You are using an outdated browser. Some of the rich features of this site is not going to function on this browser. Consider updading your browser or using a newer browser.
Certification is primarily a way of enforcing that products meet certain criteria or standards. It can exert a powerful influence on products and markets—an influence that is particularly potent when the certification program is run or sanctioned by government. It is therefore critical that any certification program with government imprimatur be structured carefully to support clear public policy goals and avoid unnecessary restraints on market innovation. The American Recovery and Reinvestment Act of 2009 (ARRA) authorizes the National Coordinator for Health Information Technology to establish a voluntary certification program or programs for health IT. Although the proposed HHS program for testing and certifying EHR technology is technically voluntary, it will play a pivotal role in triggering eligibility for approximately $34 billion in stimulus funding and consequently will have a high degree of influence over technology development and choice in a rapidly changing health IT market. For these reasons, HHS must structure the certification program carefully to focus only on those elements that are necessary to achieving its policy goals while avoiding unintended consequences. Overall, the proposed program takes an appropriately measured approach to certification, as evidenced by its independence, limits in scope, emphasis on privacy and security, and flexibility for future innovations. Certification can be a tool for achieving some public policy goals, but it is good for some objectives and not for others. The role of HHS-sanctioned testing and certification is an important but limited one. The collaborative comments offer the following recommendations: HHS should create clear, standard language about the purpose and goals of its certification program, and its limitations in addressing important public policy questions raised by the adoption and use of health IT. HHS should establish ―labeling requirements for certified products that are consistent and clear to help providers and purchasers understand the scope of the testing and certification under the HHS program to implement ARRA financial incentives. In particular, the standard language should communicate the scope of certification, as well as its limitations both in terms of implementation experience and privacy and security. HHS should clarify the rules by which EHR modules may be exempt from testing against all privacy and security certification criteria. Except for the specific circumstances in which such services are being used to help health care providers and hospitals qualify for Meaningful Use incentives under ARRA, HHS should limit the scope of extending the current certification program to other forms of health IT such as electronic personal health records (PHRs) or health information exchanges (HIEs). In the eyes of the HHS-sanctioned testing and certification program, PHRs and HIEs should only be considered when packaged as EHR modules. In other words, when they are offered as components of a complete EHR or an EHR bundle, they may be tested and certified under the same rules as EHR modules, based on the limited scope of Meaningful Use. Otherwise, the public policy benefits are not clear for certifying PHRs or HIEs outside of the Meaningful Use context. HHS should clarify the type and scope of modifications that would require a product to be recertified.
In testimony before the National Committee on Vital and Health Statistics (NCVHS) Subcommittee on Standards, Carol Diamond, MD, MPH discusses the importance of setting clear health objectives for the federal investments in health IT. The testimony also emphasizes the importance of adopting a basic set of standards that can evolve over time, enabling information to move when and where it is needed to authorized individuals, the need for a comprehensive set of privacy policies, and accountability for results. The goal of health IT must be to achieve real health improvements, create jobs, and reduce unnecessary costs. It should not be primarily the creation of standards or the certification of software. Rather, standards and certification should support measurable health improvements. Health improvements are not achieved by the mere installation of software; they are achieved through the effective use of information for better decision-making.
The release of proposed federal health information technology (IT) “meaningful use” regulations and standards marks a major, positive step forward in the nation’s efforts to improve health care by putting modern IT tools at the fingertips of medical professionals and consumers alike. The public comment period is critical for ironing out workable details, and clearly we believe some important revisions will be necessary in the final regulation. But we must not lose sight of the urgent priorities of this effort: to improve health, increase cost-effectiveness, protect privacy, and encourage innovation and broad participation across many health care settings. The Markle Foundation, the Center for American Progress, the Engelberg Center for Health Care Reform at Brookings and three dozen diverse leaders in the health sector send a letter commending federal agencies for their work drafting proposed health IT "meaningful use" regulations and standards.
We acknowledge a need for federal governmental leadership that accelerates the potential of PHRs to empower the consumer. However, certification should not be a governmental focus at this time. The risks outweigh any potential benefits. If this recommendation goes forward, it will create momentum for certification is likely to ignore a broad range of critical policies and, as well, stifle innovation by prematurely locking in current approaches to PHRs and deter new entrant in a field that is newly developing. A premature process for certification--even if it begins as voluntary and attempts to limit itself to privacy, security, and interoperability--risks undermining opportunities to empower consumers and improve the quality of care.
