Health Information Technology: Laying The Infrastructure For National Health Reform

Abstract

The enactment of the Patient Protection and Affordable Care Act is a signal achievement on the road to reform, which arguably began with the passage of the American Recovery and Reinvestment Act of 2009. That statute's Health Information Technology for Economic and Clinical Health (HITECH) provisions created an essential foundation for restructuring health care delivery and for achieving the key goals of improving health care quality; reducing costs; and increasing access through better methods of storing, analyzing, and sharing health information. This article discusses the range of initiatives under HITECH to support health reform, including proposed regulations on "meaningful use" and standards; funding of regional extension centers and Beacon communities; and support for the development and use of clinical registries and linked health outcomes research networks, all of which are critical to carrying out the comparative clinical effectiveness research that will be expanded under health reform.

Variation in Electronic Health Record Adoption and Readiness for Meaningful Use: 2008–2011

“…3 Thus, it is possible that the HITECH Act may have accelerated the existing trend in physician adoption, in addition to being influenced by market forces, state health information technology (IT) initiatives, and health care delivery and payment reform mechanisms which involve the use of EHRs. 2,16,17 Some of these forces driving EHR adoption may affect primary care physicians in particular. An examination of trends prior to 2007 indicates that primary care adoption rates were lower than specialists.…”

“…4 Furthermore, certain MU functionalities such as CPOE, electronic prescribing and clinical decision support have been associated with improvements in care. 2,[23][24][25][26][27][28][29][30] However, the full clinical benefits of MU have yet to be empirically evaluated and warrant future research. Although adoption of many functionalities varied by specialty, adoption of several functionalities associated with e-prescribing significantly increased between 2009 and 2011 across both primary care physicians and specialists.…”

“…EHRs serve as a critical component of interventions designed to improve coordination of care across a fragmented healthcare system. 2,34 To achieve the HITECH Act's goals of promoting nationwide electronic exchange and use of health information to improve quality and coordination of care, these variations in readiness to meaningfully use EHRs will need to be addressed.…”

“…1 HIT could also serve as a foundation to enable improvements in clinical care and support initiatives such as the patient-centered medical home. 2 Yet, adoption of electronic health records (EHRs) in ambulatory care has been relatively limited. In 2009, about a fifth (22 %) of office-based physicians reported having a basic EHR.…”

Guest editors’ introduction to the special section on information technology and evidence implementation

“…Provisions in the Patient Protection and Affordable Care Act of 2010-a companion to the HITECH Act of 2009 [40]-seek to ensure that services are provided for the "whole patient" [41], with a special emphasis on preventive services. Requirements for "meaningful use" [42], a legislatively mandated precondition for reimbursement of health IT expenses, will emphasize safety, patient engagement, continuous care, population health, and patient privacy as targets for IT support [43].…”