By John Halamka

Several blog readers have asked me to take a fresh look at all the
organizations related to ARRA and explain how it all works. Here's my
understanding:Office of the National CoordinatorThe
Obama administration's ONC is different from the Bush administration's
ONC in several ways. It's now funded with $2 billion to accelerate
healthcare IT adoption. Its new leader, Dr. David Blumenthal has a
policy focus, so we'll see broad policy guidance and specific
healthcare outcome goals rather than technology for technology's sake.
It has regulation – ARRA is law and there are several new privacy,
standards, and implementation requirements that were only voluntary or
market-driven previously. You can expect that ONC will have a major
role in coordinating federal agencies' use of healthcare IT as well as
adoption in the private sector. By controlling the definition of
meaningful use of healthcare IT as the gatekeeping function for paying
stimulus dollars to clinicians, ONC has real power.

HIT Standards CommitteeThe
Health IT Standards Committee is charged with making recommendations to
the National Coordinator on standards, implementation specifications,
and certification criteria for the electronic exchange and use of
health information. Initially, the HIT Standards Committee will focus
on the policies developed by the Health IT Policy Committee’s initial
eight areas (listed below). The HIT Standards Committee will also
provide for the testing of standards by the National Institute for
Standards and Technology (NIST). In its first meeting, the HIT Standards Committee created three workgroups. Below are their Broad and Specific charges:Clinical Operations Workgroup:Broad Charge –Make
recommendations to the HIT Standards Committee on requirements for
standards, implementation specifications, and certification criteria
related to EHRs and clinical operations.Specific Charge –Make
recommendations to the HIT Standards Committee on the role of EHRs and
e-prescribing, clinical summaries, laboratory and radiology report
functionality within two (2) months of the workgroup’s first meeting.
The workgroup will also take into consideration the eight (8) areas
listed in Section 3002(b)(2)(B) when developing recommendations for the
committee.Clinical Quality Workgroup:Broad Charge –Make
recommendations to the HIT Standards Committee on quality measures that
should be included in the Meaningful Use definition and for future EHR
requirements. Make recommendations to the HIT Standards Committee on
requirements for standards, implementation specifications, and
certification related to EHRs and clinical quality.Specific Charge –Make
recommendations to the HIT Standards Committee on specific quality
measures that should be included in the definition of Meaningful Use
for 2011 within two (2) months of the workgroup’s first meeting. The
workgroup will also take into consideration the eight (8) areas listed
in Section 3002(b)(2)(B) when developing recommendations for the
committee.Privacy and Security Workgroup:Broad Charge –Make
recommendations to the HIT Standards Committee on privacy and security
requirements for standards, implementation specifications, and
certification criteria.Specific Charge –Make
recommendations to the HIT Standards Committee on specific privacy and
security safeguards that should be included in the definition of
Meaningful Use, with a specific focus on the eight (8) areas listed in
Section 3002(b)(2)(B), within two (2) months of the workgroup’s first
meeting.HIT Policy CommitteeThe
Health IT Policy Committee will make recommendations to the National
Coordinator on a policy framework for the development and adoption of a
nationwide health information infrastructure, including standards for
the exchange of patient medical information. The American Recovery and
Reinvestment Act of 2009 (ARRA) provides that the HIT Policy Committee
shall at least make recommendations on standards, implementation
specifications, and certifications criteria in eight specific areas:-Technologies that protect the privacy of health information-A nationwide health information technology infrastructure-The utilization of a certified electronic record for each person in the US by 2014-Technologies that support accounting of disclosures made by a covered entity-The use of electronic records to improve quality-Technologies that enable identifiable health information to be rendered unusable/unreadable-Demographic data collection including race, ethnicity, primary language, and gender-Technologies that address the needs of children and other vulnerable populationsAt it's first meeting, The HIT Policy Committee created three workgroups – Meaningful Use, Information Exchange, and Certification.Here's
the broad and specific charge for the Information Exchange workgroup.
I'll add the details for the others as soon as I receive it.Information Exchange Workgroup:Broad Charge-Make
recommendations to the HIT Policy Committee on policies, guidance
governance, sustainability, and architectural, and implementation
approaches to enable the exchange of health information and increase
capacity for health information exchange over time.Specific Charge-Make
recommendations to the HIT Policy Committee within six (6) months
regarding priority policy areas and other issues that are necessary in
the short term to advance the exchange of health information through
implementation of HITECH. Make recommendations to the HIT Policy
Committee to inform and provide guidance on the implementation of the
Nationwide Health Information Network (NHIN)Health Information Technology Standards Panel HITSP
provides an important consultative role to the HIT Standards Committee.
As the HIT Standards Committee and its workgroups prioritize the
transactions needed to support meaningful use, they will consult
standards harmonization organizations (HITSP), Standards Development
Organizations, and Implementation Guide writers. HITSP volunteers and
staff have been placed on each of the HIT Standards Committee
workgroups to provide technical assistance.National eHealth Collaborative NeHC, based on their recent meeting,
will focus on implementation topics such as regional healthcare IT
extension centers and the reality of increasing EHR adoption in the
country.Certification Commission for Health Information TechnologyI'm
confident that CCHIT will continue to be the leading HIT certification
organization in the US, but its certification criteria will evolve. The
HIT Policy Committee's workgroup on certification is likely to provide
valuable input about certification by the Fall.I hope this
helps clarify how all these organizations relate to one another as they
all work together to support ARRA, improve healthcare quality, and
enhance efficiency, all through the implementation of interoperable
healthcare IT.

John D. Halamka, MD, MS, is CIO of the
CareGroup Health System, CIO and Dean for
Technology at Harvard Medical School, Chairman of the New England
Health Electronic Data Interchange Network (NEHEN), CEO of MA-SHARE, Chair of the US
Healthcare Information Technology Standards Panel (HITSP), and a
practicing emergency physician. He blogs regularly at Life as a Healthcare CEO, where this post first appeared.