In Phase 1 (2002–2003), the Markle Connecting for Health collaborative focused especially on moving the health care field toward the adoption of health care data standards, identifying "noteworthy" practices in privacy and security, and elaborating the role of the consumer and the personal health record.
Carol Diamond of the Markle Foundation, Marc Overhage of the Indiana HIE Organization, and Art Glasgow of Ingenix lead the panel discussion "Health Information Exchange and Health Care Stakeholders." This session is part of the Department of Health and Human Services' HIT Policy Committee and HIT Standards Committee's PCAST Work Group. The session is open to the public via live webcast. Webcast Information At least 10 minutes prior to the meeting start time, please go to: http://altarum.adobeconnect.com/PCAST If for any reason the link does not work, copy and paste the URL into your browser's address bar. Select "Enter as a guest." Enter your first and last names. Click “Enter Room.” Audio Conference Please note that space for the webcast is limited. If you are unable to log in, you may listen to the session via phone conference. US toll free: 1-877-705-2976 International Direct: 1-201-689-8798 Test Your System You will need to have an up-to-date version of Flash Player to view the web conference. Please test your system prior to the meeting by visiting Adobe Test Meeting Connection. When running this system test, you do not need to install the Adobe Connect Add-in (step 4 of the test), as that is not relevant to this meeting.
We’re now eight months into the pandemic, and its sheer toll continues to be overwhelming. In addition to the hundreds of thousands of Americans who’ve lost their lives and the millions who’ve been infected, the economic devastation rages on. Over 11 million Americans are unemployed, and the country has lost over 10 million jobs. People of color have been particularly impacted. The unemployment rate among whites is 6%, while for Blacks it is 10.8% and for Latinos it is 8.8%. While some of the jobs that have been lost could come back once the pandemic ends, many won’t. Even the jobs that do come back may look different than before, since the pandemic has led companies to increase their use of technologies like automation and artificial intelligence. Workers may need different skills and credentials to succeed the post-pandemic job market. To be clear, workers need immediate support now—from housing assistance, to increased unemployment benefits, to additional food support, and more. But we also have to help people succeed in the post-pandemic job market. And we need to make sure that those who have been hit hardest by the crisis can emerge in a stronger position to access good jobs moving forward. Employers can play a critical role in promoting an equitable recovery and ensuring workers can regain their footing in the post-pandemic job market. However, the economic and public health crisis pose grave challenges—particularly to small and medium sized businesses—that limit their ability to do so. For example, coming out of this pandemic, small and medium-sized employers may lack the resources to create apprenticeship programs or provide other on-the-job training and upskilling opportunities for their workers and new hires. They may lack the tools to recognize the capabilities workers already have—regardless of where they were built. And small and medium-sized businesses may need help improving the quality of jobs they’re hiring for. If we want employers to be at the forefront of building an equitable recovery, we have to take deliberate policy steps to encourage this and support them in doing so. To help employers and workers recover from the pandemic, policymakers should take three interconnected steps: 1. Prevent further layoffs; 2. Help employers expand training for new hires and incumbent workers; and 3. Scale organizations that will help employers improve job quality and promote inclusive hiring. Prevent further layoffs First, we need to limit further layoffs and preserve the connection between employer and worker wherever possible. The pandemic led to an unprecedented level of job loss, but it didn’t have to be that way. Third Way has proposed an Emergency Payroll Subsidy (EPS) that would help employers keep workers on the payroll during specific times of economic crisis. With the EPS program, the federal government would step in at the onset of a recession and pay a portion of each low- and middle-income worker’s paycheck until the economy stabilizes. It would exist alongside the regular unemployment insurance (UI) system, but fewer people would need to rely on UI benefits because more workers would stay attached to their employer during economic downturns. With an Emergency Payroll Subsidy in place, we can stem further layoffs during the pandemic and reimagine how we support workers during recessions in the future. Help employers expand training for new hires and incumbent workers Even with something like an Emergency Payroll Subsidy in place, the pandemic could permanently alter certain industries. Jobs may look different than before the pandemic and employers may need workers to have different skills and credentials. This means many workers would still need access to training to upgrade their skills for their current jobs, switch to different occupations within their company, or even switch to different industries entirely. In all cases, it will be vital for employers to play a role in providing training to incumbent workers and new hires. Training provided or financed by employers—that allows people to earn while they learn—is a proven way to make this type of skill-building affordable and accessible. When employers are engaged in training, it also promotes better employment outcomes because the training is aligned with the skills employers need. Yet training costs are often among the first expenses cut during economic downturns—particularly for small and medium sized businesses struggling to stay afloat. If employers step back from training during the current crisis, it makes incumbent workers more vulnerable to a rapidly changing economy and also makes it less likely that employers will hire new workers who need training. Going into this pandemic, low and middle-income workers were less likely to receive employer-provided