For some reason, this month has spurred some serious reflection about health IT and electronic health records.
First, there’s last week’s analysis of the HITECH Act and the Meaningful Use program by Mathematica Policy Research. The researchers found that the success of the program was mixed; while it spurred adoption of EHRs, increased electronic data exchange and prioritized the improvement of healthcare delivery, problems remain. For instance, it’s been difficult to move Meaningful Use past the low bar set by Stage 1. Additionally, EHRs still are not well designed, providers continue to be dissatisfied with the products, EHR data continues to be too variable to be useful and barriers to interoperability persist.
The ultimate effect of the program on patient outcomes remains “unknown.”
This is hardly the first analysis stating that the Meaningful Use program is falling short of its goals. But this evaluation was funded by the Office of the National Coordinator for Health IT. Plus, the researchers include concrete lessons learned, such as that the lack of mechanisms and infrastructure for capturing and sharing data is a “critical weakness,” that federal legislation can’t operate in a vacuum and that the law must focus on long-term goals, not just short-term ones.
Right on its heels is this week’s in-depth paper from the National Academy of Medicine reporting that the U.S. has met only one of four health IT goals set by the White House in 2004--EHR adoption--and concluding that the direction of health IT for the next five years should be “reset.”
This analysis did not just outline current problem areas, such as the Meaningful Use program’s’ mixed success; it went further and provided a comprehensive roadmap on how to improve health IT. This includes:
- Data standards and achieving interoperability at scale
- Interoperability with consumer health technology
- Improving patient identification matching to support interoperability
- Service-oriented architectures and web-based services
- Enfranchising vulnerable populations and improving care for chronic diseases
- Health data and public health
- Accelerating use of aggregated health information and research
- Building a health IT workforce
- Creating a trust fabric with health services: privacy and security
The authors recommended three “vital directions” to take: interoperability from devices to EHRs, addressing cybersecurity vulnerabilities, and deployment of a “learning health system” strategy.
What’s particularly noteworthy is that the paper is not afraid to provide specific, perhaps provocative advice regarding how to meet some of these goals, more so than roadmaps provided by the government.
For instance, the report points a finger at the 1999 law that prohibits the Department of Health and Human Services from using federal funds to develop a unique patient identifier without Congressional approval. This, according to the paper, has hindered data exchange, created errors in data matching and health records, resulted in suboptimal care, created privacy and security problems and increased costs. The paper’s authors call upon Congress to allow HHS to promulgate standards to facilitate patient identification and matching.
The report didn’t stop there. It made all sorts of other recommendations to policymakers, such as to step up to the plate to provide “highly specific” standards for end-to-end interoperability, since there is no authoritative private source, and to strengthen penalties against hackers. The report's authors also warned policymakers what not to do, such as it merely increasing the pace of health IT or picking the more “advantageous innovations.”
This is a lot of significant soul searching. There are now decisions to be made regarding what which directions to take, and what steps to prioritize.