Monday, February 1, 2010

President's Budget for the ONC

The President has submitted his proposed budget to Congress. HHS has also released the HHS Budget Brief for publication. ONC has a total of $78 million in funding requested, which include the $20-billion plus HITECH programs signed into law last February. The increase to ONC's budget will enable the health IT czar's office to continue implementing programs that accelerate the adoption of health IT nationwide, and "helping physicians achieve meaningful use of e-health records," the brief states.

The proposed budget includes $4 million for ONC "to identify consumer perspectives on consumer e-health tools and the development of patient decision aids; anticipate and mitigate unintended consequences of the electronic exchange of health information; and support state governments as they implement their HITECH grants," according the HHS brief.

Below is the relevant portion of the brief concerning the Office of the National Coordinator:

(dollars in millions)

2009 2009 2010 2011 2011 +/- 2010
Budget Authority 44 2000 42 78 36
PHS Evaluation Funds 18 -- 19 -- -19
Total, Program Level 61 2000** 61 78 17

FTE 31 -- 75 120 +45

*American Recovery and Reinvestment Act of 2009 (Recovery Act)
**The Recovery Act appropriation to ONC includes $20 million to be transferred to NIST.

The FY 2011 Budget request for the Office of the National Coordinator for Health Information Technology (ONC) is $78 million, $17 million above FY 2010. The FY 2011 President’s Budget includes resources for ONC to serve as the Federal health IT leader and coordinator and to continue implementing Recovery Act programs. These roles are vital to achieving the goals of the President’s health IT initiative and health reform. The FY 2011 Budget request, in conjunction with the $2 billion appropriated to ONC under the Recovery Act, will enable HHS to continue implementing the Health Information Technology for Economic and Clinical Health (HITECH) Act, accelerating the adoption of health IT and helping physicians achieve meaningful use of electronic health records (EHR). ONC and the Centers for Medicare & Medicaid Services (CMS) have worked closely to develop rules defining the “meaningful use” of EHRs and setting initial standards, implementation specifications, and certification criteria for EHR technology. In FY 2011 ONC and CMS will update these rules as needed. CMS, with Recovery Act funding, will provide financial incentives to help Medicare and Medicaid providers adopt and meaningfully use EHRs. Incentive payments to eligible hospitals may begin as soon as October 2010. Incentive payments to eligible professionals may begin in January 2011.

In addition to funds requested for ONC, the FY 2011 Budget request for other HHS divisions includes funds to advance the Administration’s health IT agenda. The Budget request includes $32 million in the Agency for Healthcare Research and Quality (AHRQ) to advance the use of health IT to enhance patient safety, $1.6 million in the Office of Civil Rights (OCR) for regional privacy advisors, and $1 million in the Office of the Assistant Secretary for Planning and Evaluation (ASPE) for independent evaluations of EHR adoption and economic factors influencing health IT, in coordination with ONC. In addition, the Budget request for CMS includes resources to conduct the third year of a demonstration project to encourage small physician practices to adopt EHRs.


$2 billion for health IT and includes the authorization of ONC; two new Federal Advisory Committees to guide standards and policy development processes; new grant and loan programs; and increased privacy and security protections. ONC’s plans for the $2 billion Recovery Act investment in health IT include:

♦ $693 million to establish the Health IT Extension Program to disseminate best practices for health IT implementation, adoption, and use, and provide technical assistance supporting the adoption and meaningful use of health IT; ♦ $564 million for a Health Information Exchange State Grant Program to support sub-national and regional efforts toward health information exchange, nationwide interoperability, and statewide planning;

♦ $118 million to develop the health IT workforce;

♦ $235 million for a Beacon Communities Program to demonstrate the potential of health IT and convey evidence to providers and other communities that the widespread adoption of health IT and exchange of health information is feasible and improves care delivery and health outcomes;

