1. McCartney, Patricia R. PhD, RNC, FAAN

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Ask any informaticist: the hottest discussion topic this spring is the American Recovery and Reinvestment Act (ARRA) of 2009, the new law which contains significant provisions for advancing health information technology (HIT). ARRA transforms the HIT initiatives that began in 2004 as a federal administrative agenda into an established law. The law invests $19 billion in HIT to stimulate the economy (growth in informatics jobs and businesses) and to adopt electronic health records (EHR) (Hayes, Moore, Pulley, & Robinson, 2009).


Health IT

HIT refers to using electronic information processing to manage healthcare information, data, and knowledge, in communication and decision making- all processes to improve healthcare safety, quality, and cost containment. Effective HIT management among healthcare consumers and multiple providers requires key elements; widespread EHR use (for digital data), interoperable technical standards, and secure health information exchange (HIE). To achieve this, the federal plan includes two goals, to enable patient-focused healthcare and to benefit overall population health; and four objectives, interoperability (technical standards to enable HIE), privacy and security (safeguards for electronic exchange of information), adoption (incentives for providers to implement and certification to encourage standards), and collaborative governance (public and private partnerships). The federal Web site details HIT initiatives (U.S. Department of Health and Human Services, 2009a) and links to ARRA, including the 400-page legislation.



Division A of the Act (Appropriations Provisions) includes Title VIII, Department Health and Human Services (establishes the Office of the National Coordinator) and Title XIII, Health Information Technology (short name is HITECH Act). The development of definitions and standards falls under two committees, the HIT Standards Committee (technical standards and certification criteria for electronic records) and the HIT Policy Committee (the national health information technology infrastructure and information exchange). The HITECH Act also outlines available grants, loans and demonstration projects, required privacy and security provisions, use of audits, enforcements and penalties, and initiatives for health information privacy education.


Division B of the Act (Health Provisions) includes Title IV, Medicare and Medicaid Health Information Technology. This section outlines incentives for EHR adoption, specifically formulas for incentives and penalties. These formulas are important for any healthcare provider or organization that receives Medicare and Medicaid reimbursement.


Experts suggest financial assistance will be directed toward adoption of EHRs (especially in provider offices) and toward HIE networks. Incentives will go to projects that demonstrate "meaningful use" of HIT. ARRA calls for "comparative effectiveness research" centers that examine the measurable value of treatments and strategies to improve health (U.S. Department of Health and Human Services, 2009b). The Web site demonstrates government transparency and accountability by explaining the Act, showing where money is being spent, and inviting citizen feedback (Recovery Accountability and Transparency Board, 2009).


Maternal-child nursing input is critical in shaping this HIT expansion. Never has it been more crucial to learn and participate. What should you do? Volunteer for HIT committees in your setting, respond to every survey you receive, and explore these Web site. Take advantage of learning opportunities at work through professional organizations or online.




Hayes, H., Moore, J., Pulley, J., & Robinson, B. (2009). Stimulus response. Government Health IT, 4(2), 20-29. [Context Link]


Recovery Accountability and Transparency Board. (2009). Retrieved May 1, 2009, from[Context Link]


U.S. Department of Health and Human Services. (2009a). Health information technology: For the future of health and care. Retrieved April 27, 2009, from[Context Link]


U.S. Department of Health and Human Services. (2009b). HHS.Gov/Recovery-Comparative effectiveness research funding. Retrieved April 27, 2009, from[Context Link]