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Health information technology and Healthcare
Healthcare 2 (2014) 1–2
Contents lists available at ScienceDirect
Healthcare journal homepage: www.elsevier.com/locate/hjdsi
Health information technology and Healthcare Farzad Mostashari The Brookings Institution, Engelberg Center for Health Care Reform, Washington DC, United States
art ic l e i nf o Article history: Received 21 December 2013 Accepted 21 December 2013 Keywords: Applied health information technology Healthcare Innovation Information technology
Information technology (IT) is advancing health care more rapidly than ever before. In fact, the rate of adoption of electronic health records in the last four years has trumped that from the last twenty. The Medicare and Medicaid EHR Incentive Program0 s “Meaningful Use” requirements have also accelerated the development, deployment, and use of key functionality essential to provision of safer, higher quality, and more patient-centered care for individuals and populations. As of 2013, over 50 percent of eligible clinicians and 80 percent of eligible hospitals have achieved Meaningful Use—figures that have far exceeded expectations. As adoption accelerates, we must continue to be vigilant that a digital divide does not widen. Furthermore, as Botta and colleagues discuss, the Meaningful Use framework has powerful focusing and sequencing effects. We must be sure that what is prioritized outweighs the inevitable opportunity costs. As described by Adler-Milstein, one important priority that must be shared to be effective is the exchange of information between hospitals and other healthcare providers (and with patients)—this is the main impetus behind Stage 2 Meaningful Use and the 2014 certification criteria. Implementation of interoperability and exchange is a top priority for the next 12 months. Before the HITECH Act, the digital infrastructure lacked widely adopted and well defined standards. In contrast, we now have a core set of established, clear standards that are imperative for effective information exchange. By 2014, every EHR will have capabilities to send and receive documents using a single set of standards, and providers will be able to send lab results, public health results and care summaries to both patients and other providers. Under newly strengthened privacy
E-mail address: [email protected] 2213-0764/$ - see front matter & 2014 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.hjdsi.2013.12.008
laws announced last year by Secretary Sebelius, all of this will be done with careful attention to security. The greatly accelerated transition to electronic record-keeping has not been without challenges. As described by Jamoom, concerns around financial return on investment, and productivity loss in a fee-for-service environment continue to shape physician attitudes. There is also concern among delivery system innovators that existing EHR systems are inadequate for their needs—despite the inclusion of population health and patient-engagement functionalities as part of Meaningful Use. We are also aware that there hazards inherent to the use of any technology. We are committed through the Health IT Patient Safety Action and Surveillance Plan to develop effective methods to detect IT-related medical errors and then rapidly improve existing systems. Despite these challenges, the evidence continues to pile up that whatever their shortcomings, the currently available systems are vastly superior to paper-based processes for improving patient safety and quality. Adverse drug events are reduced by computerized provider order-entry, electronic prescribing, and closed-loop medication administration. Consistent provision of quality care— and patient outcomes—are improved by registries, patient reminders, and decision-support. And depending on the reimbursement model and financial environment within which healthcare is delivered—health IT is an essential platform for delivering this better care at lower cost. Finally, we are progressing towards a new standard in which patients can easily access and own their health information—the “Blue Button” concept. Currently, all Medicare beneficiaries have online access to their claims data. Additionally, the Department of Health and Human Services is working with nearly 500 organizations to improve online access to health information for all Americans. Once patients have access to their data, they
2
F. Mostashari / Healthcare 2 (2014) 1–2
can assume accountability for their health beyond discrete healthcare encounters, through mobile apps and personally controlled health records. We have much to look forward to in the evolution of health IT: interoperability, improved usability and efficiency, better quality measurement, integration of patient generated data and feedback,
a learning healthcare system, and more effective payment reform through connected health-IT-enabled systems. Healthcare: The Journal of Innovation and Delivery Science serves as a valuable medium for disseminating and highlighting innovation and implementation in this important effort. Progress will ultimately come through incremental steps toward ambitious but attainable goals.