♦ $24 million to carry out the Department’s statutory responsibilities under the HITECH Act to draft regulations, guidance, and reports, and to conduct studies and audits to strengthen privacy protections and security safeguards;

♦ $20 million for the National Institute of Standards and Technology to develop health IT standards testing and evaluation infrastructure; and

♦ $345 million for a variety of activities designed to complement and advance the goal of supporting the care of all Americans with EHRs by 2014. In FY 2011, ONC will continue implementing Recovery Act programs, evaluate Recovery Act funded programs, and update rules and regulations as needed. ONC will also involve stakeholders and fulfill the unprecedented transparency and accountability reporting requirements for recipients of Recovery Act funding.


The interoperability of EHRs is a critical element of the national health IT agenda and a necessary building block for achieving the President’s health IT goals. The FY 2011 budget request includes $23 million to support the development of health data standards necessary to enable the interoperability of EHRs, and to ensure that standards are available for both private sector and Federal use. This funding will support the ongoing standards harmonization process, which is required for IT systems to exchange data across different health care settings. ONC will also continue implementing the new processes outlined in the HITECH Act for standards development, which include recommendations from the Health IT Policy Committee and a Health IT Standards Committee. The Health IT Policy Committee also provides policy recommendations related to the implementation of a nationwide health information technology infrastructure. The Health IT Standards Committee recommends standards, implementation specifications, and certification criteria for the electronic exchange and use of health information. Realizing the full benefits of reliable and secure health information exchange across organizations and jurisdictions requires a health information exchange network of common technical, privacy, and security standards and policies. The FY 2011 Budget request includes support for expanding health information exchange network capabilities. In FY 2011 ONC will also continue supporting Recovery Act activities that will further develop the nationwide health information network (NHIN) and support expanding health information exchange capabilities.

In addition to supporting the implementation of Recovery Act activities, ONC will also promote the adoption of health IT through working with mental health and substance abuse providers to integrate substance abuse and mental health prevention and treatment into the larger primary care delivery system health IT framework and with Medicaid and other safety net services. ONC will work closely with the Substance Abuse and Mental Health Services Administration in developing this new $4 million effort.


The FY 2011 Budget includes $7 million to support the continued development of appropriate Federal privacy and security protections of electronic health information, and State consensus efforts to address patient protections. Ensuring adequate Federal protections and facilitating multi-State collaboration is essential to building public confidence and trust in nationwide health information exchange. ONC will also work with other Federal agencies to protect and secure the transmission of health information over computer networks through a health IT cybersecurity program. In FY 2011, ONC will continue working with partners, such as OCR, CMS, States, and other stakeholders to protect patients’ health information. ONC will also continue to support the implementation and development of HITECH Act privacy and security regulations and guidance, and to update these regulations and guidance as necessary.


Increasing the adoption of health IT and reducing barriers to achieving the meaningful use of EHRs are essential to achieving the President’s health IT initiative. The FY 2011 budget includes $4 million for ONC to identify consumer perspectives on consumer ehealth tools and the development of patient decision aids, anticipate and mitigate unintended consequences of the electronic exchange of health information, and support State governments as they implement their HITECH grants.


The FY 2011 budget includes $7 million to conduct economic analysis and develop models describing the factors driving the adoption, meaningful use, and interoperability of EHRs, and to evaluate and measure the success of programs funded under the Recovery Act and other ONC efforts to further the adoption and meaningful use of health IT. ONC will use $38 million to increase Federal staff and reduce contractor support to continue efficiently implementing Recovery Act programs and to continue a communications and outreach program begun in CY 2009.


In FY 2011, ONC will continue to define measures of success and report on these measures as appropriate. ONC will use existing performance measures as well as the milestones and objectives of the Federal Health IT Strategic Plan (as will be reflected in the CY 2010 revision), and the Recovery Act operating plans in developing these measures. ONC will also measure its success by continuing to fund surveys on the adoption rates of EHRs among physicians and hospitals.