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Update on Federal HIT Legislation. Kirsten Beronio Mental Health America. Hopes for HIT. Improved care coordination Ability to assess interventions in real-world settings Increased dissemination of best practices Increased consumer engagement and empowerment. Primary Concerns.

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Update on Federal HIT Legislation

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update on federal hit legislation

Update on Federal HIT Legislation

Kirsten Beronio

Mental Health America

hopes for hit
Hopes for HIT
  • Improved care coordination
  • Ability to assess interventions in real-world settings
  • Increased dissemination of best practices
  • Increased consumer engagement and empowerment
primary concerns
Primary Concerns
  • Existing and increased risks to privacy with increased use of HIT
  • Inadequate consumer access to own medical records
  • Lack of enforcement of rights and responsibilities
protecting privacy
Protecting Privacy
  • New entities (PHR vendors, HIEs, RHIOs) not covered by federal privacy and security rules
  • Requiring consent not adequate and maybe harmful
  • Marketing loopholes
  • Risks of inappropriate disclosure due to health care operations being very broadly defined
consumer access
Consumer Access
  • Right to access not well implemented
  • Systems should enable consumer interface
  • Concerns about proposals to segregate sensitive information
inadequate enforcement
Inadequate Enforcement
  • Many complaints and numerous violations
  • HHS opted to encourage voluntary compliance
  • Not a single civil penalty imposed
hitech act
  • Establishes infrastructure to set federal standards for nationwide, interoperable HIT system
  • Provides incentives for implementation by providers
  • Sets up new privacy protections, consumer access provisions, enhanced enforcement mechanisms
establishing federal standards
Establishing Federal Standards


  • Codifies Office of Nat Coordinator for HIT
  • Establishes HIT Policy Committee
    • To set priorities for areas where standards are needed
    • To consider technologies to protect privacy among other issues
  • Establishes HIT Standards Committee
    • To develop standards, implementation specifications, certification criteria
  • Federal agencies required to comply with standards, but voluntary for private sector
incentives for implementation
Incentives for Implementation
  • HHS to allocate $2 billion for following uses:
    • Establish an HIT extension program to help providers with implementation
    • Create HIT research center to provide technical assistance and develop best practices and support regional centers to provide tech assist
    • Provide grants to states (or qualified state-designated entities) to promote HIT, including in medically underserved communities
    • Competitive grants to states and Indian tribes for loan programs for providers to purchase HIT, train personnel
    • Demos to integrate HIT into clinical education
incentives for implementation1
Incentives for Implementation
  • Medicare incentive payments for physicians and hospitals for adoption and “meaningful use” of certified HIT
  • Medicaid incentive payments for certain providers:
    • Physicians, dentists, nurse midwives, nurse practitioners, hospitals, rural health clinics, FQHCs
privacy protections
Privacy Protections
  • Applies HIPAA privacy and security requirements to personal health record vendors and health info exchange org.s
  • Requires notification of breach w/in 60 days
  • Calls for privacy officer in each regional office and nat pub ed campaign on privacy rights
  • Directs narrowing health care operations defn
  • Prohibits sale of personal health info and further limits use for marketing
privacy protections1
Privacy Protections
  • Clarifies right to restrict disclosures of personal health info for payment or health care operations if pay out-of-pocket
  • Preservation of the therapist-patient privilege
consumer access1
Consumer Access
  • Establishes a right to an accounting of disclosures over previous 3 yrs
  • Establishes a right to an electronic copy if maintained as electronic record
enhanced enforcement
Enhanced Enforcement
  • Increased penalties for HIPAA violations
  • HHS required to investigate complaints (no longer discretionary)
  • Fines collected go to Office of Civil Rights
  • GAO to develop methodology for allocating percentage to consumers harmed
  • State AGs authorized to prosecute HIPAA privacy and security violations
psychotherapy note definition
Psychotherapy Note Definition
  • Secretary directed to study whether to expand defn to include testing data
  • Psychotherapy notes have special status: consumer authorization required for disclosure except for treatment
  • Consumers do not have access