Launching HITECH.

n engl j med 362;5 nejm.org february 4, 2010 382 I is the lifeblood of modern medicine. Health information technology (HIT) is destined to be its circulatory system. Without that system, neither individual physicians nor health care institutions can perform at their best or deliver the highest-quality care, any more than an Olympian could excel with a failing heart. Yet the proportion of U.S. health care professionals and hospitals that have begun the transition to electronic health information systems is remarkably small.1,2 On December 30, the government took several critical steps toward a nationwide, interoperable, private, and secure electronic health information system. The Department of Health and Human Services (DHHS) released two proposed regulations affecting HIT (www.healthit.hhs.gov). The first, a notice of proposed rulemaking (NPRM), describes how hospitals, physicians, and other health care professionals can qualify for billions of dollars of extra Medicare and Medicaid payments through the meaningful use of electronic health records (EHRs). The second, an interim final regulation, describes the standards and certification criteria that those EHRs must meet for their users to collect the payments. In addition, between August and December 2009, my office — the DHHS Office of the National Coordinator for Health Information Technology (ONC) — announced nearly $2 billion worth of new programs to help providers become meaningful users of EHRs and to lay the groundwork for an advanced electronic health information system. All these actions were authorized by the Health Information Technology for Economic and Clinical Health (HITECH) Act, which was part of the American Recovery and Reinvestment Act of 2009, also known as the stimulus bill (see table).3 The provisions of the HITECH Act are best understood not as investments in technology per se but as efforts to improve the health of Americans and the performance of their health care system. The installation of EHRs is an important first step. But EHRs will accomplish little unless providers use them to their full potential; unless health data can flow freely, privately, and securely to the places where they are needed; and unless HIT becomes increasingly capable and easy to use. Understanding this, Congress and the Obama administration structured the HITECH Act so as to reward the meaningful use of qualified, certified EHRs — an innovative and powerful concept. By focusing on the effective use of EHRs with certain capabilities, the HITECH Act makes clear that the adoption of records is not a sufficient purpose: it is the use of EHRs to achieve health and efficiency goals that matters. The effort to achieve meaningful use provides the best lens through which to understand the government’s actions in implementing the HITECH Act. The administration is trying to do four basic things: define meaningful use, encourage and support the attainment of meaningful use through incentives and grant programs, bolster public trust in electronic information systems by ensuring their privacy and security, and foster continued HIT innovation. The publication on December 30 of an NPRM on Medicare and Medicaid’s EHR Incentive Program (www.healthit.hhs.gov) is part of defining meaningful use. Though both federal rule making and the regulation’s content are complex, there are a few useful general points to be made. First, the NPRM is a proposal, not a final regulation, and further public comment is invited for a period of 60 days. This invitation is far from pro forma: the DHHS firmly believes that insights from physicians, hospitals, consumers, payers, and other health care stakeholders can improve this rule. Second, the DHHS believes that the proposed requirements would be challenging yet attainable, especially with assistance provided through other HITECH Act programs. What is more, achieving meaningful use would advance Americans’ health. The DHHS defined meaningful use carefully so as to further five health care goals: improving the quality, safety, and efficiency of care while reducing disparities; engaging patients and families in their care; promoting public Launching HITECH