AMIA Policy Activities

The last few years have clearly been the most exciting ever for health information technology (HIT) policy. The nation has made a huge investment in HIT through the Recovery Act of 2009 and its HITECH provisions, on the premise that electronic health records and widespread information exchange can improve the quality, safety, and efficiency of our healthcare system and transform the care delivery experience for providers, patients, and families—all while helping to improve population health and health data systems. But implementation of such an ambitious program brings many challenges. We think that the next few years will be even more important for AMIA and other HIT stakeholders as we realistically face uncertainty about returns on the national investment.

Our goals in writing this column are to describe the role of the AMIA and its Public Policy Committee (PPC), to highlight some accomplishments of past years, and to discuss some of the new activities going forward. Through many educational and advocacy efforts, AMIA and its members play a significant role in helping shape HIT policy, and AMIA serves as an independent voice around issues relating to HIT and informatics more broadly. AMIA's influence is enhanced by the diversity of its members' expertise, which includes clinical, public health, and consumer informatics, research, education, health administration, and computer sciences, among many others. Members in academic, government, corporate, and community settings all benefit from AMIA's extensive educational and information-sharing activities at the Annual Symposium, in e-News, on the web site, and in other forums. AMIA members serve on a host of influential policy-relevant committees, including the Health Information Technology Policy Committee, the Health Information Standards Committee, the National Committee on Vital and Health Statistics, and various Institute of Medicine and National Quality Forum committees. In particular, the Policy and Standards committees—which are federal advisory committees—have provided direct input to the Office of the National Coordinator around policy issues based on a body of evidence developed by

AMIA members and others over many years. Testimony provided to Congress and the Policy and Standards Committees by AMIA members also has helped to inform policy-makers about issues of interest to the broader HIT community.

The key role of the AMIA PPC is to make recommendations to the AMIA Board of Directors regarding AMIA positions on public policy issues at a national level. This is carried out in a variety of ways but primarily focuses on tracking agency and legislative activities, developing policy statements for Board approval, holding discussions at AMIA health policy meetings, and developing a variety of white papers and position statements to help educate the AMIA membership, other stakeholders, and the media about key policy issues.

For example, in carrying out their responsibilities to implement provisions of the Recovery Act and the Affordable Care Act (healthcare reform), many federal agencies have undertaken activities related to HIT. These include the Office of the National Coordinator, the Centers for Medicare and Medicaid Services, the Food and Drug Administration, the National Institute for Standards and Technology, and the President's Council on Science and Technology, to name just a few. The new legislation has resulted in a deluge of requests for commentary and testimony on an array of draft guidance documents and proposed regulations, with some of the most notable being the meaningful use criteria, privacy and security, mobile applications, clinical decision support, metadata, and The Common Rule. In 2011, AMIA's PPC members collaborated with the Board, AMIA members, and AMIA staff to produce 17 public comments on proposed regulations, which has played an important role in improving them.

AMIA's PPC also has a number of activities directed at developing broader policy statements. These include published summaries of the annual policy invitational meeting on special topics such as secondary use of data, unintended consequences, innovation, and clinical documentation.1–5 The educational activities of the PPC also include policy forums at AMIA meetings, online tutorials through the AMIA web site, and mentoring for aspiring policy leaders. In addition, we have created a series of issue briefs on key topics, and have generated a number of white papers intended for general audiences and the media. Some have been published in the Association's journal (J Am Med Inform Assoc) and others are available on the AMIA web site (http://www.amia.org/public-policy/positions-and-statements).

Although the Board oversees advocacy initiatives in support of AMIA positions, all of AMIA's policy activities involve close collaboration with Washington Health Strategies Group, whose tracking of federal activities, Congressional hearings, and legislation in areas of interest to AMIA members and the informatics community provides AMIA with real-time information on national priorities. Washington Health Strategies Group works with AMIA staff and also provides regular policy updates for corporate members and hosts the annual Hill Day, in which members of the PPC and other AMIA members meet with Congressional members and staff to discuss current policy issues, such as the implementation challenges involved with HITECH.

While AMIA's main focus has been on federal activities, the PPC recently spun off a Regional Informatics Action Group to assist those working on policy issues in states. The state-level implementation of regional extension centers and health information exchanges under HITECH, and health insurance exchanges under healthcare reform, could yield a vibrant ecosystem for innovative partnerships and information-sharing in the future.

HITECH laid the groundwork for transformational change in the way healthcare will be delivered and experienced by clinicians and patients, and for expanding an information infrastructure through which clinical data can be reused for research, planning, and population health. But with implementation on such a large scale, there is a risk of perpetuating the same fragmentation that has led to medical errors and disparities in quality and care integration. We need to carefully study and learn from the early adopters about the implementation process, and share information that encourages innovation and quality improvement.

While it may feel that the healthcare industry is traveling on an unknown path, AMIA can help to lead the way by promoting the trusted environment needed for HIT and exchange in the future. We need to continue to demonstrate how AMIA, a diverse community of practice with shared interests, can evolve better systems through collaborative efforts. In the long run, that's the best way for our field to deliver on the promise of HIT.