In 2009, Congress passed the Health Information Technology for Economic and Clinical Health (HITECH) Act, ushering in an era focused on EHR adoption.
In the most recent issue of The New England Journal of Medicine, two groups clashed over the impact of HITECH and the path moving forward.
The first perspective article is written by four former national coordinators who served during the Obama administration: Vindell Washington, Karen DeSalvo, Farzad Mostashari and David Blumenthal.
Overall, they see HITECH as primarily successful, since now “almost all U.S. hospitals and nearly 80 percent of office-based practices use certified EHRs.” Moreover, 87 percent of patients report having access to their health information, according to the article.
But it hasn’t all been fine and dandy. Physicians struggle with EHR usability and the “lack of actionable information generated by [EHRs],” the authors note.
To make the road ahead easier, they believe the healthcare industry must focus on interoperability and finding meaningful ways to utilize data.
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Government stakeholders can play a key role in reaching these goals. “Going forward, the national coordinator for health IT will continue to bring together stakeholders in areas where collaboration wouldn’t naturally occur and federal regulation is not desired,” they wrote. “The ONC also has an essential role in coordinating federal agencies in developing guidelines for technology deployment — collaboration that must be complemented by private-sector-led innovation.”
In the second perspective article, two health IT executives — John Halamka and Micky Tripathi — take a separate perspective on HITECH.
Though the act helped the healthcare field undergo rapid computerization, the authors don’t remember its overall impact quite as fondly:
Along the way, however, we lost the hearts and minds of clinicians. We overwhelmed them with confusing layers of regulations. We tried to drive cultural change with legislation. We expected interoperability without first building the enabling tools. In a sense, we gave clinicians suboptimal cars, didn’t build roads, and then blamed them for not driving.
The problems, they claim, came from a lack of infrastructure, which inhibited interoperability.
Interestingly, this opinion differs from an earlier version of Halamka, who seemed to support HITECH in 2011.
Moving forward, the executives believe the government should not be overly involved in EHR and interoperability efforts. For example, meaningful use and MIPS requirements should be simplified. Agencies like ONC and CMS should encourage connection among private-sector networks.
“We believe that now is the time to step back and recalibrate the role of the federal government on the basis of lessons learned,” Halamka and Tripathi note. “If the post-HITECH era can return control of the agenda to customers, developers, and multistakeholder collaborations, we should be able to recapture the hearts and minds of our clinicians.”
Photo: MATJAZ SLANIC, Getty Images
