HIE HITECH ARRA Fact Sheet - himss

HIMSS Health Information Exchange
ARRA HITECH FAQs Related to HIE
1. What is the ARRA HITECH Act and how does it impact health information
exchange (HIE) efforts in the United States?
ARRA refers to the American Recovery and Reinvestment Act, also known as the “stimulus bill” that was
signed into law on February 17, 2009. The Health Information Technology for Economic and Clinical
Health (HITECH) Act is a subset of ARRA that was an “act within the act” embedded in the ARRA
legislation. Whereas ARRA includes $787 billion in total economic stimulus for the United States
economy, HITECH addresses a subset—about $36 billion in funding—which is specifically aimed at
helping healthcare providers obtain meaningful use of health information technology (HIT), including
electronic health records (EHRs) and care coordination through health information exchange (HIE). Most
HITECH dollars will be paid out as Medicaid and Medicare incentive payments to healthcare providers
beginning in 2011. However, an expected $2 billion in HITECH funding will be distributed across all 50
states and 6 territories to help advance the creation and expansion of HIE infrastructure and services. $1.2
billion in HITECH funding opportunities were announced in August, 2009.
Additional information:
• HIMSS Web site: ARRA – HITECH and Healthcare Reform
• HHS:: HealthIT.hhs.gov: Recovery.gov
2. What funding opportunities does HITECH offer?
Health Information Technology Regional Extension Centers
The National HIT Extension program is designed to support the training and consulting needs of the many
healthcare providers seeking to adopt EHRs and achieve meaningful use by offering “education, outreach
and technical assistance, to help providers in their geographic service areas select, successfully implement,
and meaningfully use certified EHR technology to improve the quality and value of health care.” This
program collaborates with a set of regional extension centers (RECs) and is widely expected to be statelevel
programs for most states. The grants for these REC programs are competitive with awards expected to
range from a few million dollars to $30 million. They are planned to be made in two rounds to be awarded
in January and March, 2010—totaling about $640 million. Government agencies are not eligible to receive
these funds—only not-for-profit organizations may apply—and awards will cover geographic areas that
cannot overlap (multi-state awards are possible).
HIE Cooperative Agreement Program
The HIE Cooperative Agreement Program is designed to support the development of HIE infrastructure
and capacity in all states—especially in support of the meaningful use of EHRs relevant to health
information exchange. The related grants are available only to a state, or qualified State Designated Entities
(SDEs) designated by a state governor. An SDE must be a non-profit organization with a governance body
that is broad and diverse, and must closely collaborate with state agencies such as Medicaid. The state (or
the SDE) may sub-contract to achieve their program objectives. Funding under this program will start in
January, 2010. The program will award $564 million with at least $4 million for each state and at most $40
million to a single state.
© 2009 Healthcare Information and Management Systems Society (HIMSS). 1

EHR Adoption Loan Program
This is a federal grant program in which states are the grantees that, in turn, use the money to fund a loan
program to healthcare providers to purchase, use, support, and provide training on EHRs and secure
electronic health information exchange. The loans can be made to purchase EHRs, utilize EHRs (including
upgrades to meet meaningful use objectives), train personnel, and improve HIE. The loans can be made
below market interest rates for up to 10 years. Specifics on this program have not yet been announced by
the Office of the National Coordinator for Health Information Technology (ONC.)
Workforce Training Grants
This grant program is designed to integrate informatics training into programs for educating those in the
healthcare professions—especially physicians, nurses, physician assistants and dentists. There is also a
training program grant that focuses on expanding training in medical informatics to both health
professionals and information technology professionals. ONC has recently announced the availability of
$80 million in grants – $70 million for community college training programs and $10 million to develop
educational materials to support these programs. Details of this program will follow.
Healthcare Information Enterprise Integration Research Centers
This grant program contains funding for eligible institutions to establish centers for research in health
information integration. Announcements from the government regarding the details of the funding have
not been published yet.
Medicare/Medicaid EHR Adoption Incentives
This is an incentive program in which about $36 billion (approx $20 billion net) is set aside to reward
Medicaid and Medicare providers for meaningful use of EHRs. The Medicaid program and the Medicare
program have significant tactical differences. The Medicaid program is a reimbursement program for EHR
adoption that will be administered by each state with reimbursements that may be as large as $65,000 per
eligible professional (physician, dentist, certified nurse mid-wife, nurse practitioner, and certain physician
assistants). The Medicare program provides up to $44,000 ($48,500 for those in healthcare shortage areas)
through 2015 per eligible professional (physician, dentist, optometrist, podiatrist, and [limited]
chiropractors). The Medicare program also has a penalty phase that withholds an increasing percentage of
Medicare reimbursements for non-EHR adoption starting in 2016. These programs also are extended to
hospitals and federally qualified health centers. Healthcare providers may participate in only one of these
two programs; it not yet clear whether hospitals are eligible to participate in both programs simultaneously.
Beacon Community Cooperative Agreement Program
This grant program is aimed at established communities with the goal of building upon existing technical
infrastructure to enhance the community’s ability to achieve meaningful use through a wide variety of
possible activities. Communities must already have 30% adoption of EHR systems (25% in rural areas),
and funding cannot be used to support EHR adoption for providers already eligible for CMS incentives.
$220 million will be available over 36 months to fund up to fifteen qualified applicants through a
cooperative agreement with ONC. Awards, which are expected to be made in March 2010, will be between
$10 and $20 million. Eligible applicants include not-for-profit and government agencies.
Addition information:
• HHS: HealthIT.hhs: Funding Opportunities
• Medicare and Medicaid Health Information Technology: TITLE IV OF THE AMERICAN
RECOVERY AND REINVESTMENT ACT
• HIMSS Web site: ARRA – HITECH and Healthcare Reform
© 2009 Healthcare Information and Management Systems Society (HIMSS). 2

