In our Orchard Software online forums, we have been getting a lot of questions regarding what the differences are among all of the acronyms affecting healthcare information technology. In this post, we deliver a break-down of all these acronyms in one location. Please comment below if you have any more questions.
American Recovery and Reinvestment Act (ARRA) is the stimulus act from 2009 that started it all. The stimulus act included measures for upgrading the health IT (HIT) infrastructure to increase interoperability (making it easier for entities to share health information). The section of ARRA covering health IT is known as HITECH.
HITECH has two main arms:
- ONC (Office of the National Coordinator) is charged with defining the standards that must be met for a system to become certified and overseeing the certified systems.
- CMS (Centers for Medicare and Medicaid Services) is charged with defining the criteria needed to meet Meaningful Use and overseeing the users of the certified systems. Meaningful Use is the incentive for providers and hospitals to implement electronic systems. Basically, if they meet the Meaningful Use requirements, they will receive payment from CMS. Meaningful Use is a graduated process, defined in three stages. Each stage will build upon the others and increase the ability to share health information. Currently, only Stage 1 has been defined and is what is driving Meaningful Use today.
HIEs are Health Information Exchanges among many providers, hospitals, insurance companies, etc. HIEs can be local, regional, or statewide. HITECH established grant monies for states to develop HIEs. Many HIEs are now forming and are focusing on how data will be shared among the members of the HIE, since the members most likely will have a variety of EMR systems and each state can format their own program under the current Stage 1 rule.
RECs are Regional Extension Centers. The ONC has funded RECs to offer technical assistance, guidance, and information on best practices to support and accelerate healthcare providers’ efforts to become Meaningful Users of EHRs. They are educational in nature, and not required for Meaningful Use.
So where does LOINC (Logical Observation Identifiers Names and Codes) fit in all this? One of the optional menu items to attain Stage 1 Meaningful Use is that an EMR must incorporate lab results as structured data. For Stage 1, ONC did not mandate a particular standard for how structured data should be incorporated. LOINC is one of the possibilities. We look to the final rule for Stage 2 to further define the standards. LOINC are result codes based on test methodology, so if your HIE contains six different labs that all have unique methods for a particular test, there will be six different LOINC. LOINC will be included in the HL7 result transmission from the LIS to the EMR.
Part of the confusion is that LOINC are also being developed for order choices. Thus far, LOINC order codes are not universally accepted. When CPOE (Computerized Provider Order Entry) becomes mandated for labs, we may hear more about them. Understand that while CPOE is a core item (required) for Stage 1, it is for medication orders only and not labs. We expect lab orders to be required in Stage 2; although, the proposed rule states the orders do not need to be transmitted.
The final rule for Stage 2 is expected to be published in July of 2012 and will go into effect on January 1, 2013. So if LOINC becomes the mandated standard, there is still some time. The proposed Stage 3 rule is expected by year end 2013, with the final version published mid-2014 to go into effect January 1, 2015. Providers and hospitals have until 2015 to meet Meaningful Use. If not, CMS will reduce payments to those who have not.
Those are the only mandated deadlines mentioned in HITECH. However, as vendors, labs, and providers all work towards interoperability, they may want this data in advance to conduct the appropriate testing and validation. Meaningful Use will have a huge impact on your facility, but the lab actually has a limited role.
I hope this puts everything into perspective. Orchard Software has convenient pages on our website to explain ARRA, HITECH, LOINC, and the rest of the HIT acronyms with helpful diagrams and related information. They can easily be found on the left side of our website. Again, if you have a question regarding this post, please leave a comment or visit www.orchardsoft.com. Remember to visit our blog frequently to receive the latest HIT information!
Ginger Wooster, MBA, MT (ASCP)
Director of Regulatory Affairs & Applications Specialist
Orchard Software Corporation