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 (tele-health). 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 facilitate the collection and retrieval of data, reduce errors and duplication, foster care coordination, support clinical decisions, and help consumers and caregivers be more actively involved in managing their health and health care decisions (see also this chapter’s section on Health Promotion and Consumer and Family Engagement in Health—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 HITECH 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 HITECH provision mandates that qualify 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 (MACRA). 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) or 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 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.
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 in integrating the technological infrastructure to enable interoperability in commercial EHR systems; cost; and the need to train health care workers to create and maintain databases. 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. While consumer-mediated data-sharing could potentially improve the flow of digital health information, 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.
Tele-health uses communications technology to deliver health care, health information, and health education at a distance. Tele-medicine generally indicates physician services and tele-health is a more universal term for the current array of services provided. These services can also be used in long-term services and supports (LTSS) and home- and community-based services (HCBS) settings. Examples of services are include remote patient monitoring and live video interactions with health care providers.
While tele-health services are expanding rapidly in many states, a number of factors limit their ability to reach beneficiaries, including the lack of high-speed broadband service in many sparsely populated areas, the inability of clinicians in some states to work across state lines, and Medicare’s limit on payment for tele-health services to only when services are provided in a clinical office and by a specialist.
Services provided by tele-health have great potential to help consumers more easily connect with various health care clinicians, maintain their quality of life, and remain in their communities longer by providing an opportunity to manage their care. Tele-health gives people the ability to schedule health-related appointments and request prescription refills. It can remind them to take medications and serve as a method to link to a health care provider when time or distance is a barrier. Tele-health can also support family caregivers’ efforts to take care of their loved ones.
Tele-health uses telecommunications technology to deliver health care, health information, or health education at a distance. .
Tele-health encompasses four distinct domains of applications:
- live video (synchronous) —live, two-way interaction between a provider and a patient, caregiver, or another provider using audiovisual telecommunications technology;
- store-and-forward (asynchronous) —transmission of recorded health history (for example, pre-recorded videos and digital images such as x-rays and photos) through a secure electronic communications system to a practitioner;
- remote patient monitoring (RPM) —personal health and medical data collection from an individual in one location via electronic communication technologies, which is transmitted to a provider (sometimes via a data processing service) in a different location for use in care and related support; and
- mobile health (mHealth) —health care and public health practice and education supported by mobile communication devices such as cell phones, tablet computers, and personal digital assistants.
While services providing tele-health are increasing rapidly in many states, there are restrictions that can limit beneficiary access, including
- Medicare’s narrow definition of “site of origin.” Medicare fee-for-service only pays for tele-health care when the site of origin, or site of care, is provided in a clinical office and the tele-health service connects to a specialist. This definition restricts Medicare beneficiaries who have trouble getting to a clinical setting—for geographic reasons or the lack of transportation.
- Medicare fee-for-service pays for chronic-care management that is provided via tele-health only for those who fit limited criteria;
- the lack of high-speed broadband cable in various communities across the country; and
- the inability of clinicians to work across state lines. (Interstate licensing compacts can resolve this issue.)
HEALTH INFORMATION TECHNOLOGY: Policy
Advancing the use of Health Information Technology
The Department of Health and Human Services (HHS) should ensure progress to full implementation of the meaningful use requirements so that federal Health Information Technology (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 (EHRs) provide consumers and families with comprehensive, meaningful, easily accessible health care information, where feasible.
Federal and state governments should advance the use of health information technology through the adoption of interoperable electronic health records 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 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 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.
Incorporating long-term services and supports service plans in electronic health records
Federal and state governments should encourage coverage and payment of tele-health services (including by removing unnecessary restrictions that limit beneficiary access) for eligible beneficiaries to improve access and the quality of care, allow patients to remain safely in the community, and assist with care transitions from institutional to community settings.
Congress should remove geographic restrictions on Medicare coverage for tele-health services.
States should adopt interstate licensure compacts for physicians, Advanced Practice Registered Nurses, Registered Nurses, and other licensed health professionals, to expand provider networks and reduce interstate barriers to the use of tele-health services.
Services provided by tele-health should offer quality and ensure that patient-related records and communications are protected from fraud (see this chapter’s Section - s Health Care Coverage: Medicare—Quality Improvement in Medicare; Reforming the Delivery of Health Care Services—Privacy and Confidentiality of Health Information).
Tele-health clinicians should be required to follow all standards of care and regulations appropriate to their profession and inform patients of their credentials.
Policymakers should ensure that individuals have access to the technologies that enable tele-health (see also Chapter 10, Utilities: Telecommunications, Energy, and Other Services - Broadband Services). The mode of care provided to the individual should align with the preferences of the person and family caregiver and be appropriate to meet their needs.