Key Components of the HITECH Act include:

Health Information Technology for Economic & Clinical Health (HITECH) Action Plan January 30, 2010 Vision Mission Market Description/ Key Trends To engage RDs in the initiative for health care improvement provided by the Health Information Technology for Economic & Clinical Health Act (HITECH), in particular, the adoption and meaningful use of health information exchange (HIE) across the U.S. health system. Advancing ADA s Strategic Plan by enabling RDs and DTRs to position themselves as food and nutrition experts and maintain professional viability. To ensure that RDs and DTRs integrate technology into their specific areas of practice in alignment with the policies and standards driven by the HITECH Act. To collaborate with stakeholders of the HITECH Act to optimize progress in individual and population health by inclusion of nutrition care. To plan for RD participation as a team member in the National Health Information Network (NHIN), the nationwide initiative to promote exchange of health information. The HITECH Act, passed within one month of President Barack Obama s inauguration, provides for an unprecedented level of activity and policy development for health care improvement. This component of the American Recovery & Reinvestment Act (ARRA) provides necessary funding for the continued effort of health information technology (HIT) adoption and health information exchange across the United States. Significant progress at the national level began in 2004 with an Executive Order from President Bush, which charged that all Americans should have access to an Electronic Health Record (EHR) by the year 2014. Significant public-privategovernment collaboration at the national level occurred from 2004 until the HITECH Act was signed into law in February 2009. The HITECH Act is an answer to the call for critically needed funding to continue efforts of reaching this goal. Key Components of the HITECH Act include: Coordinating Agency. Empowering the Office of the National Coordinator of Health IT (ONC) as the principal Federal entity charged with coordination of nationwide efforts to implement and use the most advanced health information technology and the electronic exchange of health information. ONC is part of the Department of Health and Human Services (DHHS). Federal Advisory Committee Act (FACA) Committees. Creation of two FACA Committees (ONC Standards Committee and ONC Policy Committee) to coordinate recommendations to ONC and the Centers for 1

Medicare & Medicaid Services (CMS). Medicare & Medicaid Incentives. Financial incentives to eligible providers (EP) and qualifying hospitals who adopt and use electronic health systems in a meaningful way to support health quality improvement and can exchange health data. Medicare/Medicaid EPs include physicians, dentists, podiatrists, optometrists, chiropractors, certified nurse-midwives, nurse practitioners, and physician assistants. While RDs are not included as an EP, policies resulting from this portion of the HITECH Act will impact health care delivery and exchange between providers and facilities. Standards Harmonization & Product Certification. Requirement that the federal government adopt and use certified products and standards. At present, the Health Information Technology Standards Panel (HITSP) is providing harmonization of standards for use. The Certification Commission for Health Information Technology (CCHIT) is the present certifying body for electronic health records. Additional certifying bodies may evolve in 2010. Regional Extension Centers. Seventy plus centers, each serving 100,000 primary care providers and a defined geographic area offer technical assistance, and best practices to support health care providers meaningful use of EHRs. Health Information Exchanges. Financial support to states and qualified State Designated Entities (SDE) 1 to develop and advance mechanisms for information sharing across the health care system. Workforce Training. Four components designed to rapidly train existing IT and/or health professionals in HIT implementation skills: Curriculum Development Centers, Community College Consortia to Educate IT Professionals In Health Care, Competency Examination for Individuals Completing Non-Degree Training Programs and Program of Assistance for University Based Training. Beacon Communities. Proving grounds for meaningful use of EHRs and HIE, to test the value of HIT in improving health care in measurable ways, in secure/private way and in different types of health communities. The framework for development of the policies and standards supporting HIT adoption in the United States ensures transparency for collaboration, decisions, and public comment. ONC coordinates the implementation of the HITECH Act, in collaboration with other agencies. The main agencies involved include: Certification Commission on Health Information Technology (CCHIT) Founded in 2004, and certifying electronic health records (EHRs) since 2006, the 1 State Designated Entities are typically non profit entities created to manage state health information exchanges. 2

