Overview of Health IT

Accelerate Adoption of Health Information Technology and Increase Interoperability

What is it?

The U.S. health care system has been called the world's largest, most inefficient information enterprise. Most health information is still stored on paper in individual physician offices and health care organizations. The use of information technology (IT) in the health care system trails far behind other sectors of the economy, and the United States trails far behind other countries in use rates of health IT. Health IT refers to a variety of electronic tools for managing health information. Applications of health IT include the electronic medical record (EMR), the electronic health record (EHR), the personal health record (PHR), computerized physician order entry (CPOE), clinical decision support (CDS), picture archiving and communications systems (PACS), and e-prescribing. In addition, health information exchanges (HIEs) are being developed to support information sharing electronically among health care providers. Health IT is an enabling technology that may allow other cost containment strategies to be implemented (for example, better claims transaction processes, more efficient management of patients within systems, reducing unnecessary utilization through more clinically detailed criteria for matching patients to interventions). Policy options focus on approaches to accelerating adoption of health IT, including financial incentives, direct provision, regulatory mandates, development of standards, and enhancing the interoperability of health IT through the establishment of health information exchanges at the local, regional, and national levels.

Proponents believe that widespread adoption and use of such health IT applications will make substantial improvements in health care delivery, leading to improved quality, better health, and lower costs. However, much of the promise associated with health IT requires high levels of adoption (90 percent of doctors' offices, hospitals, and other clinical settings) and high use of interoperable systems (in which information can be exchanged across unrelated systems) that are designed to change clinical workflow (for example, improved management of chronic disease).

How would it work?

Several types of policies could be used to increase the adoption and use of health IT. Some policymakers have proposed financial incentives or subsidies for providers who adopt or use health IT. Others have proposed the direct provision of health IT hardware and/or software to providers, changing current law to relax antikickback standards that are believed to impede the sharing of health IT among health care organizations. Still others have proposed mandates for health care providers to adopt health IT. Alternative approaches focus on interoperability, such as developing standards for health information exchange that would increase the utility of health IT, enhancing privacy and security rules to protect personal health information that is transmitted electronically, funding research related to the development of a unique patient identifier for interoperable systems, and providing funding for the development of health information exchanges.

In Congress there is considerable bipartisan support for promoting health IT. The American Recovery and Reinvestment Act (ARRA), which was signed into law by President Obama on February 17, 2009, incorporated the Health Information Technology for Economic and Clinical Health (HITECH) Act as Title XIII. HITECH amends the Public Health Service Act to codify the Office of the National Coordinator for Health Information Technology (ONC) within the U.S. Department of Health & Human Services (HHS) and requires the national coordinator to establish a governance mechanism for a nationwide health information network. It directs the secretary of HHS to appoint a chief privacy officer in the Office of the ONC. HITECH also establishes a transparent and open process for the development of standards that will allow for nationwide electronic exchange of information and requires the secretary of HHS to review and determine whether to adopt such standards. The new law also establishes a voluntary certification process for health information technology products and directs the national coordinator to support the development and routine updating of, and make available, qualified EHR technology unless the secretary determines that provider needs and demands are being met by the marketplace.

The new law provides grants and loan funding to support health IT (HIT) architecture, the development and adoption of certified EHRs, training in best practices and infrastructure, and tools for the promotion of telemedicine. It also improves and expands current federal privacy and security protections for health information by establishing a federal breach notification requirement for health information; subjecting additional entities to the HIPAA Privacy Rules; allowing patients to request an audit trail; prohibiting the sale of an individual's health information without their authorization; requiring authorization for use of health information for marketing and fundraising activities; increasing penalties for violations of HIPAA; and providing resources for enforcement and oversight activities. Finally, Title IV of ARRA also provides significant financial incentives through Medicare and Medicaid programs to encourage hospital and doctors to adopt and use certified EHRs, and then subsequently reduces payments for those who are not meaningful EHR users by FY 2011 for hospitals and FY 2015 for physicians.

Not all options require congressional action. Policy options also include regulatory initiatives, grants, and research funding by federal agencies to improve health IT adoption, interoperability, and interconnectivity. Agencies of HHS, including the Agency for Healthcare Research and Quality (AHRQ), the Assistant Secretary for Planning and Evaluation (ASPE), the Centers for Medicare & Medicaid Services, (CMS), and the ONC, all have jurisdiction over aspects of health IT.

Indirect mechanisms can be employed to promote health IT. Mandates to report provider performance or the instituting of pay for performance (P4P) incentives could increase the adoption of EMRs to facilitate the reporting of P4P data. The move toward PHRs could increase pressure on physicians to adopt EMRs that can 'load' such information into Web-based PHRs controlled by patients. Reductions in malpractice insurance that are tied to better documentation of medical encounters via EMRs could also theoretically increase adoption of health IT.

Has it been tried before?

The adoption of health IT in physician offices and hospitals has been done in a piecemeal and relatively slow manner. Survey data suggest that about 32 percent of hospitals and 17 to 25 percent of physician practices have an operational EMR system (Blumenthal et al., 2006; HIMSS, 2007). There are also significant differences in the adoption rate associated with the size of a physician practice. The reported range is 13 to 16 percent for solo offices and 19 to 57 percent for large practices (Blumenthal et al., 2006). Anecdotal evidence suggests that this difference is related to various factors, including lack of access to capital, inability or unwillingness to disrupt patient care during start-up, lack of technical expertise, concerns about privacy, and little evidence of a return on investment.

Still, the federal government and some state governments are pushing ahead with incentives and mandates. For example, Minnesota has mandated the use of e-prescribing technology in the 2008 Minnesota Health Care Reform Act.