David Blumenthal and Aneesh Chopra: HIT requires alignment of incentives

While some people working in healthcare say electronic health records have slowed digitization in the industry, two former federal IT officials believe that there are other factors preventing a digital health revolution.

David Blumenthal, M.D., former National Coordinator for Health IT, and Aneesh Chopra, former U.S. chief technology officer, in a Harvard Business Review post, defend the estimated $31 billion the federal government has spent on pushing the adoption of electronic health records.

"Underlying the challenges facing the digital health revolution are economic and social issues that must be addressed if the potential value of electronic records is to be realized," they say.

While the industry is making progress toward some goals, such as the adoption of API standards, interoperability and data-sharing remain elusive, Blumenthal and Chopra add.

Disincentives such as the fee-for-service reimbursement system, provider unwillingness to share patient data and lack of interoperability among technology vendors remain barriers, according to Blumenthal and Chopra, and technical fixes and better records won't be enough to solve all the issues.

"We need incentives that reward quality and safety improvement and cost reduction. [W]e need penalties for providers and vendors that slow-walk the digital revolution to protect their economic interests," they say.

Chopra has warned previously that there are too many bystanders in health IT, pointing to APIs and Health Level Seven's Fast Healthcare Interoperability Resource (FHIR) standard as ways to improve data sharing in healthcare. But providers must be willing to get involved, he's said.

Interoperability involves not just exchange of data, but the ability to effectively use that data once it has been received, according to Doug Fridsma, president and CEO of the American Medical Informatics Association. A central question in the quest for interoperability, he says, is, "What do we want to try to accomplish?"

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