3. I keep hearing about “Meaningful Use.” What does that mean and how is that
relevant to qualifying for HITECH incentives?
The HITECH Act requires that providers demonstrate “meaningful use” of health information technology
to receive HITECH incentives. The text of the Act indicates that meaningful use includes electronic
prescribing, electronic exchange of health information, and submission of information on clinical quality
measures. The intended approach to meeting the meaningful use guidelines is for providers to use an EHR
in conjunction with and HIE of some type. ONC provided draft guidelines on Meaningful Use in June,
2009 and a modified version in July, 2009. The draft guidelines propose three sets of criteria, one each for
2011, 2013 and 2015. Conceptually, the 2011 criteria address capture and sharing of data; the 2013 criteria
address advanced care processes with decision support; and the 2015 criteria address improved outcomes.
The proposed rule making process for Meaningful Use is anticipated to be released in December, 2009.
Additional Information:
• HHS: healthit.hhs.gov: Meaningful Use
• HIMSS Economic Stimulus for the Healthcare IT Industry
4. How is HIE relevant to achieve Meaningful Use?
To meet the definition of meaningful use, it is expected that healthcare providers will implement and use an
EHR and then exchange information electronically with other healthcare organizations. While HIE is not
overtly required in the draft meaningful use definition, several of the requirements are services or
capabilities commonly offered or facilitated by HIEs. Furthermore, the HITECH Act includes funding for
states to create and/or grow their HIE infrastructure to help providers prepare for and meet meaningful use.
The final meaningful use guidelines are expected to be written such that providers will have a path to meet
the definition whether or not they are in a community with an established HIE.
5. Where can providers go for assistance and support?
There are several sources of support that may be available to providers, including:
• Regional extension centers (RECs), as mandated in the economic stimulus legislation, will provide
direct support to providers. These centers will provide technical assistance and help with
implementation for both physicians and hospitals, from selecting vendors to changing workflow
patterns to improving clinical performance. The names, contact information, and service areas for
regional extension centers will be published by ONC when available.
• EHR system vendors are a key source of support. Services are sometimes bundled with software
purchase or may be priced separately. Authorized (and unaffiliated) third-party vendors often
supplement vendor support.
• HIEs may provide support for EHR systems and for HIE implementation.
• Professional societies and organizations (e.g., hospital associations, local medical associations, or local
chapters of national medical associations) may provide additional support for their members or others
in the community.
6. How should a hospital prepare to achieve the HIE requirement/aspects of
meaningful use?
© 2009 Healthcare Information and Management Systems Society (HIMSS). 3

