As the federal government mandated the use of Electronic Health Records [EHRs], the workforce surrounding the systems in which those records are housed, transmitted and manipulated had to grow.
The government, for its part, has encouraged that growth in the form of contributions from the Office of the National Coordinator for Health Information Technology [ONC]. The ONC is housed within the U.S. Department of Health and Human Services and is charged with “nationwide efforts to implement and use the most advanced health information technology and electronic exchange of health information,” according to healthit.gov.
Developing the Workforce
As part of its commitment to health IT and electronic health record [EHR] implementation, the ONC developed initiatives and financial policies to help build the workforce to support its broader goals. Perhaps the best example of this is the Health IT Workforce Development Program. Its goal is to train health IT professionals to be ready to help providers implement EHR systems for providers.
The program targeted 12 roles that play a major part in the success of healthcare IT efforts. Six roles required University-Based Training [UBT] that culminated with participants earning master’s degrees, and six required certifications that could be found through a number of outlets including community colleges.
According to Health IT Today, the six UBT offerings are:
1. Clinician/Public Health Leader: This person leads deployment of health IT to improve quality, safety and outcomes of health services. Titles may include Chief Medical Information Officer or Chief Informatics Officer.
2. Health Information Management and Exchange Specialist: Supports the collection, management, exchange and analysis of medical information in electronic form.
3. Health Information Privacy and Security Specialist: This person supports the same efforts as the management and exchange specialist but does so with a focus on maintaining the security and integrity of that information.
4. Research and Development Scientists: Create new models and solutions that advance capabilities of health IT. They also conduct studies concerning the effectiveness of health IT and its impact on healthcare quality.
5. Programmers and Software Engineers: The architects of health IT solutions, these professionals are well trained in both the healthcare and computer information spheres.
6. Health IT Sub-specialist: This person’s training combines healthcare and public health knowledge with knowledge of IT and an expertise in factors that shape health IT policy, such as ethics, business, systems engineering, psychology and policy and planning.
In committing to the development of these roles and training professionals who can fill them, the ONC has awarded millions of dollars’ worth of grants to universities and state agencies to further refine the roles and educate candidates capable of fulfilling them.
Today, direct efforts to grow the workforce continue through investment in curriculum development, population health strategies, cybersecurity initiatives, information standards development and promotion of interoperability efforts.
In recent years, ONC Workforce Development Program efforts have been focused on updating training materials in four areas: population health, care coordination, new care delivery and payment models, and value based/patient centered care.
Additionally, a goal of training 6,000 incumbent healthcare workers across various types of care facilities to use new health information technology has been identified.
[b] PurposeThe National Coordinator shall perform the duties under subsection [c] in a manner consistent with the development of a nationwide health information technology infrastructure that allows for the electronic use and exchange of information and that—
[1]
ensures that each patient’s health information is secure and protected, in accordance with applicable law;
[2]
improves health care quality, reduces medical errors, reduces health disparities, and advances the delivery of patient-centered medical care;
[3]
reduces health care costs resulting from inefficiency, medical errors, inappropriate care, duplicative care, and incomplete information;
[4]
provides appropriate information to help guide medical decisions at the time and place of care;
[5]
ensures the inclusion of meaningful public input in such development of such infrastructure;
[6]
improves the coordination of care and information among hospitals, laboratories, physician offices, and other entities through an effective infrastructure for the secure and authorized exchange of health care information;
[7]
improves public health activities and facilitates the early identification and rapid response to public health threats and emergencies, including bioterror events and infectious disease outbreaks;
[8]
facilitates health and clinical research and health care quality;
[9]
promotes early detection, prevention, and management of chronic diseases;
[10]
promotes a more effective marketplace, greater competition, greater systems analysis, increased consumer choice, and improved outcomes in health care services; and
[11]
improves efforts to reduce health disparities.
[c] Duties of the National Coordinator
[1] StandardsThe National Coordinator shall—
[B]
make such determinations under subparagraph [A], and report to the Secretary such determinations, not later than 45 days after the date the recommendation is received by the Coordinator; and
[2] HIT policy coordination
[A] In general
The National Coordinator shall coordinate health information technology policy and programs of the Department with those of other relevant executive branch agencies with a goal of avoiding duplication of efforts and of helping to ensure that each agency undertakes health information technology activities primarily within the areas of its greatest expertise and technical capability and in a manner towards a coordinated national goal.
