Health Affairs: HIE present snag in reaching HITECH's goals
To reach the goals intended in the HITECH Act, providers and patients must be persuaded of the value of health information exchange and support its implementation, according to an article published in the March issue of Health Affairs.
Marsha R. Gold, ScD, senior fellow at Mathematica Policy Research in Washington, D.C., and colleagues examined the marketplace and regulatory forces that influence HITECH’s success to identify outstanding challenges, some beyond the provisions’ control.
In enacting the HITECH provisions of the American Recovery and Reinvestment Act, Congress set ambitious goals for the nation to integrate IT into healthcare delivery. The provisions called for the electronic exchange of health information and the adoption and meaningful use of health IT in healthcare practices and hospitals.
“Privacy concerns and remaining technical challenges must also be overcome,” the author added. “Achieving HITECH’s goals will require well-aligned incentives, both visionary and practical pursuit of exchange infrastructure, and realistic assumptions about how quickly such wholesale change can be accomplished.”
For affordability, one issue that remains is that it’s not clear that the meaningful use incentives will be large enough to cover financial barriers, particularly for smaller practices and providers with limited access to capital and concerns about cash flow. “Providers vary in their dependence on Medicare and Medicaid; whether or not private payors step up with incentives aligned to those of public payors may make a large difference in some providers’ response to HITECH,” the authors wrote. “Ultimately, providers must see a long-term business case for adoption, with short-term implementation costs and efficiency losses offset by enhanced productivity, care delivery capacity and long-term revenue growth.”
Although HITECH can influence providers’ decisions on EHRs, the legislation alone is unlikely to be the driving force, according to the authors, who stated providers’ buy-in will depend on swaying peers and professional organizations, who are in turn influenced by a range of tangible and intangible factors.
For data harmonization, current national standards effectiveness and their ability to evolve as technology changes and meaningful use standards become more demanding remain to be determined. Additionally, for privacy and security concerns, “Legal protections aside, patients as well as providers must value and be willing to consent to exchange of information. Otherwise, meaningful use that requires exchange will be limited.
“Given HITECH’s implementation environment and aggressive timeline, its success is likely to be measured less by ultimate outcomes (improved quality and efficiency) than by the evidence it provides to policy makers and stakeholders that progress is being made and warrants continued investment,” the authors concluded. “Given HITECH’s goals, this probably means evidence that providers are adopting EHRs at a reasonable pace; data are flowing more easily among diverse providers, vendors, patients and geographic locales; and meaningful use is starting to yield positive effects on health and other valued outcomes, at least in areas with robust systems.”
Marsha R. Gold, ScD, senior fellow at Mathematica Policy Research in Washington, D.C., and colleagues examined the marketplace and regulatory forces that influence HITECH’s success to identify outstanding challenges, some beyond the provisions’ control.
In enacting the HITECH provisions of the American Recovery and Reinvestment Act, Congress set ambitious goals for the nation to integrate IT into healthcare delivery. The provisions called for the electronic exchange of health information and the adoption and meaningful use of health IT in healthcare practices and hospitals.
“Privacy concerns and remaining technical challenges must also be overcome,” the author added. “Achieving HITECH’s goals will require well-aligned incentives, both visionary and practical pursuit of exchange infrastructure, and realistic assumptions about how quickly such wholesale change can be accomplished.”
For affordability, one issue that remains is that it’s not clear that the meaningful use incentives will be large enough to cover financial barriers, particularly for smaller practices and providers with limited access to capital and concerns about cash flow. “Providers vary in their dependence on Medicare and Medicaid; whether or not private payors step up with incentives aligned to those of public payors may make a large difference in some providers’ response to HITECH,” the authors wrote. “Ultimately, providers must see a long-term business case for adoption, with short-term implementation costs and efficiency losses offset by enhanced productivity, care delivery capacity and long-term revenue growth.”
Although HITECH can influence providers’ decisions on EHRs, the legislation alone is unlikely to be the driving force, according to the authors, who stated providers’ buy-in will depend on swaying peers and professional organizations, who are in turn influenced by a range of tangible and intangible factors.
For data harmonization, current national standards effectiveness and their ability to evolve as technology changes and meaningful use standards become more demanding remain to be determined. Additionally, for privacy and security concerns, “Legal protections aside, patients as well as providers must value and be willing to consent to exchange of information. Otherwise, meaningful use that requires exchange will be limited.
“Given HITECH’s implementation environment and aggressive timeline, its success is likely to be measured less by ultimate outcomes (improved quality and efficiency) than by the evidence it provides to policy makers and stakeholders that progress is being made and warrants continued investment,” the authors concluded. “Given HITECH’s goals, this probably means evidence that providers are adopting EHRs at a reasonable pace; data are flowing more easily among diverse providers, vendors, patients and geographic locales; and meaningful use is starting to yield positive effects on health and other valued outcomes, at least in areas with robust systems.”