How does NIST fit into HITECH Certification and Meaningful Use (MU)?

NIST is the National Institute of Standards and Technology and was formerly known as the National Bureau of Standards (NBS) between 1901 and 1988. NIST is a measurement standards laboratory which is a laboratory of metrology, the science of measurement, which establishes standards for a country or organization. NIST is a non-regulatory federal agency within the U.S. Department of Commerce. NIST's mission is to promote U.S. innovation and industrial competitiveness by advancing measurement science, standards, and technology in ways that enhance economic security and improve quality of life. Their core competencies include measurement science, rigorous traceability and development and use of standards.

The American Recovery and Reinvestment Act of 2009 encourages eligible professionals, eligible hospitals and critical access hospitals to move toward the use of electronic health records. The ARRA legislation calls for the Office of the National Coordinator (ONC) for Health IT, in consultation with NIST, to establish a program for the testing and certification of health information technology as being in compliance with certification criteria to meet defined meaningful use requirements.

In collaboration with ONC, NIST developed testing requirements, test cases, and test tools in support of the health IT certification program. NIST’s approved test procedures can be viewed here. Questions about the test procedures can be sent to NIST at hit-tst-fdbk@nist.gov.

What is ARRA?

ARRA is the American Recovery and Reinvestment Act of 2009. This Act, commonly referred to as ‘the Stimulus’ or ‘The Recovery Act,’ was passed by Congress on February 17, 2009. ARRA was the government’s response to the economic crisis. The Act includes a number of projects and programs but its immediate goals were the following:  

• Stimulate economic activity and invest in the nation’s long-term growth
• Provide assistance to those most impacted by the economic recession
• Produce new jobs and protect existing jobs
• Increase levels of accountability and transparency in government spending

ARRA contains general incentives related to health care information technology in, such as the creation of a national health care infrastructure, and specific incentives designed to encourage the adoption of certified electronic health record (EHR) systems among hospitals and providers. In addition to the programs related to the healthcare industry, ARRA also addresses tax incentives for individuals and companies, and programs related to education, infrastructure, transportation, energy infrastructure, housing, scientific research, government buildings and facilities, etc.

To read more about ARRA and track the spending related to this Act, visit http://www.recovery.gov/.

What is the HITECH Act?

The Health Information Technology for Economic and Clinical Health (HITECH) Act is part of the American Recovery and Reinvestment Act of 2009 (ARRA) which was passed February 17, 2009. According to the Final Rule documentation, two titles of the ARRA , Title IV of Division B and Title XIII of Division A, constitute the Health Information Technology for Economic and Clinical Health Act or HITECH Act. Title IV amends the Social Security Act to establish incentive payment programs for eligible professionals, eligible hospitals, critical access hospitals and Medicare Advantage Organizations to encourage these entities to adopt meaningful use of healthcare information and certified electronic health records.

The bill has four main goals to improve health information technology:

• Give the government a leadership role in the development of standards in the general use of and the exchange of electronic health information. These standards are intended to improve quality and coordination of care.
• Invest billions of dollars in healthcare infrastructure and incentive programs to reward eligible professionals (EP) and hospitals that use certified systems to electronically exchange patient information.
• Save billions of dollars by improving quality and coordination of care and reducing medical errors and duplicative care.
• Strengthen requirements on security and privacy related to healthcare information.

While the U.S. Government has been encouraging the healthcare industry to move toward electronic health records since 2004, they received limited response. President Bush set aside millions of dollars to fund demonstration projects to ‘test the effectiveness of health information technology and establish best practices for more widespread adoption in the healthcare industry’ and established the Office of the National Coordinator for Health Information Technology to lead the way. The HITECH Act, put in place by the Obama Administration, has established a less voluntary approach since there are financial incentives for those who participate and financial penalties for those who choose not participate or do not adopt in a timely manner.

