The Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 invested $30 billion to stimulate the adoption and “meaningful use” of electronic health records and related infrastructure—with the belief that such heath information technology (HIT) can help achieve the “triple aim”: better care experiences, better population health, and reduced per-capita costs.
We interviewed 47 national leaders and stakeholders—including federal government employees and policymakers, HIT experts, health providers, purchasers, payers, patient advocates, and electronic health record (EHR) and other HIT vendors—to learn from their early experiences in using HIT to improve health care delivery.
We found broad consensus that the HITECH Act has achieved its core aim of promoting adoption of EHRs in the hospital and ambulatory care sectors. However, stakeholders noted that this is just the beginning: to leverage HIT to help achieve the triple aim, much more needs to happen. In particular, there is a need to stimulate greater competition in the vendor marketplace, develop a coherent national policy to promote health information exchange and interoperability, and, wherever possible, align policy initiatives promoting use of HIT with financial and structural reforms that reward the value, rather than the volume, of care.
Interviewees expressed concerns that existing EHR systems do not adequately meet most clinical or operational needs. Another major concern—repeatedly raised in interviews—is that most EHRs systems are not interoperable, making it very difficult to facilitate health information exchange among providers. This means that many clinicians do not have a comprehensive, longitudinal picture of patients’ clinical histories and treatments. Some of those interviewed feared that the United States has missed an opportunity to achieve health information exchange rather than just adoption of EHRs.
Implications for Policy
Our findings suggest a number of areas in need of policy attention if the U.S. is to capitalize on the considerable momentum generated by the HITECH Act and translate its investment into better patient experiences, better population health, and lower costs.
For example, EHRs can improve patient experience by enhancing the quality and safety of care by automating tasks such as medication reconciliation, and by promoting shared decision-making and care coordination. Population health can be enhanced through EHR systems that enable providers to review care and outcomes for a panel of patients, and facilitate coordination of care, irrespective of where it is provided. Such systems can help achieve savings in clinical laboratory and radiology testing and medication management through the availability of real-time data, which can prevent duplication of testing, electronic medication reconciliation, and automated dispensing. Finally, EHR systems can help lower costs with the development of robust clinical decision support systems that can encourage best practice, promote shared decision-making and reduce the variation of care provided.
To make further gains, early adopters of EHRs can share their insights, experiences, and protocols. There is also a need to stimulate competition among vendors in order to enhance the usability of EHR systems, promote health information exchange, and catalyze developments in EHR modules to support population management. Given its convening role, the Office of the National Coordinator for Health Information Technology (ONC) could lead efforts to improve EHR systems, for example by hosting workshops along with the National Academy of Medicine, American Medical Informatics Association, and other stakeholders.
Of course, much more than technology will be needed to transform health care delivery and achieve the triple aim. To drive down costs while improving care, providers will need to take on greater financial risk for the costs of care—with payment policies encouraging them to reduce variation in care, choose lower-cost generic treatments when possible, and focus on prevention and proactive care management. The ONC-convened workshops could be an opportunity to encourage more radical thinking on potential strategies that incorporate HIT to deal with these thorny issues.
Early evidence suggests that our nation’s substantial investment in HIT is beginning to bear fruit, but achieving broad health system transformation will depend on aligning efforts to use HIT with wider structural and financial reforms.