Former ONC leaders cite challenges in maximizing EHR benefits
Four former national coordinators for health information technology have penned a perspective on achievements made in using electronic health records under the HITECH Act and where providers and the HIT industry still must go to continue past progress.
The law spurred rapid progress toward digitizing the industry, which now is at an inflection point, say the authors, who include Vindell Washington, MD, Karen DeSalvo, MD, Farzad Mostashari, MD, and David Blumenthal, MD. EHRs have primed the industry to now achieve several positive results, including improving clinical guidelines, and sharing patient data seamlessly and securely.
HITECH, they contend, has paved the way for population health management and a national infrastructure for data exchange, as about 80 percent of office-based practices now use a certified EHR with a majority of them sharing data, and nearly 90 percent of patients having access to their electronic health information. Further, hundreds of studies show that HITECH had a positive effect on care quality, safety and efficiency.
But there have been many challenges along with the achievements, the national coordinators acknowledge, including congressional expectations of rapid funding and program development. “A short timeline meant that some organizations simply expanded existing proprietary EHRs; the design was hampered as clinical documentation requirements were in competition with billing and compliance needs.”
Many providers remain frustrated with poor EHR usability and a lack of actionable information being generated, they note. “In part, such limitations are attributable to the decision to allow proprietary standards and data blocking in the market, which has led to suboptimal data sharing.”
Consequently, the coordinators call for a cultural change to better advance interoperability, and they support policy changes that are moving providers toward value-based reimbursement that reward quality and outcomes instead of volume of services.
The coordinators also promote an emerging public health model called Public Health 3.0, which encourages collaboration to use data to enhance the societal effects of public health work. “This initiative will require integrating traditional public health data, clinical data and data on social determinants of health,” they explain. “Such integrated data sets could inform targeted interventions, and anonymized data could be shared with scientists to accelerate the translation of evidence into practice.”
Finally, the coordinators call for HIT developers to work with third-party vendors to spur innovation, and advancement of a learning health system to promote continuous improvement and innovation. The complete perspective, published in the New England Journal of Medicine, is available here.