Hospitals can take several steps, including:
o Hospitals should take an inventory of the ways that health information is currently exchanged, both
within their organization and to outside entities. This may include demographic data, lab results,
immunization and disease registries, e-prescribing, public health disease and syndromic surveillance.
o Hospitals should also review local or regional HIE activities that are taking place in the community.
o Hospitals should review the state’s strategy for HIE. States are now developing their HIE strategic
plans under the state coorperative agreement program . Hospitals need to understand the options and
resources available to support their involvement in achieving exchange of health information.
o Hospitals should then define their strategy for extending their ability to exchange health information
and stay informed as the 2013 and 2015 health information exchange meaningful use requirements
are defined.
7. How should a physician practice prepare to achieve the HIE requirement/aspects
of meaningful use?
Physicians can take several steps, including:
o Physician practices should first take an inventory of the ways that health information is currently
exchanged within the practice. This may include demographic data, lab results, PQRI data, or
immunization data.
o Physician practices should also review local or regional HIE activities that are taking place in the
community, including reference labs, hospitals or other organizations.
o Physician practices should review the state’s strategy for HIE. States are now developing their HIE
strategic plans under the state cooperative agreement program. Physician practices need to
understand options and resources available to support their involvement in achieving exchange of
health information.
o Physician practices should then define their strategy for exchanging health information and stay
informed as the 2013 and 2015 health information exchange meaningful use requirements are
defined.
8. What is a regional extension center?
HITECH allows funding for 70 or more regional centers, each serving a defined, non-overlapping
geographic area. Each REC should be a U.S.-based nonprofit organization with established support and
recognition within the local communities they propose to serve. The REC should focus effort on individual
and small group practices (

ONC required that each state establish a State Government Health Information Technology (IT)
Coordinator as part of the HIE cooperative agreement application, and encouraged states to be involved in
the selection of REC candidates. RECs are meant to operate independent of state governments.
10. Do HIEs have a role in regional extension centers?
In the ARRA HITECH law, there is no linkage between RECs and HIEs (called health information
organizations by ONC) but coordination is encouraged. The REC application asks for letters of support
from HIEs and coordination with HIEs is referenced in the application. Similarly, the application for
funding for the state HIE cooperative agreement program asks how the development of the state HIE will
coordinate with the RECs to support meaningful use. As each state determines how to manage HIE itself
or selects a state designated entity (SDE) to manage HIE, the state or SDE is likely to realize that a close
working relationship between the statewide HIE entity and the RECs serving the state makes substantial
sense. In some cases, an organization operating an HIE may apply for funding as an REC so long as the
organization meets the program requirements.
11. What is known about the type of state agencies or organizations that are
applying to be extension centers?
According to the funding application, the REC candidate entities are to be United States-based, non-profit
organizations that are established and recognized in the communities they propose to serve. REC
candidates need to demonstrate a track record in providing support to EHR implementations and a REC
must be organized or capable of being organized to provide such support to at least 1,000 priority primary
care providers in the first two years of the four-year agreement. This must represent at least 20% of the
total primary care providers in the proposed service area. Priority providers are primary care providers
(physicians, nurse practitioners and physician assistants) in individual and small group practices (< 10
professionals) primarily focused on primary care, public and critical access hospitals, community health
and rural health centers and other setting serving predominantly un-insured, underinsured and medically
underserved populations.
Once the applications are received and awards made by ONC, a more accurate picture of REC organization
profiles will become available.
12. What is the State HIE Cooperative Agreement Program?
The State HIE Cooperative Agreement Program is designed to support the development of health
information exchange infrastructure and capacity in all states—especially in support of the meaningful use
of EHRs relevant to HIE. The related grants are available only to a state, or qualified SDE designated by a
state governor. An SDE must be a non-profit organization with a governance body that is broad and
diverse, and must closely collaborate with state agencies such as Medicaid. The state (or the SDE) may
sub-contract to achieve their program objectives. Funding under this program will start in January, 2010.
The program will award $564M with at least $4M for each state and at most $40M to a single state.
Additional Information:
• HHS: State Health Information Exchange Cooperative Agreement
© 2009 Healthcare Information and Management Systems Society (HIMSS). 5

