Health Information Technology
Health information technology (HIT) encompasses an array of technologies to store, share, and analyze health information. Among these technologies are electronic health records (EHR) and electronic drug prescribing or “e-prescribing.” HIT is a critical tool to enhance quality improvement efforts. It can promote and facilitate the collection and retrieval of data, reduce errors and duplication, foster care coordination, support clinical decisions, and help consumers and family caregivers be more actively involved in managing their health and in health care decisions. (See this chapter’s section Health Promotion and Consumer and Family Engagement in Health—Consumer and Family Engagement in Health.) Widespread use of HIT could also lead to savings.
As a result of federal financial incentives authorized by the HITECH Act, the nation’s health care providers have made remarkable progress in implementing HIT. For example, nearly all hospitals and three-quarters of physicians are now using certified EHR. HITECH also funded the Office of the National Coordinator for Health Information Technology and authorized the development of standards and certification processes to guide HIT investments. But 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; the lack of standards for EHR systems to exchange information; the cost of automation; and the need to train health care workers to create and maintain databases.
A national health information infrastructure should:
- inform clinical practice through the use of EHR;
- support consumers’ ability to become active participants in managing their care and to play a key role in decisions about their health care;
- connect healthcare providers and home- and community- based service providers through regional collaborations;
- improve patient care through electronic personal health records and tele-health systems; and
- improve the health of the general population through better monitoring of the quality of care, improved dissemination of information about evidence-based practices, and more unified public health surveillance efforts.
E-prescribing systems use digital devices to enter, modify, review, and communicate drug prescriptions. Well-designed systems help reduce medication errors at the point of prescribing and increase formulary adherence. They also can promote efficiency through the electronic connection between the prescribing clinician and dispensing pharmacy.
A key HITECH provision mandates that to be eligible for financial assistance, physicians, hospitals, and most other eligible providers must put the technology to “meaningful use.” CMS has defined this term in various regulations, including those proposed to implement the Medicare Access and CHIP Reauthorization Act of 2015. According to CMS, meaningful use is using certified EHR technology to:
- improve quality, safety, efficiency, and reduce health disparities;
- engage patients and family;
- improve care coordination, and 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 to enhance HIT’s ability to exchange data, functionality, utility, and security.
Easy access to comprehensive and meaningful information stored in EHR can empower consumers and family caregivers who wish to have more control over decisions regarding their health and well-being. It can also help them actively manage their health and partner with their care teams. Most participants in a recent focus group conducted by AARP had accessed their EHR through an online portal run by their provider. They reported that they greatly valued having access to their medical records because the information allowed them to better monitor their chronic conditions, more easily communicate with health care providers, adhere to treatment plans, find and fix errors, and directly contribute their information to research.
In addition, HIT can support improvements in the quality and efficiency of care when health care providers seamlessly exchange a patient’s medical records with each other and make that information available to clinicians whenever and wherever they need it. HIT systems that support direct provider-to-provider exchanges allow a clinician to query another clinician’s software system for relevant information from the patient’s EHR, or enable a provider to share relevant portions of a patient’s EHR directly with other members of the care team. With real-time access to information on what treatments, drugs, or hospital stays people have already encountered, clinicians can provide consumers with better coordinated and safer care.
Unfortunately, there are major roadblocks to health care providers directly sharing electronic data, even when transfers can be done securely. In particular, many hospitals and doctors do not have the technical ability or are unwilling to share patients’ electronic health data with one another. Such “information blocking” has kept most consumers’ health records locked up in separate software systems and unable to follow as people move through the health care system. A new approach to sharing data seeks to circumvent current limitations of direct provider-to-provider exchange of EHR. The concept known as “consumer-mediated data-sharing” calls on providers to give consumers their medical records, and for consumers to control and authorize (through a third-party digital application) access to their electronic health information by health care providers or other persons. Consumer-mediated data-sharing could potentially improve the flow of digital health information needed to support quality, safe, and efficient care. However, it also has 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
Promoting Health information technology (HIT)
The Department of Health and Human Services (HHS) 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 policy makers should use health care payment policies to ensure that EHRs provide consumers and families with comprehensive, meaningful, easily accessible health care information, where feasible.
Federal and state governments should encourage the use of HIT through adoption of interoperable electronic medical records and information exchange, including exploring innovative approaches to integrating information and sharing data to support better care and consumer and family engagement. They should develop infrastructures to support standards and privacy protections that are at least consistent with national standards.
Federal and state policy makers should ensure that policies to promote interoperability do not impose undue burden and responsibility on consumers and family caregivers. These policies should complement not replace provider responsibility to obtain and share health information needed to provide high-quality care.