Health Information Technology

Background

Health information technology (HIT) encompasses an array of technologies that store, share, and analyze health information, as well as communicate about, diagnose, and treat patients.

HIT ranges from electronic health records (EHR) to consumer-facing mobile health applications such as telehealthThe use of electronic telecommunications technologies to deliver health care, health information, or health education at a distance. A related term, Telemedicine, generally indicates physician services. (see more below). HIT can support improvements in the quality and efficiency of care when health care providers can easily exchange medical records and ensure that their patients’ health information is available when needed. A robust health information infrastructure can simplify many processes. It can facilitate the collection and retrieval of data, reduce errors and duplication, foster care coordination, and support clinical decisions. And it can help consumers and caregivers be more actively involved in managing their health and health care decisions (see also Consumer and Family Engagement in Health). HIT can also improve population health through better monitoring of quality of care, improved dissemination of information about evidence-based practices, and more unified public health surveillance efforts. Widespread use of HIT could also lead to savings.

Primarily driven by federal financial incentives authorized by the Health Information Technology for Economic and Clinical Health (HITECHThe Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 enacted stricter data security requirements for all health care organizations as well as their business associates.) Act, the nation’s health care providers have made progress in implementing HIT – most notably by shifting their record-keeping from paper to computerized systems. Nearly all hospitals and three-quarters of office-based physicians are now using certified EHR. A key HITECHThe Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 enacted stricter data security requirements for all health care organizations as well as their business associates. provision mandates that in order to qualify for financial assistance, physicians, hospitals, and most other eligible providers must put the technology to “meaningful use.” The Centers for MedicareMedicare is the federal health insurance program for people who are age 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (ESRD), (permanent kidney failure requiring dialysis or a transplant). & MedicaidA joint federal/state program that provides health care and LTSS. However, to qualify for Medicaid LTSS, people must have extremely low assets and income, or they have to “spend down” most of their assets. Services (CMS) has defined this term in various regulations, including those proposed to implement the MedicareMedicare is the federal health insurance program for people who are age 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (ESRD), (permanent kidney failure requiring dialysis or a transplant). Access and Children’s Health Insurance Program Reauthorization Act of 2015. According to CMS, meaningful use is using certified EHR technology to:

  • improve quality, safety, efficiency;
  • reduce health disparities;
  • engage patients and family;
  • improve care coordination;
  • improve population and public health; and
  • maintain privacy and security of patient health information.

Other regulations describe the requirements for EHR, including the standards, implementation specifications, and certification criteria.

Meaningful use requirements and other factors that incentivize care coordination have driven the development of provider-to-provider and consumer-mediated health information exchange systems. HIT systems that support direct provider-to-provider exchanges allow clinicians to query other clinicians’ software systems for relevant information from the patient’s EHR (typically in the context of unplanned care encounters). They also enable providers to share relevant portions of a patient’s EHR directly with other members of the care team. Such information exchange can allow clinicians to better understand their patients’ past medical histories and encounters, avoid medication errors, and decrease the use of duplicative (and potentially harmful) procedures and tests. An alternate but complementary approach to sharing data puts consumers in charge of their medical records. Through consumer-mediated exchange systems, patients can use a third-party digital application to aggregate, control, and authorize access to their electronic health information by health care providers or other people, including family caregivers People who provide long-term services and supports to family members, relatives, friends, and neighbors. Some family caregivers are unpaid; others are paid through government programs, private funds, or long-term care insurance policies. .

Despite tremendous promise, various barriers limit HIT’s ability to improve the quality, safety, and efficiency of care. Among these hurdles are concerns about privacy, confidentiality, and security. Roadblocks exist in integrating the technological infrastructure to enable interoperabilityThe ability of different information systems to exchange, integrate and cooperatively use data in a coordinated manner, within and across organizational, regional and national boundaries, to enable timely and seamless portability of information. in commercial EHR systems. Cost, as well as the need to train health care workers to create and maintain databases, also creates impediments to implementation. Additionally, many hospitals and clinicians do not have the technical ability or may be unwilling to share patients’ electronic health information, even when transfers can be done securely.

Many consumers may not want or be able to assume responsibility for identifying appropriate recipients of their records and authorizing their distribution. Consumer-mediated data-sharing could potentially improve the flow of digital health information. It could also have the potential to burden consumers with the task of authorizing data access and with the responsibility of identifying appropriate recipients for their health information.

HEALTH INFORMATION TECHNOLOGY: Policy

HEALTH INFORMATION TECHNOLOGY: Policy

Use of Health Information Technology (HIT)

The Department of Health and Human Services should ensure progress to full implementation of the meaningful use requirements so that federal HIT investments advance health and improve quality and efficiency in the health care system.

Federal and state policymakers should use health care payment policies to ensure that electronic health records provide consumers and families with comprehensive, meaningful, easily accessible health care information, where feasible.

Federal and state governments should advance the use of HIT through the adoption of interoperable electronic health records (EHR) and information exchange systems. They should continue to explore innovative approaches to integrating information and sharing data to improve care and support consumer and family caregiver People who provide long-term services and supports to family members, relatives, friends, and neighbors. Some family caregivers are unpaid; others are paid through government programs, private funds, or long-term care insurance policies. engagement. They should develop infrastructures to support standards and privacy protections that are at least consistent with national standards.

Federal and state policymakers should ensure that policies to promote interoperabilityThe ability of different information systems to exchange, integrate and cooperatively use data in a coordinated manner, within and across organizational, regional and national boundaries, to enable timely and seamless portability of information. do not impose undue burden and responsibility on consumers and family caregivers People who provide long-term services and supports to family members, relatives, friends, and neighbors. Some family caregivers are unpaid; others are paid through government programs, private funds, or long-term care insurance policies. . These policies should complement, not replace, provider responsibility to obtain and share health information needed to provide high-quality care.

Long-term services and supports (LTSS) plans included in EHRs

Federal and state governments should incorporate LTSSLTSS encompasses a broad range of assistance with activities of daily living and health-related tasks for people with functional limitations caused by physical or mental impairments. LTSS may be delivered in institutions or in a person’s home or a residential care setting. service plans in EHR. This enables providers to utilize a standardized care plan as consumers with LTSSLTSS encompasses a broad range of assistance with activities of daily living and health-related tasks for people with functional limitations caused by physical or mental impairments. LTSS may be delivered in institutions or in a person’s home or a residential care setting. needs move across settings.