The HITECH Act of 2009 sought to promote the adoption and the use of health IT across the country. Six years later, EHR adoption rates reached 83 percent for physicians, and providers are progressing on their ability to send and receive electronic information, according to ONC data briefs.
The Robert Wood Johnson Foundation, in collaboration with Mathematica Policy Research, the Harvard School of Public Health and the University of Michigan School of Information, released a report looking at the progress of the HITECH Act, where the industry currently stands and what a post-HITECH World will look like.
Here are four key findings from "Health Information Technology in the United States, 2015: Transition to a Post-HITECH World."
1. Health information exchanges have progressed to a larger scale than the previous local exchanges, according to the report. The report finds 82 percent of private acute care hospitals send data and 81 percent receive data. However, "substantial" challenges remain, including financial sustainability, hiring and retaining staff, agreement on what a HIE includes and governance issues, among others.
"This reveals not only how difficult it is to develop and sustain a robust HIE effort, but how difficult it is for policymakers to foster an environment in which HIE efforts can flourish," reads the report. "Developing legislation that simultaneously tackles technical, financial, governance, human resource, privacy and security, and patient consent domains is daunting and far more difficult than if there were a single, substantial barrier inhibiting HIE progress."
2. The HITECH Act included a handful of individual initiatives and programs all related to health IT, such as the development of Regional Extension Centers, HIT Workforce Development and Strategic HIT Advanced Research Projects. The report suggests these programs were developed in disparate environments without any collaboration.
"The overall design of HITECH as an amalgamation of multiple programs compounded these distinct challenges. Rather than taking a holistic approach to address recognized barriers, the legislation authorized a number of discrete programs without clearly articulating the need to ensure effective coordination and communication across these programs," according to the report.
3. While big data has been a focus for healthcare providers, the report suggests there still lacks a strategic approach to data analysis, and the only way to do so is to have a multidisciplinary team working with the data to draw out key insights. Doing has the potential for significant advancements in clinical care, patient safety, efficiency, consumer engagement, personalized medicine, transparency and information sharing, and population health.
"There is indeed a strong potential for big data to transform the healthcare system, as long as these concerns — data security, data sharing, development of analytic capabilities, collaboration among stakeholders and consumer engagement — are addressed effectively," according to the report.
4. The authors suggest payment reform and interoperability must follow the same route of healthcare innovation. Currently, payment practices in healthcare are centered on the provider. "Disaggregated, atomic unit prices and hyper-aggregated populations convey no meaningful information that consumers can individually act upon. Therefore, both occlude the emergence of consumer markets for healthcare delivery, and even worse, give health professionals substantial incentives to resist transparency and external data exchange," reads the report.
However, the authors suggest that higher rates of collaboration with outside providers may help increase the likelihood of data sharing, saying total cost of care payments become more profitable than episodic care payments when providers are co-managing a patient from different organizations.
"Close to a decade ago we posited that health information exchanges could be the lever that finally links the archipelago of cloistered health professional institutions and creates the network of data and feedback loops that are essential to an efficient and effective health care system. That vision never came to be, partially because payment reform lagged the push to get health professionals to adopt health information technology, and partially because the models used to link data, the HL7v3 RIM, were deeply flawed. Those two failures have now been partially overcome and the promise of true health information exchange — linking data across health professional organizations — is finally set to dawn," reads the report.
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