Commission established the first comprehensive, practical definition of what capabilities are needed in these systems. The HITECH Act acknowledges the importance of EHR certification by requiring certification of EHR products for EP and hospitals pursing incentive payments. ONC will also allow additional certification paths for EHRs; details are forthcoming in early 2010. National ehealth Collaborative (NeHC) The National ehealth Collaborative is a public-private partnership dedicated to the creation of a secure, interoperable, nationwide health information network that will advance the American public s interest in health and improve the quality, safety, efficiency and accessibility of health care. The Collaborative builds on the accomplishments of the American Health Information Community (AHIC), a federal advisory committee established in 2005, and AHIC Successor, Inc., founded in 2008 to transition AHIC s accomplishments into a new non-profit membership organization, now known as the National ehealth Collaborative (NeHC). National Health Information Network (NHIN) The mission of NHIN is to achieve better quality, value, and affordability of health and wellness services by establishing the Nationwide Health Information Network as the common, secure, nationwide, interoperable network for exchanging health information, and to provide this infrastructure with low adoption barriers. ADA Activities At the professional level, the American Dietetic Association has supported a Nutrition Informatics Work Group (NIWG) since 2007, composed of RDs with expertise in health information technology. At the 2008 Fall House of Delegates Meeting (HOD), a dialogue on Nutrition Informatics validated the importance of continued development. Recommendations from the NIWG to the HOD were used to identify additional strategies by the HOD. Prioritized recommendations from HOD were incorporated into the final report to the ADA Board of Directors (BOD) in 2009. The report recommendations were accepted in their entirety (October 21, 2009), which will establish a BOD/House of Delegates Nutrition Informatics Committee to become operational on June 1, 2010. Numerous other critical initiatives and committees within ADA support the alignment of nutrition with adoption of HIT and health care improvement. These include: Nutrition Care Process/Standardized Language (NCP/SL) Committee - to assure harmonization of standardized process and nutrition terminology in all appropriate areas of patient care. Quality Management Committee - to align best practices of food and nutrition into the quality reporting measures of EHRs. Legislative & Public Policy Committee - to ensure organizational agreement and work as it pertains to HIT. Evidence-Based Practice Committee - to integrate pertinent nutrition related practice guidelines into Clinical Decision Support products and protocols as these are established. Council on Future Practice - to crosswalk nutrition practice with present and future standards of EHR and HIE processes to determine future practice opportunities. Research Committee - to align nutrition informatics processes with the 3

research process, in areas of existing nutrition research, including nutrition informatics research on quality care delivery. Coding and Coverage Committee - to coordinate any reimbursement policy changes/additions created by the HITECH initiative. This Action Plan embraces the work and recommendations of the ADA committees listed above. Plus it encourages members to work collaboratively in the best interest of the RD and DTR. In addition to nutrition informatics backgrounders from previous work and collaboration with the BOD and HOD, members will receive informational articles about how HITECH impacts RD/DTRs work practices, new career opportunities as a result of HITECH, and how to make an influence decisions made by the ONC. Objectives Develop a U.S. nutrition workforce capable of using electronic health records to improve health care. Determine basic informatics competencies necessary for RDs and DTRs to perform their present jobs. Promote the updating of existing dietetics education requirements to include necessary IT skills for emerging RDs and DTRs. Encourage RDs at all levels to participate in HITECH Workforce Training and advancement. Engage RDs and DTRs in development and participation in the National Health Information Network to assure continued prominence as the food and nutrition expert and health care team stakeholder. Actively participate (at committee/decision making level) with appropriate external health related agencies to collaborate on appropriate integration of nutrition care into HIT practice and polices. Embrace a consistent level of leadership and advocacy transparency for members to promote peer networking, mentoring, and advancement. Strategies Utilize the organizational structure within ADA to build consensus, disseminate information, and embrace best practices of HIT utilization. Conduct a gap analysis of the approved ADA NIWG Report to the BOD and the HITECH Action Plan. In many instances, timelines for original strategies have been impacted by the aggressive timeline of the HITECH Act. Provide multiple avenues for members to understand critical components of the HITECH Act and how HIT will affect their practice. Create a consistent educational approach for the membership (as a member benefit via the Web site) to support the adoption of HIT into nutrition care. Utilize the structure and framework of the Nursing Informatics TIGER Initiative in creating similar success in advancement of the informatics field. Partner with the ADA Washington, DC office and the Legislative and Public Policy Committee to integrate laws and policies governing health care reform into the HIT Agenda. 4

