Rucker; Jon White, MD
; Vindell Washington
; Karen DeSalvo
; Jacob Reider
; Farzad Mostashari
; David Blumenthal
; Robert Kolodner
; Karen Bell
; David Brailer
Programs
The Health Information Technology for Economic and Clinical Health Act seeks to improve American health care delivery and patient care through an unprecedented investment in health information technology. The provisions of the HITECH Act are specifically designed to work together to provide the necessary assistance and technical support to providers, enable coordination and alignment within and among states, establish connectivity to the public health community in case of emergencies, and assure the workforce is properly trained and equipped to be meaningful users of Electronic Health Records.EHR Incentive Program Payments and Meaningful Use
The HITECH Act set meaningful use of interoperable EHR adoption in the health care system as a critical national goal and incentivized EHR adoption. The "goal is not adoption alone but 'meaningful use' of EHRs — that is, their use by providers to achieve significant improvements in care." The Centers for Medicare and Medicaid managed and distributed these federal funds for the meaningful use of electronic health records in conjunction with state Medicaid departments with the cooperation and support of ONC and ONC programs.
As of March 2014, more than $22.5 billion in combined Medicare and Medicaid EHR Incentive Program payments have been made since 2011. More than $14.8 billion in Medicare EHR Incentive Program payments have been made between May 2011 and March 2014. More than $7.7 billion in Medicaid EHR Incentive Program payments have been made between January 2011 and March 2014. More than 470,000 eligible professionals, eligible hospitals, and critical access hospitals are actively registered in the Medicare and Medicaid EHR Incentive Programs as of March 2014. According to Modern Healthcare, payments have been made to 90.4% of the 5,011 estimated eligible hospitals; and 69.6% of the estimated 527,200 eligible professionals.
ONC Programs
The following ONC programs help to build the foundation for every American to benefit from an electronic health record, as part of a modernized, interconnected, and vastly improved system of care delivery. Note: The list of programs below is in the process of being revised and updated.
- Health Information Technology Extension Program: A grant program to establish Health Information Technology Regional Extension Centers to offer technical assistance, guidance and information on best practices to support and accelerate health care providers’ efforts to become meaningful users of Electronic Health Records. While RECs are no longer technically funded by ONC, many of these former grantees have no-cost extensions which allows them to spend whatever is left in their respective grants, as well as find ways to continue their work. The REC program goals were to enroll 100,000 Primary Care Providers in the REC program, help them go "live" on EHRs, and help them demonstrate Meaningful Use. As of January 2014, 136,303 PCPs were enrolled, 123,770 went "live," and 85,106 had demonstrated Meaningful Use. RECs were also encouraged to reach out to all providers, not only PCPs. Among all providers, 149,315 enrolled with RECs, 132,989 went "live" on EHRs, and 89,299 demonstrated Meaningful Use. ONC continues to partner with these former grantees.
- State Health Information Exchange Cooperative Agreement Program: A grant program to support States or State Designated Entities in establishing health information exchange capability among healthcare providers and hospitals in their jurisdictions. This program was initially envisioned to support query-based health information exchange programs in each state and territory achieving health goals through health information exchange, 2) improving long-term and post-acute care transitions, 3) consumer-mediated information exchange, 4) enabling enhanced query for patient care, and 5) fostering distributed population-level analytics. As of Quarter 3 of 2013, 44 states/territories had directed exchange broadly available, with another 6 reporting regional or piloted programs. As of Quarter 3 of 2013, 32 states/territories had operational query-based exchange broadly available statewide through single or multiple services/entities, 8 had query-based exchange broadly available in regions but not statewide, and 16 did not have operational query-based exchange options available. ONC is continuing to partner with these state entities.
- Strategic Health IT Advanced Research Projects Program: A grant program to fund research focused on achieving breakthrough advances to address well-documented problems that have impeded adoption:
- *Security of Health Information Technology
- *Patient-Centered Cognitive Support
- *Healthcare Application and Network Platform Architectures
- *Secondary Use of EHR Data
- Beacon Community Program: A grant program for communities to build and strengthen their health information technology infrastructure and exchange capabilities. These communities will demonstrate the vision of a future where hospitals, clinicians, and patients are meaningful users of health IT, and together the community achieves measurable improvements in health care quality, safety, efficiency, and population health. According to a March 2013 Evaluation, "The Beacon Communities have implemented a wide variety of interventions, including innovations in care delivery, provider feedback and performance measurement initiatives, health IT development projects, and tools to improve the process of care for providers and consumers. Each Beacon Community has tailored its activities to reflect its unique resources, goals, and populations, resulting in a broad range of activities. In many cases, the Communities have chosen to focus all or some of their efforts on specific disease categories." While Beacon programs are no longer technically funded by ONC, many of these former grantees have no-cost extensions which allows them to spend whatever is left in their respective grants, as well as find ways to continue their work. ONC continues to partner with these former grantees.
- Health IT Workforce Training Programs
- Community College Consortia to Educate Health Information Technology Professionals Program: A grant program that seeks to rapidly create health IT education and training programs at Community Colleges or expand existing programs. Community Colleges funded under this initiative will establish intensive, non-degree training programs that can be completed in six months or less. This is one component of the Health IT Workforce Program.
- Program of Assistance for University-Based Training: A grant program to rapidly increase the availability of individuals qualified to serve in specific health information technology professional roles requiring university-level training. This is one component of the Health IT Workforce Program.
- Curriculum Development Centers Program: A grant program to provide $10 million in grants to institutions of higher education to support health information technology curriculum development. This is one component of the Health IT Workforce Program.
- Competency Examination for Individuals Completing Non-Degree Training Program: A grant program to provide $6 million in grants to an institution of higher education to support the development and initial administration of a set of health IT competency examinations. This is one component of the Health IT Workforce Program.
Advisory committees
Health IT Policy Committee
The Health IT Policy Committee recommends a policy framework for the development and adoption of a nationwide health information technology infrastructure that permits the electronic exchange and use of health information. Vice-chair of this committee is Paul Tang, MD, MS, who is Vice President, Chief Innovation and Technology Officer at Palo Alto Medical Foundation.
Health IT Standards Committee
The Health IT Standards Committee recommends to the National Coordinator standards, implementation specifications, and certification criteria. The Standards Committee also harmonizes, pilot tests, and ensures consistency with the Social Security Act. Vice-chair of this committee is John Halamka, MD, MS, who is Chief Information Officer of Beth Israel Deaconess Medical Center, Professor at Harvard Medical School, and a practicing Emergency Physician.