Common Acronyms for HITECH Certification and Meaningful Use (MU)

While reading through all of the HITECH Certification and Meaningful Use (MU) articles, procedures, laws, etc., one difficulty I've found in fully understanding the documentation is due to the number of acronyms used by the writers. So, I thought it might be helpful to get a list of the most common acronyms and not only define what they stand for, but write a short piece on each to give people an idea about how each fits into certification and meaningful use (MU).

 

Here's my list:

• HITECH - Health Information Technology for Economic and Clinical Health Act
• ARRA - American Recovery and Reinvestment Act of 2009
• NIST - National Institute of Standards and Technology
• ONC - Office of the National Coordinator for Health Information Technology
• CMS - Centers for Medicare & Medicaid Services
• EHR - Electronic Health Record
• EP - Eligible Professional
• CAH - Critical Access Hospital
• PQRI - Physician Quality Reporting Initiative
• A/I/U - Adopt, Implement, or Upgrade
• CCN - CMS Certification Number
• CQM - Clinical Quality Measure
• HIT - Health Information Technology

Over the next week or so I will post the definitions of these acronyms - tune back in to read more about these important certification and MU concepts.

 

If there is an acronym that I left off that you think should be included in the list, post a comment and I will research it for you!

Complete EHR vs. Modular EHR

In order for providers and hospitals to attest to ‘Meaningful Use’ and receive incentive payments, they will first need a Certified Electronic Health Record (EHR).  EHR's can be certified in one of two ways: Complete EHR Certification or Modular EHR Certification. 

Complete EHR
A complete EHR has been tested and certified by an Authorized Testing and Certification Body (ACTB) and meets all of the government’s requirements as a whole.  This means that if an eligible professional (EP) or hospital implements a complete EHR, they can register for the Medicare EHR Incentive Program and begin attesting to Meaningful Use criteria once they have met meaningful use for a consecutive 90-day reporting period.  EP’s and hospitals will need to register on the CMS website to attest Meaningful Use (MU).

Unfortunately, with a complete EHR, you cannot buy individual pieces of the system and assume that the pieces are certified as modules.   

Modular EHR
A modular EHR allows an EP or hospital to combine certified modules from different systems in order to meet the government requirements for a certified EHR.  For modular certification, the ONC Certification Numbers for each of the certified products must be collected and submitted to ONC as a ‘package’ solution.  ONC reviews the package solution and if it meets all requirements for a certified system, they issue a new certification number which is used to attest Meaningful Use (MU).

A modular approach may be seen as a more complex solution due to the work required ensuring all modules integrate together, but the modular approach also has a number of advantages:

·    Complete EHR's can be very expensive compared to the modular approach.

·    If an EP or hospital already has a module(s) in place that staff is familiar with, it may be inefficient and costly to train the staff on a new system.  

·    Transferring data to a new system may be time consuming and costly.

·    The modular approach allows the EP or hospital to use their vendor of choice for each application. 

A modular approach also allows an EP or hospital to buy certain certified modules in addition to self-certifying their homegrown system to meet the requirements on the remaining modules. 

Using a Complete EHR and Certified Modules
The ONC Regulations FAQ 9-10-014-1 clarifies the rules further to include the possibility of using a certified module in addition to possessing a complete EHR if the modular function is preferred or superior to the function in the complete EHR. 

Meeting the definition of Certified EHR Technology can be achieved in numerous ways; including using EHR technologies that perform duplicative or overlapping capabilities (if that is what an eligible health care provider chooses to do) so long as all of the applicable certification criteria adopted by the Secretary have been met and those EHR technologies are certified. Consequently, an eligible health care provider could use both certified capabilities (e.g., CPOE) at the same time in two different sections/departments of its organization. The eligible health care provider would however be responsible for reconciling the data between those two certified capabilities for purposes of reporting to CMS or the States.

Dynamic Health IT
Dynamic Health IT is ready to assist you or can take the lead role in your certification process.  We offer practical and effective solutions, including software addressing HITECH Certification criteria which can easily be integrated with your current systems.  We have expertise with the criteria and certification methodology used by the most popular ATCB’s – CCHIT and Drummond Group.