Resource Requirements Risk and Risk Mitigation Invest in organizations at the national level which are aligned with policy advancement in health care consensus development. Demonstration of long term commitment will require financial commitment to membership fees. Agencies in this category may include, but are not limited to: National Quality Forum National Priorities Partnership National ehealth Initiative. Project resources (staff, consultant) for years 2010-2015 need to align with the HITECH goals, Nutrition Informatics Committees goals and ADA s Strategic Plan. Support member participation/collaboration with identified workgroup and organizational task forces (meeting attendance, presentation preparation, research, etc.). Partner with organizations aligned with policy advancement in health care to add strength to the multi-pronged agenda for wellness, exercise and nutrition (e.g. American College of Sports Medicine and others). The ambitious timeline for HITECH planning, discussions and funding opportunities requires prompt at times, even spontaneous -- action and response in order to provide pertinent nutrition specific comment to initiatives and strategy. Mitigation includes: Daily attention to changes, funding announcements, e-mails and meetings. Create a work plan for educating RDs and DTRs on key content areas which will promote best practices of nutrition care across all areas of practice (e.g. encouraging the local use of Clinical Decision Support [CDS] protocol which has appropriate nutrition specific triggers for nutrition assessment and care.). Regular communication with critical ADA staff 2 and members to allow for appropriate content development and knowledgeable discussions in face-to-face meetings. Structured compilation of facts, initiatives and research data related to nutrition which allows prompt access under tight timelines. The knowledge required for ADA members to adequately understand the scope of health information technology adoption and information exchange may be a significant burden for some practitioners and interfere with their ability to perform the same work using tools of technology. Mitigation includes: Creation of a cultural framework, which sets the stage for positive collaboration and professional conduct in a rapidly changing health care environment. Consistent communication and an effective plan to educate RDs and DTRs on integrating health IT into their work structure. Identification of most critical areas for practitioner comprehension to allow for controlled, integrated learning. 2 Vice President, Governance & Practice, Director, DPG Relations, Director, Quality Management, Director, Nutrition Services Coverage, Director, Regulatory Affairs, Chief Science Officer, Senior Research Manager 5

Action Plans Members: Include regularly scheduled updates on progress of HITECH Act and how members can be engaged in the adoption of HIT and HIE. This includes not only the ADA committees listed above but ADA Workgroups based upon the content and collaboration. Nutrition Informatics Committee: Identify how existing RDs and DTRs, students and interns can optimize programs supported by the HITECH to further their knowledge and career in areas related to health IT, quality improvement, project management and health related career unintended consequences of HITECH. HITECH supports the recommendations of the Nutrition Informatics Work Group and provides the newly formed Nutrition Informatics Committee with an aggressive timeline and with the need to re-prioritize recommendations. Long Term Commitment Weave strategies utilized within ADA s Strategic Plan into a long range Nutrition Informatics Action Plan modeled after the Nursing Informatics Strategies Technology Informatics Guiding Education Reform (TIGER) Initiative. The Tiger Initiative s purpose is to enable nurses to use informatics tools, principles, theories, and practices to make healthcare safer, more effective, efficient, patient-centered, timely, and equitable by interweaving enabling technologies transparently into nursing practice and education, making information technology the stethoscope for the 21st century. They have developed a 10-year vision and 3-year action plan which positions the nursing profession to be responsive and engaged in the adoption of electronic health record. While most of the work was completed prior to the HITECH Act, much of the strategy and tools will be useful to RD and DTRs as they transition to EHRs and an electronic practice environment. 6