Milestone Steps for Health Information Technology Adoption

By Arianna Talaie

In the marathon of adopting health information technology (HIT), it is the landmark steps—the defining, digitalizing and downloading of the system—that facilitate the greatest strides toward widespread implementation.

A newly released Robert Wood Johnson Foundation (RWJF) annual report and several Web First articles from August issue of Health Affairs assess the recent progress and challenges of HIT adoption among U.S. health care providers and hospitals, regarding  meeting Stage One and Two standards of the meaningful use program. With the 2010 onset of government incentives for electronic health record (EHR) adoption, the use of EHRs by hospitals and office-based physicians has grown substantially alongside the expansion of operational health information exchanges (HIEs).

According to the RWJF report, 44 percent of hospitals adopted a basic EHR system in 2012, an increase of 17 percentage points from 2011, and triple the rate of adoption in 2010.

“Electronic health records can provide an enormously rich database to overcome the messiness (of implementation),” says Catherine M. DesRoches, PhD, senior researcher at Mathematica Policy Research.

Employment of HIT tools, including EHRs, is escalating, with 43 percent of office-based physicians adopting all 14 core criteria for Stage One, and 42 percent of hospitals reporting the implementation of all functionalities—a spike from 18.4 percent in 2011 and 4.4 percent in 2010. Standards for Stage Two were released last year, and although only five percent of hospitals reported meeting the 16 core objectives to date, 63 percent already satisfy 11 out of the 15 of the requirements.

“For the first time in history, a single set of standards and vocabulary will be applied to procedures, immunizations, and more,” says Farzad Mostashari, MD, national coordinator for health information technology. “This will allow patients to be partners in their own care, letting data go to them securely instead of paying 75 cents per page and waiting 30 days.”

The agreement on the packaging of information of the Stage Two standards will eliminate translations and promote the accessibility of open data through secure exchange messaging. The Health Information Technology for Economic and Clinical Health (HITECH) Act increased funding and non-financial incentives for EHRs, which can facilitate secure messaging—use of which has grown by 61 percent since 2010.

“This electronic sharing between providers can lead to better care coordination and greater efficiency, and reduce duplication of services,” says Julia Adler-Milstein, PhD, assistant professor at the University of Michigan School of Public Health.

The importance of state involvement in advancing HIT solutions is highlighted in the recent Office of the National Coordinator (ONC) report to Congress, noting that 39 states have operational directed exchange mechanisms widely accessible for subscription.

Despite the expansion, operational HIEs and primary care providers are pressed with long-term financial barriers as they also challenge the sustainability of the business model. With impending deadlines and penalties in the picture, another concern is that fewer than half of U.S. hospitals have a basic EHR system.

“We must ensure that ‘meaningful use’ is contextualized in a broader setting to offer tolerance towards change and disruption in health care,” says Ashish K. Jha, MD, MPH, Associate Professor at the Harvard School of Public Health.

Advocates remain optimistic in the renovation of work models, provider accountability, and personal accessibility. Just four years ago, a majority of prescriptions and hospitals were on paper. An unprecedented transformation has since taken off, and it is with these initial milestone steps that the path towards digitization can proceed.

“No country our size in the world has been able to move this fast in EHR adoption,” says Dr. Jha. “It’s about getting systems to talk to one another—it’s about getting the data to flow.”

Arianna-Arianna Talaie is a Health Care Affairs intern at the Association for American Medical Colleges in Washington, D.C. She is a rising sophomore at the College of William & Mary, studying Government and Global Studies with a focus on Public Policy.