The President’s Council of Advisors on Science and Technology has issued a report reviewing the implementation of health information technologies under the Health Information Technology for Economic and Clinical Health (HITECH) Act (part of the American Recovery and Reinvestment Act) and urging greater attention to leveraging fundamental improvements to health care delivery systems through the implementation of these technologies. Here are the key findings from the report:
Several identifiable barriers in the healthcare system currently discourage innovation and vigorous competition in the market to create effective health IT systems. First, most current health IT systems are proprietary applications that are not easily adopted into the workflow of a clinician’s day, and whose proprietary data formats are not directly exchangeable from one system to another. It is difficult for data to be disaggregated, indexed, searched, and assembled to provide accurate information to treat a patient, because the context for individual entries in a record is often implicit at best. Second, most healthcare organizations that utilize electronic health records (EHRs) view them as purely internal resources, and have little incentive for investment in secondary or external uses, such as making them accessible in appropriate form to patients, to a patient’s healthcare providers at other organizations, and in de-identified or aggregated form to public health agencies and researchers. Third, legitimate patient concerns about privacy and security make patients uneasy about participating in health IT systems or granting consent for their information to be used in research. Fourth, health IT has historically been oriented toward administrative functions, not better care. This is in part because, under the current fee-for-service payment model, the economic benefits of investing in health IT can rarely be realized by the provider or organization that makes the investment.
While commending the efforts to date from the Office of National Coordinator for Health Information Technology and the Centers for Medicare and Medicaid Services (CMS) to implement the HITECH Act, the report recommends “significantly accelerated progress toward the robust exchange of health information”, including greater standardization of a universal, open and extensible health information exchange language, fine-grained and persistent privacy protections, and network infrastructure support. The report also notes the need for CMS to upgrade its own information technology capabilities to keep pace with the anticipated widespread adoption of health information technologies by health care providers and for increased engagement of other federal agencies and departments such as the Veteran’s Administration and the Centers for Disease Control and Prevention in implementing the full potential of health information technologies nationally.