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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

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