HITECH and Meaningful Use at a Crossroads

It is hard to believe that the Health Information Technology for Economic and Clinical Health (HITECH) Act was passed into law five years ago, in 2009, and at the end of the year, the massive legislation was shaped into a program that has profoundly altered the informatics world, not to mention all of healthcare. Like most large undertakings, especially when infused with politics, the results have been mixed. Clearly the goals of EHR adoption have been substantial in hospitals and by physicians, even if the resulting systems have not achieved the ideals we held out for them. Perhaps as much depending on your political views as much as your informatics views, the glass is either partially empty or partially full.

On the positive side, a large proportion of US physicians [1] and nearly all US hospitals [2] now use an electronic health record. While many have argued that there should have been a much greater focus from the start on data interoperability, we are seeing progress with the rapid coalescence behind the FHIR, ReST, and OAuth2 standards in the Argonaut Project of HL7.

On the negative side, the systems we have implemented have been driven by meaningful use criteria. While no one would argue against these criteria generally (e.g., problem lists, electronic prescribing, etc.), many have argued that healthcare organizations have had to devote too much effort to meeting the criteria rather than innovating and leading with the beneficial aspects of technology. By the same token, the focus of vendors has had to be on certification to insure their customers can meet the meaningful use criteria with their products. On top of this is the toxic political environment in the US, with one's views' on HITECH and the Affordable Care Act being a sort of political Rorschach Test, making it even more difficult to have a meaningful conversation.

I tend to be glass-half-full kind of person, although I certainly acknowledge the limitations of the situation we are in now. It is easy to find critics of the current situation, but I tend to prefer to read and converse with those who present a balanced view that recognizes the problems in paper-based healthcare that led us to adopt the (still not achieved) promise of information technology (IT)-enabled healthcare. I give a special call-out to my colleagues Bob Wachter [3] and Jacob Reider [4] for their recent writings, and the former for his book that was just released [5], which I am enjoying but admittedly not done reading yet.

The real question is how we can get from here to where we want to be. This is especially so with the release of the Notice of Proposed Rule Making (NPRM) for Meaningful Use Stage 3 as well as the legislation to solve the Sustainable Growth Rate (SGR) problem (the "doc fix") of Medicare, which contains a proposal to roll the Meaningful Use Program into a more coalesced approach to incentives for quality in the Medicare Program.

My own view is that we should be focusing on data standards and interoperability, aiming to allow innovation to flourish on top of it. We also need to be open and critical of current failings, but also willing to move beyond negativity and linking the current situation to politics and/or greed. Not that both of these are not present, but that we need to come together as a community so those negative attributes are held in check by the greater community working toward more positive goals.

References

1. Charles, D, Gabriel, M, et al. (2014). Adoption of Electronic Health Record Systems among U.S. Non-federal Acute Care Hospitals: 2008-2013. Washington, DC, Department of Health and Human Services. http://www.healthit.gov/sites/default/files/oncdatabrief16.pdf.
2. Hsiao, CJ and Hing, E (2014). Use and Characteristics of Electronic Health Record Systems Among Office-based Physician Practices: United States, 2001–2013. Hyattsville, MD, National Center for Health Statistics, Centers for Disease Control and Prevention. http://www.cdc.gov/nchs/data/databriefs/db143.htm.
3. Wachter, B (2014). Meaningful Use. Born, 2009, Died, 2014? Wachter's World, November 13, 2014. http://community.the-hospitalist.org/2014/11/13/meaningful-use-born-2009-died-2014/.

4. Reider, J (2015). Spring Deliveries from Washington. The Health Care Blog, March 22, 2015. http://thehealthcareblog.com/blog/2015/03/22/spring-deliveries-from-washington/.

5. Wachter, R (2015). The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine’s Computer Age. New York, NY, McGraw-Hill.