training that could help them earn more in their current roles or level up to better-paying opportunities. Unfortunately, current federal workforce policy does little to target limited public resources toward training that leads to good jobs. Many employers receive public dollars to provide training, but often that funding subsidizes training that leads to low-wage jobs or training that employers were already planning to provide. However, public resources could be leveraged to ensure that those who have long been excluded from opportunity have access to training that leads to good jobs. While we need more funding for workforce development, we also need to stretch our finite public resources as far as possible. During the crisis, policymakers need new approaches to create and expand employer-provided training opportunities that lead to quality jobs for both new hires and incumbent workers. Markle has proposed making changes to the way federal funding supports employer-provided training. Policymakers should put job quality at the heart of our public workforce development system by prioritizing funds for training that leads to jobs that provide a living wage, standard benefits, paid sick leave, and meaningful worker voice. To do this, the federal government could provide funding to states to award grants to employers that provide training that meets standard criteria. Employers would be awarded funding to cover a portion of an employee’s wages while that person is in a training program. Federal guidelines should require that states only provide funding to employers offering robust on-the-job training that leads to a job with a living wage and other benefits. Funding could also help address the barriers that prevent employers, especially small and medium-sized business, from providing training. For examples, funding could help employers partner with local training providers, design and deliver training curricula, purchase equipment, and pay workers’ wages while they participate in training. The federal government can also help states create or expand upskilling programs, such as California’s Employment Training Panel (ETP), which reimburses employers that invest in approved training. The ETP has been found to have positive impacts on sales and jobs, particularly for small and medium-sized employers. Scale organizations that will help employers improve job quality and promote inclusive hiring While expanding high-quality employer-provided training is a critical step, employers can and should go further. Employers can reduce barriers that prevent people of color from accessing good jobs by adopting more equitable and inclusive hiring practices. This means reducing their reliance on proxies like degrees, helping them focus on and understand job applicants’ skills, and taking explicit steps to reduce racial bias from the hiring process. Employers can also improve the quality of existing jobs by raising pay, providing benefits like paid sick leave, and expanding worker voice over the decisions that impact their day-to-day jobs. Current federal policy does not dedicate sufficient resources to supporting these broader efforts. To help employers—particularly small and medium-sized employers—promote job quality, Markle has proposed funding to scale the impact of intermediary organizations that work directly with groups of businesses across a sector or region. These intermediaries could include local community-based organizations, economic development agencies, workforce boards’ business services teams, chambers of commerce, labor management partnerships, or community colleges. All of these organizations are accustomed to working with employers in some way. If funded sufficiently, they can provide the more comprehensive kind of support needed to help employers expand access to quality jobs. For example, intermediaries could work with employers to structure jobs to improve pay, provide technical assistance to help employers hire more people of color, or help employers launch and deliver training programs that help people move into higher-paying jobs. Their effectiveness would be measured by their ability to help employers create more good jobs and hire from or advance the careers of people from populations that are disproportionately unemployed in the region. By taking these steps to help people succeed in the post-pandemic job market, promote quality jobs, help employers create good jobs and train their workers, and permanently change how economic shocks affect workers, we can create an economy that is more equitable than before the pandemic and provides more opportunity to all workers. This post was co-authored by Third Way and the Markle Foundation. Kelsey Berkowitz is a Senior Policy Advisor for Third Way’s Economic Program, David Marsh is Senior Manager for State & Federal Policy at the Markle Foundation.
There has been an increasing recognition by both the public and private sectors of the ability to improve the quality and safety of healthcare with interoperable healthcare information technology (IT) systems. The need for standards adoption to enable information systems to exchange clinical data in a private and secure manner both within and across institutions is also more widely recognized than ever before. This paper will: (1) provide an overview of the significant activity that is occurring both within the public and private sectors regarding interoperable information systems and data standards; (2) provide a high-level summary of the evidence supporting the use of information technology in healthcare; (3) summarize both the limited research and anecdotal evidence that currently exists related to the value of connectivity across systems; (4) describe the importance of pilot projects for both better understanding the value and of an interconnected electronic health system and for developing an effective migration strategy towards such a system; and (5) highlight the additional work needed in this area.
Topics include setting objectives, information sharing and standards, a new urgency for results, new privacy policies, accountability for results, shaping technology policy to measurable health goals, and validating the use of standards with an open, market-based approach. There is also an appendix detailing lessons learned within the realm of information technology.