Health Information Technology

Health information technology (HIT) encompasses an array of technologies utilized by health care professionals and patients. Various forms of HIT store, share, and analyze health information. HIT can also communicate about, diagnose, and treat patients.

HIT ranges from electronic health records to consumer-facing mobile health applications such as telehealth (see also Telehealth). HIT can support improvements in the quality and efficiency of care when health care providers can easily exchange medical records and ensure patient 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 (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. Two federal laws have spurred improvements in HIT and benefited patients as well as health providers and clinicians. The Health Information Technology for Economic and Clinical Health Act required providers to transition their record-keeping from paper to computerized systems. In 2016, The 21st Century Cures Act further advanced health information interoperability by making sharing the norm and preventing information blocking, except under specified conditions. In addition, the bill established that patients be able to download their data using any electronic platform of their choice.

Under these laws, the Centers for Medicare & Medicaid Services (CMS) has taken steps to advance HIT and the sharing of electronic health information. CMS’s Meaningful Use program incentivized providers to adopt electronic health records. The successor program of Meaningful Use, The Promoting Interoperability Program, seeks to improve interfacing between electronic health systems and patient access to health information. Blue Button 2.0, rolled out in 2018, allows Medicare beneficiaries to receive their Medicare Part A, B, and D claims and encounter data through digital tools and apps.

In 2024, CMS finalized its Interoperability and Prior Authorization Rule, which built on these previous CMS efforts. The Rule requires payers to develop application programming interfaces to improve health information exchange and enable appropriate and necessary access to health records for patients, healthcare providers, and payers.

To aid in the interface of technologies to enable interoperability, The Office of the National Coordinator for HIT has put in place standards to facilitate data-sharing across platforms. The Trusted Exchange Framework and Common Agreement establishes interoperability policy, simplifies connectivity, and supports patient access to their data.

HIT systems that support direct provider-to-provider or payer-to-payer exchanges allow clinicians to query other clinicians’ software systems for relevant information from the patient’s electronic health record (EHR). This is typically done 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 or allow patients to carry their records with them when they switch plans or carriers. Such information exchange can allow clinicians to better understand their patients’ medical histories and encounters, avoid medication errors, and decrease duplicative (and potentially harmful) procedures and tests. An alternate but complementary approach to sharing data puts consumers in charge of their medical records. Sometimes referred to as 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, implementation barriers have limited interoperability. Consequently, the technologies have had limited opportunity to improve the quality, safety, and efficiency of care. Meanwhile, roadblocks have prevented payer-to-payer information exchanges from allowing patient information to travel with them to a new payer or provider. Other impediments include operational issues such as the cost and the need to train health care workers how to create and maintain databases and how to segment patient data as well as where to segment the data to preserve patient privacy, yet ensure sufficient information for clinicians to provide appropriate level of care.

One way to circumvent these barriers is to ask consumers to share information with their clinicians or providers directly. Yet, 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.

CMS’s use of standardized data sets is a crucial step in advancing interoperability. The United States Core Data for Interoperability (USCDI) standard defines the data used in health information exchange and upon which quality outcomes, clinical care, and access are measured. USCDI data elements continue to expand and evolve in order to support data share and potentially advance research around critical health issues, such social determinants of health and health equity (see also Health Care Quality Measurement and Improvement).

Artificial intelligence (AI) and algorithmic tools in health care: AI-powered decision-making tools have several applications in the health care field, from diagnosing patients to assisting commercial insurance brokers in the Medicare shopping process.

When used appropriately, the application of AI tools in health care holds promise for improving quality of care and reducing costs. While both insurers and providers are rapidly increasing their use of AI, there is limited research on whether these tools are achieving the goals of lowering costs and improving patient outcomes.

However, it is well documented that Medicare Advantage plans use AI to make coverage determinations that have resulted in beneficiaries being inappropriately discharged from skilled nursing stays. While Medicare requires an individualized assessment of each beneficiary’s qualification for coverage in certain care settings, AI- tools offer recommended decisions that are based on previous patient experiences. This neglects the nuance and individuality of the current patient’s condition. Oftentimes, plans, providers, and beneficiaries do not fully understand the scope of these tools’ development and use. Clinicians and plans rely on these tools with many questions left unanswered. This is partly due to the proprietary nature of utilization management-focused AI-powered decision-making tools, which prevents the public from understanding and challenging their results.