The HITECH Act has stimulated adoption of digital infrastructure in healthcare to improve care and reduce costs, but problems with usability, interoperability and the fee-for-service paradigm require further government action, according to research published in the Journal of the American Medical Informatics Association.
The authors conducted 47 interviews with government, health policy and HIT experts, as well as physicians, payers, patient advocates, and vendors from across the United States.
There was widespread acknowledgement that HITECH was directly responsible for catalyzing adoption of EHRs in hospitals and ambulatory settings. Physicians, however, expressed concerns about the usability of EHRs and computerized decision support systems, seeing them as immature technologies written on old code bases originally designed for hospital billing, according to the report.
Many believe the current generation of EHRs to be inadequate for supporting multidisciplinary teamwork essential to delivering patient-centered care, and for making quality measurement a part of care delivery.
They cited poor usability and interoperability as major drawbacks. Nevertheless, the authors also heard various accounts of how the digitized infrastructure was being used to improve the quality and safety of care and to save money.
Vendors and physicians alike, however, criticized the detailed Meaningful Use requirements as a distraction from more development and clinical priorities.
Those interviewed viewed the Office of the National Coordinator for Health IT as having an important role to play in promoting competition in the acute sector market. Some strongly argued that ONC should ask the Federal Trade Commission to launch an inquiry into the possible monopoly position emerging with EHR vendor Epic.
Another suggested approach was for ONC and the Centers for Medicare & Medicaid Services to force vendors to open up their application program interfaces and encourage them to collaborate with smaller vendors and the medical informatics community.
The two areas seen as requiring the most policy attention--interoperability and further financial reform--also were considered quite challenging.
The HITECH Act includes a host of "specific objectives, milestones and metrics," including a number that have yet to be accomplished, including electronic data exchange, as FierceEMR's Marla Durbin Hirsch has pointed out.
The Workgroup for Electronic Data Interchange recently cited progress toward the goals of its roadmap for healthcare information exchange, but work still to be done.
To learn more:
- read the research