[B] HIT Advisory Committee
The National Coordinator shall be a leading member in the establishment and operations of the HIT Advisory Committee and shall serve as a liaison between that Committee and the Federal Government.
[3] Strategic plan
[A] In generalThe National Coordinator shall, in consultation with other appropriate Federal agencies [including the National Institute of Standards and Technology], update the Federal Health IT Strategic Plan [developed as of June 3, 2008] to include specific objectives, milestones, and metrics with respect to the following:
[ii]
The utilization of an electronic health record for each person in the United States by 2014.
[iv]
Ensuring security methods to ensure appropriate authorization and electronic authentication of health information and specifying technologies or methodologies for rendering health information unusable, unreadable, or indecipherable.
[vii]
Strategies to enhance the use of health information technology in improving the quality of health care, reducing medical errors, reducing health disparities, improving public health, increasing prevention and coordination with community resources, and improving the continuity of care among health care settings.
[viii]
Specific plans for ensuring that populations with unique needs, such as children, are appropriately addressed in the technology design, as appropriate, which may include technology that automates enrollment and retention for eligible individuals.
[B] Collaboration
The strategic plan shall be updated through collaboration of public and private entities.
[C] Measurable outcome goals
The strategic plan update shall include measurable outcome goals.
[4] Website
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 technology infrastructure.
[5] Certification
[B] Certification criteria described
In this subchapter, the term “certification criteria” means, with respect to standards and implementation specifications for health information technology, criteria to establish that the technology meets such standards and implementation specifications.
[C] Health information technology for medical specialties and sites of service
[i] In general
The National Coordinator shall encourage, keep, or recognize, through existing authorities, the voluntary certification of health information technology under the program developed under subparagraph [A] for use in medical specialties and sites of service for which no such technology is available or where more technological advancement or integration is needed.
[ii] Specific medical specialties
The Secretary shall accept public comment on specific medical specialties and sites of service, in addition to those described in clause [i], for the purpose of selecting additional specialties and sites of service as necessary.
[D] Conditions of certificationNot later than 1 year after December 13, 2016, the Secretary, through notice and comment rulemaking, shall require, as a condition of certification and maintenance of certification for programs maintained or recognized under this paragraph, consistent with other conditions and requirements under this subchapter, that the health information technology developer or entity—
[ii]
provides assurances satisfactory to the Secretary that such developer or entity, unless for legitimate purposes specified by the Secretary, will not take any action described in clause [i] or any other action that may inhibit the appropriate exchange, access, and use of electronic health information;
[iii] does not prohibit or restrict communication regarding—
[iv]
has published application programming interfaces and allows health information from such technology to be accessed, exchanged, and used without special effort through the use of application programming interfaces or successor technology or standards, as provided for under applicable law, including providing access to all data elements of a patient’s electronic health record to the extent permissible under applicable privacy laws;
[vi] provides to the Secretary an attestation that the developer or entity—
[I]
has not engaged in any of the conduct described in clause [i];
[II]
has provided assurances satisfactory to the Secretary in accordance with clause [ii];
[III]
does not prohibit or restrict communication as described in clause [iii];
[IV]
has published information in accordance with clause [iv];
[V]
ensures that its technology allows for health information to be exchanged, accessed, and used, in the manner described in clause [iv]; and
[VI]
has undertaken real world testing as described in clause [v]; and
[E] Compliance with conditions of certification
The Secretary may encourage compliance with the conditions of certification described in subparagraph [D] and take action to discourage noncompliance, as appropriate.
[6] Reports and publications
[A] Report on additional funding or authority needed
Not later than 12 months after February 17, 2009, the National Coordinator shall submit to the appropriate committees of jurisdiction of the House of Representatives and the Senate a report on any additional funding or authority the Coordinator or the HIT Policy Committee or HIT Standards Committee requires to evaluate and develop standards, implementation specifications, and certification criteria, or to achieve full participation of stakeholders in the adoption of a nationwide health information technology infrastructure that allows for the electronic use and exchange of health information.
[B] Implementation report
The National Coordinator shall prepare a report that identifies lessons learned from major public and private health care systems in their implementation of health information technology, including information on whether the technologies and practices developed by such systems may be applicable to and usable in whole or in part by other health care providers.
[C] Assessment of impact of HIT on communities with health disparities and uninsured, underinsured, and medically underserved areas
The National Coordinator shall assess and publish the impact of health information technology in communities with health disparities and in areas with a high proportion of individuals who are uninsured, underinsured, and medically underserved individuals [including urban and rural areas] and identify practices to increase the adoption of such technology by health care providers in such communities, and the use of health information technology to reduce and better manage chronic diseases.