13. What is the state governments’ role in HIE State Cooperative Agreements?
According to the ONC Funding Opportunity Announcement (FOA), states and/or their SDEs are to use
their authority, programs, and resources to:
• Develop state-level directories and enable technical services for HIE within and across states;
• Remove barriers and create enablers for HIE, particularly those related to interoperability across
laboratories, hospitals, clinician offices, health plans and other health information trading partners;
• Convene healthcare stakeholders to ensure trust in and support for a statewide approach to HIE;
• Ensure that an effective model for HIE governance and accountability is in place;
• Coordinate an integrated approach with Medicaid and state public health programs to enable
information exchange and support monitoring of provider participation in HIE as required for
Medicaid meaningful use incentives;
• Develop or update privacy and security requirements for HIE within and across state borders; and
• Coordinate activities across Medicaid and state public health programs, to avoid duplicate efforts
and to ensure integration and support of a unified approach to information exchange.
14. What is known about the type of state agencies or organizations that are
applying for State HIE Cooperative Agreement Program funding?
Under the ARRA HITECH law, states have been required to appoint a State Government Health IT
Coordinator and the state must submit a request for either an HIE planning grant or an HIE implementation
grant. The actual applicant can be either the state itself or an SDE that acts for the benefit of the state to
manage HIE. In many states, there has been a fast-paced program to identify or form an organization that
meets the SDE requirements. In some states, multiple organizations found themselves in competition to be
their states SDE. In other states, which had a single state entity responsible for HIE at the time that ARRA
HITECH was passed in February, 2009, the existing state agency or statewide independent entity will likely
be the applicant.
Once the applications are received and awards made by ONC, a more accurate picture of state or SDE
organization profiles will become available.
15. I hear that my EHR software must be ‘certified’ to qualify for HITECH
incentives. What does that mean?
In August, 2009 the Certification and Adoption Workgroup gave recommendations to the HIT Policy
Committee. They proposed that, “HHS Certification means that a system is able to achieve the minimum
government requirements for security, privacy, and interoperability, and that the system is able to produce
the Meaningful Use results that the government expects.”* In other words, certification should be focused
on the capability to achieve meaningful use, not feature/function. They also recommended multiple
certification organizations, and that the National Institute of Standards and Technology (NIST) assist in the
establishment of an accreditation organization and process. In addition, they recommended the leverage of
existing certification work primarily conducted by the Certification Commission for Health Information
Technology (CCHIT).
The certification process will be codified in a December, 2009 Notice of Proposed Rulemaking and will
define the process for certifying EHRs including modular and open source approaches. After a comment
period, the final certification process and criteria will be available sometime in Spring, 2010.
© 2009 Healthcare Information and Management Systems Society (HIMSS). 6

*http://healthit.hhs.gov/portal/server.pt?open=18&objID=878086&parentname=CommunityPage&parenti
d=53&mode=2&in_hi_userid=11113&cached=true
16. Do HIEs also need to be certified?
No, the HITECH Act does not require that HIEs be certified. In August, 2009 CCHIT froze the 2009
certification program for HIEs, and in October, 2009 CCHIT announced the following: “We are not
offering a CCHIT Certified® Comprehensive program for Health Information Exchanges (HIEs) at this
time. We will continue to monitor the environment to determine if a need for Comprehensive certification
becomes apparent as the policies and programs of the US Department of Health and Human Services
unfold.”**
**http://www.cchit.org/get_certified/open_hie
17. What is public health’s role or involvement in ARRA HITECH-funded
activities?
Public’s health role will differ depending on the choices made by a particular state or region. All three of
the major funded activities have the potential to involve public health as a significant participant:
• Funding through the Centers for Medicare & Medicaid (CMS) for EHR system deployment to primary
care providers and hospitals can build upon existing public health relationships or activities, such as
disease reporting or surveillance. In addition, the “meaningful use” criteria of the legislation explicitly
include communication with public health agencies (including immunization registry data submission
and syndromic surveillance) as a priority.
• Regional extension centers are not required to involve public health (they need not even involve state
or local government), but public health can be a useful contributor to ensuring that EHR systems
properly support the functions and data required for public health reporting.
• Statewide HIE planning and implementation can effectively build upon public health data exchange
activities, and can draw upon available public health expertise in developing and maintaining data
sharing agreements, matching/merging patient information from multiple sources, coding and
semantics, and technical assistance using HL7 or other relevant standards.
18. What is a state Medicaid program’s role or involvement in ARRA HITECHfunded
activities?
Each state Medicaid program (SMP) has a strong role in HITECH. Each SMP is responsible for
administering the meaningful use incentives for all of the eligible professionals who opt to use their status
as a significant Medicaid client provider to qualify under this program. Each SMP is required to have a
State Medicaid HIT Plan that must integrate with the state’s HIE strategy funded under the State HIE
Cooperative Agreement Program grants.
19. I heard that HITECH expands on HIPAA requirements. Is that true?
© 2009 Healthcare Information and Management Systems Society (HIMSS). 7

Yes, most HIEs and state Medicaid programs are also HIPAA covered entities and, as such, are obliged to
meet the new (mostly privacy and security) elements in HITECH—notably the Notice of Breach
requirement, transmission of electronic protected health information (ePHI) to patients, accounting of
treatment, payment and healthcare operations (TPO) disclosures, business associate changes, and new
minimum necessary guidance.
Check out the HIMSS Web site for additional information on
ARRA – HITECH and Healthcare Reform
Contact HIMSS Government Relations for questions and information on ARRA,
legislation and regulations.
© 2009 Healthcare Information and Management Systems Society (HIMSS). 8