Key players and initiatives

The Who's Who of HIT consists of many organizations, both public and private.  Here's a summary of the key players and their current initiatives.

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Government groups and organizations:

Office of the National Coordinator for HIT (ONC):  The ONC operates under the administration of the Department of Health and Human Services (HHS).  It is charged with coordinating the development of a national health information network by assisting the development and harmonization of efforts toward HIT standards, certification, interoperability and security.

American Health Information Community (AHIC):  AHIC is an ONC-appointed a “community” of stakeholders representing payers, employers, physician groups, HIT vendors and federal agencies.  AHIC meets monthly and has multiple workgroups to address key HIT-related issues:

1. Consumer Empowerment Workgroup, charged with developing recommendations to make a patient-managed electronic tool, similar to a Personal Health Record, which would make patient demographic and medication history available to providers. This would benefit patients who are repeatedly asked for registration and health history at every point of care.
2. Electronic Medical Records Workgroup, charged with developing recommendations on acceleration of EMR adoption nationwide.
3. Chronic Care Workgroup, charged with developing recommendations on remote monitoring and assessment of chronically ill patients, as well as suggestions on methods of improved communication between these patients and their providers.
4. Biosurveillance Workgroup, charged with developing recommendations to support real-time nationwide public health monitoring, specifically transmission of Emergency Dept and Lab data to public health agencies. This would potentially expedite the identification and treatment of potential bioterrorist attacks or disease outbreaks.
5. Confidentiality, Privacy and Security Workgroup: Although privacy and security are discussed across the other four workgroups, a workgroup dedicated solely to this issue was formed in August 2006.

The Centers for Medicare and Medicaid Service (CMS): CMS sponsored a pilot program in four states which provided free EHR selection and implementation support for physician practices. The program, Doctors Office Quality-Information Technology (DOQ-IT) is supported by the Medicare Quality Improvement Community, (Med-QIC). Although the first phases of the program are over, Med-QIC still has many HIT-adoption resources for physicians and providers (see our Tools section for links to these resources). CMS has rolled out National Provider Identifiers (NPIs) for use in the submission of electronic claims, as well as starting a voluntary pay-for-performance initiative (P4P) facilitated by electronic claims submittal. Although participating physicians are not directly rewarded by CMS for HIT use, HIT enables better quality analysis and reporting, so HIT and CMS's quality-related programs are considered linked.

HHS (The Department of Health & Human Services):  HHS oversees the activity of the ONC and its workgroups.  In this way, HHS is actively engaged in most national HIT-related initiatives.  HHS also recently relaxed anti-kickback and Stark Rule regulations for HIT donation, promoting the donation of HIT to physician practices.  Donating organizations no longer have to fear the loss of non-profit tax exemption or worry about anti-kickback sanctions under this new policy.

AHRQ (The Agency for Health Research and Quality):  AHRQ has awarded contracts related to HIT initiatives, specifically those related to information sharing and regional health networks.  AHRQ is a powerful research body and makes recommendations for the collection of data for quality improvement and better public health.

NCVHS (National Commission for Vital Health Statistics):  NCVHS is the research advisory body to HHS.  It publishes regular reports, making criticisms and recommendations regarding health data initiatives, and national health information policy.  NCVHS studies public health issues of all kinds, but has offered specific suggestions to HHS regarding HIT initiatives and quality improvement.

Public-private initiatives:

The ONC awarded 5 federal contracts to private-sector organizations based on 5 major concerns/priorities.

1.  Standards Development: awarded to the Health Information Technology Standards Panel (HITSP).  HITSP will develop standards for a NHIN, considering issues such as EHR functionality, interoperability, and privacy.
2.  Certification of EHR Products:  awarded to the Certification Commission for Health Information Technology (CCHIT).  CCHIT has developed criteria by which to federally certify specific technologies (59 products are currently certified by CCHIT).
3.  National Health Information Network (NHIN) Prototype: awarded to multiple regional consortia to develop prototypes for Regional Health Information Organizations (RHIOs) and models for data exchange.  This group is led by major technology companies: Accenture, CSC, IBM, and Northrup Grumman.
4.  Privacy and Security: awarded to the Health Information Security and Privacy Collaboration (HISPC), a stakeholder group led by the Research Triangle Institute.  This group will evaluate variations in state law regarding privacy and security of data exchange, attempting to harmonize efforts across states.
5.  HIT Adoption Survey Initiative: awarded to George Washington University, Massachusetts General Hospital, Partners Health Care and Brigham & Women’s Hospital.  This group will develop a methodology for assessing national HIT adoption, and carry out adoption research.

Private organizations:

The Markle Foundation/Connecting for Health:  The Markle Foundation is one of the most respected leaders in HIT.  Markle's key objective is to accelerate the use of information technology to improve health and healthcare.  It sponsors such initiatives as Connecting for Health, a collaborative organization emphasizing interconnectivity of HIT.  Some Connecting for Health initiatives include a roadmap for interoperability and data exchange, privacy and security working groups, and advocacy for personal health records.  Markle/Connecting for Health have memberships that are comprised of many HIT organizations and industry stakeholders. Their role as convener provides them with significant influence in HIT thought leadership, setting national policy, and achieving consensus across stakeholders on complex issues.

eHI (eHealth Initiative):  The mission of eHI is to advocate for improvements in quality, safety, and efficiency of healthcare through information technology. Its initiatives include workgroups that evaluate adoption and information exchange issues and make recommendations for release to the industry. Workgroups include discussion topics such as HIT in Small and Medium Practices, ePrescribing, Incentives for Adoption and “Connecting Communities,” which emphasizes health information exchange and Regional Health Information Organization (RHIO) development.

Professional organizations like the American Medical Association (AMA), AAFP (American Academy of Family Physicians), AHA (American Hospital Organization) and ACP (American College of Physicians):  These organizations offer HIT-adoption information and ‘how-to’ resources for their members.  They also advocate at the state and national levels for HIT-supportive legislation and represent physicians’ interests in national discussions about HIT.

HIMSS (Health Information Management Systems Society):  HIMSS is a key player in the HIT arena with significant credibility and visibility through its conference sponsorship, leadership in various HIT initiatives, HIT resources and subject matter expertise. HIMSS brings together technology developers and technology users to improve health care through the use of technology.

AHIMA (American Health Information Management Association): AHIMA represents health information management professionals and is actively involved in accelerating the use of EMRs. It is involved with many leading organizations to craft policy related to EMRs and a national infrastructure for medical information exchange.

AMIA (American Medical Informatics Association):  AMIA represents various health information technology stakeholders in order to advance the improvement of the nation's health through the use of HIT. The association is involved in eHealth Initiative and was a founder of the “Got EHR?” initiative.

HL7 (Health Level Seven):  HL7 was one of the first organizations to create standards by which to evaluate EHRs.  CCHIT collaborated with HL7 to create their national EHR certification standards.  HL7 continues to develop standards for  the electronic interchange of clinical, financial, and administrative data between health care organizations.

For more information on AMA policy and initiatives, please see our section on AMA policy and activity.