[D] Evaluation of benefits and costs of the electronic use and exchange of health information
The National Coordinator shall evaluate and publish evidence on the benefits and costs of the electronic use and exchange of health information and assess to whom these benefits and costs accrue.
[E] Resource requirementsThe National Coordinator shall estimate and publish resources required annually to reach the goal of utilization of an electronic health record for each person in the United States by 2014, including—
[i]
the required level of Federal funding;
[ii]
expectations for regional, State, and private investment;
[iii]
the expected contributions by volunteers to activities for the utilization of such records; and
[7] Assistance
The National Coordinator may provide financial assistance to consumer advocacy groups and not-for-profit entities that work in the public interest for purposes of defraying the cost to such groups and entities to participate under, whether in whole or in part, the National Technology Transfer Act of 1995 [15 U.S.C. 272 note].[1]
[9] Support for interoperable networks exchange
[A] In general
The National Coordinator shall, in collaboration with the National Institute of Standards and Technology and other relevant agencies within the Department of Health and Human Services, for the purpose of ensuring full network-to-network exchange of health information, convene public-private and public-public partnerships to build consensus and develop or support a trusted exchange framework, including a common agreement among health information networks nationally. Such convention may occur at a frequency determined appropriate by the Secretary.
[B] Establishing a trusted exchange framework
[i] In generalNot later than 6 months after December 13, 2016, the National Coordinator shall convene appropriate public and private stakeholders to develop or support a trusted exchange framework for trust policies and practices and for a common agreement for exchange between health information networks. The common agreement may include—
[II]
a common set of rules for trusted exchange;
[III]
organizational and operational policies to enable the exchange of health information among networks, including minimum conditions for such exchange to occur; and
[IV]
a process for filing and adjudicating noncompliance with the terms of the common agreement.
[ii] Technical assistance
The National Coordinator, in collaboration with the National Institute of Standards and Technology, shall provide technical assistance on how to implement the trusted exchange framework and common agreement under this paragraph.
[iii] Pilot testing
The National Coordinator, in consultation with the National Institute of Standards and Technology, shall provide for the pilot testing of the trusted exchange framework and common agreement established or supported under this subsection [as authorized under section 17911 of this title]. The National Coordinator, in consultation with the National Institute of Standards and Technology, may delegate pilot testing activities under this clause to independent entities with appropriate expertise.
[C] Publication of a trusted exchange framework and common agreement
Not later than 1 year after convening stakeholders under subparagraph [A], the National Coordinator shall publish on its public Internet website, and in the Federal register,[2] the trusted exchange framework and common agreement developed or supported under subparagraph [B]. Such trusted exchange framework and common agreement shall be published in a manner that protects proprietary and security information, including trade secrets and any other protected intellectual property.
[D] Directory of participating health information networks
[i] In general
Not later than 2 years after convening stakeholders under subparagraph [A], and annually thereafter, the National Coordinator shall publish on its public Internet website a list of the health information networks that have adopted the common agreement and are capable of trusted exchange pursuant to the common agreement developed or supported under paragraph [3] [B].
[ii] Process
The Secretary shall, through notice and comment rulemaking, establish a process for health information networks that voluntarily elect to adopt the trusted exchange framework and common agreement to attest to such adoption of the framework and agreement.
[E] Application of the trusted exchange framework and common agreement
As appropriate, Federal agencies contracting or entering into agreements with health information exchange networks may require that as each such network upgrades health information technology or trust and operational practices, such network may adopt, where available, the trusted exchange framework and common agreement published under subparagraph [C].
[F] Rule of construction
[i] General adoption
Nothing in this paragraph shall be construed to require a health information network to adopt the trusted exchange framework or common agreement.
[ii] Adoption when exchange of information is within network
Nothing in this paragraph shall be construed to require a health information network to adopt the trusted exchange framework or common agreement for the exchange of electronic health information between participants of the same network.
[iii] Existing frameworks and agreements
The trusted exchange framework and common agreement published under subparagraph [C] shall take into account existing trusted exchange frameworks and agreements used by health information networks to avoid the disruption of existing exchanges between participants of health information networks.
[iv] Application by Federal agencies
Notwithstanding clauses [i], [ii], and [iii], Federal agencies may require the adoption of the trusted exchange framework and common agreement published under subparagraph [C] for health information exchanges contracting with or entering into agreements pursuant to subparagraph [E].
