Health Information Technology

Background

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 (EHR) to consumer-facing mobile health applications such as 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 this chapter’s section on 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. The 21st Century Cures Act (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. Health information developers are required to adopt a secure, standardized application programming interface (API) to enable seamless access, exchange, and use of electronic health information. This benefits patients as well as health providers and clinicians. 

The Centers for Medicare & Medicaid Services (CMS) has taken steps to advance HIT and the sharing of electronic 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. Most recently, CMS’ Promoting Interoperability Program seeks to improve interfacing between systems and patient access to health information. Despite these efforts, as of the end of 2021, only a fraction of Medicare beneficiaries (just over one million of the 36 million enrolled in Traditional Medicare at that time) had downloaded their data. CMS additionally promulgated regulations to require the sharing of claims and encounter data for Medicare MA plans, Medicaid, and exchanged-based plans. However, CMS is “exercising enforcement discretion” of those rules for payer-to-payer sharing. The result is that patient records will not follow a patient when they switch providers or when they move between Traditional Medicare and MA. 

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 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 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, various barriers limit interoperability. Consequently, the opportunity to improve the quality, safety, and efficiency of care is limited as well. Roadblocks continue to exist in payer-to-payer information exchanges. Thereby, patient information is prevented from traveling with them to a new payer or provider. Cost and the need to train health care workers how to create and maintain databases create impediments to implementation. Other impediments include operational issues such as how to segment patient data. Also 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. In 2021, USCDI version 2 included for the first time data definition for select social determinants of health, sexual orientation, and gender identity data elements. These support interoperability and potentially advance research. They also can identify disparities and advance solutions to improve health equity (see also this chapter’s section on Health Care Quality Measurement and Improvement). 

HEALTH INFORMATION TECHNOLOGY: Policy

HEALTH INFORMATION TECHNOLOGY: Policy

Use of health information technology (HIT)

The Department of Health and Human Services should guarantee full implementation of the meaningful use requirements so that federal HIT investments advance health care 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, and easily accessible health care information. 

Federal and state governments should advance the use of HIT by adopting 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 engagement. Infrastructures to support standards and privacy protections that are at least consistent with national standards should be developed. 

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. 

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

Federal and state governments should incorporate LTSS service plans in EHR. This enables providers to utilize a standardized care plan as consumers with LTSS needs move across settings.