Contents lists available at ScienceDirect
Healthcare journal homepage: www.elsevier.com/locate/hjdsi
Health information technology and Healthcare Farzad Mostashari The Brookings Institution, Engelberg Center for Health Care Reform, Washington DC, United States
art ic l e i nf o Article history: Received 21 December 2013 Accepted 21 December 2013 Keywords: Applied health information technology Healthcare Innovation Information technology
Information technology (IT) is advancing health care more rapidly than ever before. In fact, the rate of adoption of electronic health records in the last four years has trumped that from the last twenty. The Medicare and Medicaid EHR Incentive Program0 s “Meaningful Use” requirements have also accelerated the development, deployment, and use of key functionality essential to provision of safer, higher quality, and more patient-centered care for individuals and populations. As of 2013, over 50 percent of eligible clinicians and 80 percent of eligible hospitals have achieved Meaningful Use—figures that have far exceeded expectations. As adoption accelerates, we must continue to be vigilant that a digital divide does not widen. Furthermore, as Botta and colleagues discuss, the Meaningful Use framework has powerful focusing and sequencing effects. We must be sure that what is prioritized outweighs the inevitable opportunity costs. As described by Adler-Milstein, one important priority that must be shared to be effective is the exchange of information between hospitals and other healthcare providers (and with patients)—this is the main impetus behind Stage 2 Meaningful Use and the 2014 certification criteria. Implementation of interoperability and exchange is a top priority for the next 12 months. Before the HITECH Act, the digital infrastructure lacked widely adopted and well defined standards. In contrast, we now have a core set of established, clear standards that are imperative for effective information exchange. By 2014, every EHR will have capabilities to send and receive documents using a single set of standards, and providers will be able to send lab results, public health results and care summaries to both patients and other providers. Under newly strengthened privacy
E-mail address: [email protected] 2213-0764/$ - see front matter & 2014 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.hjdsi.2013.12.008
laws announced last year by Secretary Sebelius, all of this will be done with careful attention to security. The greatly accelerated transition to electronic record-keeping has not been without challenges. As described by Jamoom, concerns around financial return on investment, and productivity loss in a fee-for-service environment continue to shape physician attitudes. There is also concern among delivery system innovators that existing EHR systems are inadequate for their needs—despite the inclusion of population health and patient-engagement functionalities as part of Meaningful Use. We are also aware that there hazards inherent to the use of any technology. We are committed through the Health IT Patient Safety Action and Surveillance Plan to develop effective methods to detect IT-related medical errors and then rapidly improve existing systems. Despite these challenges, the evidence continues to pile up that whatever their shortcomings, the currently available systems are vastly superior to paper-based processes for improving patient safety and quality. Adverse drug events are reduced by computerized provider order-entry, electronic prescribing, and closed-loop medication administration. Consistent provision of quality care— and patient outcomes—are improved by registries, patient reminders, and decision-support. And depending on the reimbursement model and financial environment within which healthcare is delivered—health IT is an essential platform for delivering this better care at lower cost. Finally, we are progressing towards a new standard in which patients can easily access and own their health information—the “Blue Button” concept. Currently, all Medicare beneficiaries have online access to their claims data. Additionally, the Department of Health and Human Services is working with nearly 500 organizations to improve online access to health information for all Americans. Once patients have access to their data, they
2
F. Mostashari / Healthcare 2 (2014) 1–2
can assume accountability for their health beyond discrete healthcare encounters, through mobile apps and personally controlled health records. We have much to look forward to in the evolution of health IT: interoperability, improved usability and efficiency, better quality measurement, integration of patient generated data and feedback,
a learning healthcare system, and more effective payment reform through connected health-IT-enabled systems. Healthcare: The Journal of Innovation and Delivery Science serves as a valuable medium for disseminating and highlighting innovation and implementation in this important effort. Progress will ultimately come through incremental steps toward ambitious but attainable goals.