[v] Consideration of ongoing work
In carrying out this paragraph, the Secretary shall ensure the consideration of activities carried out by public and private organizations related to exchange between health information exchanges to avoid duplication of efforts.
[d] Detail of Federal employees
[1] In general
Upon the request of the National Coordinator, the head of any Federal agency is authorized to detail, with or without reimbursement from the Office, any of the personnel of such agency to the Office to assist it in carrying out its duties under this section.
[2] Effect of detailAny detail of personnel under paragraph [1] shall—
[A]
not interrupt or otherwise affect the civil service status or privileges of the Federal employee; and
[3] Acceptance of detailees
Notwithstanding any other provision of law, the Office may accept detailed personnel from other Federal agencies without regard to whether the agency described under paragraph [1] is reimbursed.
[July 1, 1944, ch. 373, title XXX, § 3001, as added Pub. L. 111–5, div. A, title XIII, § 13101, Feb. 17, 2009, 123 Stat. 230; amended Pub. L. 114–255, div. A, title IV, §§ 4001[b], 4002[a], 4003[b], [e][2][A][i], [ii], [C], Dec. 13, 2016, 130 Stat. 1158, 1159, 1165, 1174.]
[1] See References in Text note below.
[2] So in original. Probably should be “Register,”.
[3] So in original. Probably should be “subparagraph”.
Editorial Notes
Amendments
2016—Subsec. [c][1][A]. Pub. L. 114–255, § 4003[e][2][C][i], substituted “under section 300jj–12 of this title” for “under section 300jj–13 of this title”.
Pub. L. 114–255, § 4003[e][2][A][i], substituted “HIT Advisory Committee” for “HIT Standards Committee”.
Subsec. [c][2][B]. Pub. L. 114–255, § 4003[e][2][C][ii], added subpar. [B] and struck out former subpar. [B]. Prior to amendment, text read as follows: “The National Coordinator shall be a leading member in the establishment and operations of the HIT Policy Committee and the HIT Standards Committee and shall serve as a liaison among those two Committees and the Federal Government.”
Subsec. [c][3][A][v]. Pub. L. 114–255, § 4003[e][2][A][ii], which directed amendment of this section by substituting “HIT Advisory Committee” for “HIT Policy Committee and the HIT Standards Committee” wherever appearing, was executed to cl. [v] by making the substitution for “HIT Policy Committee, the HIT Standards Committee”, to reflect the probable intent of Congress.
Subsec. [c][5][C]. Pub. L. 114–255, § 4001[b], added subpar. [C].
Subsec. [c][5][D], [E]. Pub. L. 114–255, § 4002[a], added subpars. [D] and [E].
Subsec. [c][6][A]. Pub. L. 114–255, § 4003[e][2][A][i], which directed amendment of this section by substituting “HIT Advisory Committee” for both “HIT Policy Committee” and “HIT Standards Committee” wherever appearing, but not within the term “HIT Policy Committee or the HIT Standards Committee”, was not executed to subpar. [A] as provided in the exception, notwithstanding text that reads “HIT Policy Committee or HIT Standards Committee”, to reflect the probable intent of Congress.
Subsec. [c][9]. Pub. L. 114–255, § 4003[b], added par. [9].
Statutory Notes and Related Subsidiaries
Provider Digital Contact Information Index
Pub. L. 114–255, div. A, title IV, § 4003[c], Dec. 13, 2016, 130 Stat. 1167, provided that:
“[1] In general.—
Not later than 3 years after the date of enactment of this Act [Dec. 13, 2016], the Secretary of Health and Human Services [referred to in this subsection as the ‘Secretary’] shall, directly or through a partnership with a private entity, establish a provider digital contact information index to provide digital contact information for health professionals and health facilities.
“[2] Use of existing index.—
In establishing the initial index under paragraph [1], the Secretary may utilize an existing provider directory to make such digital contact information available.
“[3] Contact information.—
An index established under this subsection shall ensure that contact information is available at the individual health care provider level and at the health facility or practice level.
“[4] Rule of construction.—
“[A] In general.—
The purpose of this subsection is to encourage the exchange of electronic health information by providing the most useful, reliable, and comprehensive index of providers possible. In furthering such purpose, the Secretary shall include all health professionals and health facilities applicable to provide a useful, reliable, and comprehensive index for use in the exchange of health information.
“[B] Limitation.—
In no case shall exclusion from the index of providers be used as a measure to achieve objectives other [than] the objectives described in subparagraph [A].”