The HITECH Act and its Meaningful Use program have met with some success, but its achievements have fallen short of hopes, according to a new study in Milbank Quarterly.
The study, conducted by Mathematica Policy Research as part of a larger project funded by the Office of the National Coordinator for Health IT, found that electronic health records exist in some form in most professional practices and hospitals, more information is being shared electronically and the focus of attention has evolved from EHR adoption to the use of health IT to improve healthcare delivery and outcomes.
However, it has been hard to move Meaningful Use beyond the low bar set by Stage 1 of the program. Providers’ dissatisfaction with the ability of EHRs to integrate with their workflow created opposition to future stages of Meaningful Use. EHRs vary in ability to support more advanced functionalities, and many barriers to interoperability persist.
The study also found that the regional extension centers (REC) program met its goal of getting 100,000 providers to achieve Meaningful Use, especially primary care physicians with small practices and underserved populations. However, most RECs will face challenges in sustainability without grant money.
The ultimate effect on outcomes is “still unknown,” the study's authors write.
Some of the lessons learned from HITECH implementation, according to the study, include:
- While EHR adoption grew rapidly, the lack of more robust mechanisms and infrastructure for capturing data and sharing it was a “critical weakness”
- While federal legislation can be a “powerful stimulus” for change, its effectiveness depends on the ability to accommodate private healthcare markets and diversity in state and local policies
- The legislation was focused on short-term results, but also needed a long-term approach
“[T]he future of health IT support nationally is likely to depend on the ability of the technology to satisfy its users that health IT functionalities address the interests policymakers and other stakeholders have in using technology to promote better care, improved outcomes and reduced costs," the authors write.