History of Health Information Technology in the U.S.

The HITECH ActLecture a – Regional Extension Centers and Workforce Training

This material Comp5_Unit3 was developed by The University of Alabama Birmingham, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number 1U24OC000023

The HITECH ActLearning Objectives

• Discuss the barriers to adoption of Health IT that the HITECH Act is designed to address

• Discuss how the following ARRA/HITECH requirements relate to previous developments in health IT:– Certified electronic health records– Concept of meaningful use including e-prescribing, clinical decision support,

interoperability and HIE, structured documentation of quality measures– Incentives to providers– Education of clinicians– Workforce development

• Give examples of how the HITECH provisions support healthcare reform efforts

• Discuss the overall vision for the effects of the HITECH Act

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History of Health Information Technology in the U.S. The HITECH Act

Lecture a

History of Health IT

• Original use– Billing and collections

• Later use– Administrative purposes – similar to any other business

• Most recently– Clinical settings by clinicians (doctors, nurses, others)

• Potential– Improvement of quality of care (IOM reports)

• More IT benefits– Improve efficiency– Reduce healthcare costs

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History of Health IT

• More receptive to systematizing care• More comfort with computers• Greater receptivity to using technology• Improved and innovative technology• Goal: for all Americans to have their data in

electronic health records by 2014

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Barriers to Improving Quality and Reducing Costs

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Barriers to Improving Quality and Reducing Costs

• Low adoption rates– Cost– Impact on productivity– Manpower

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Barriers to Improving Quality and Reducing Costs

• Low adoption rates– Cost– Impact on productivity– Manpower

• Adoption is not enough– Must be used appropriately

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Barriers to Improving Quality and Reducing Costs

• Low adoption rates – Cost– Impact on productivity– Manpower

• Adoption is not enough– Must be used appropriately

• Information must be shared– Standards

• Lack of agreement– Privacy and Confidentiality

• Public and professional concerns

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Barriers to Improving Quality and Reducing Costs

• Technology needs improvement– Usability to support decision making– Models for information exchange– Information security issues

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Barriers to Improving Quality and Reducing Costs

• Technology needs improvement– Usability to support decision making– Models for information exchange– Privacy and security issues

• Sustained leadership

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Lecture a

American Recovery and Reinvestment Act (ARRA)

• $787 billion in funding– Grants to states to distribute for jobs, infrastructure – Grants to individuals through NIH and other federal

agencies– Other provisions

• Health Information Technology for Economic and Clinical Health (HITECH) Act– $19+ billion for Health IT

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The HITECH Vision

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Courtesy: Office of the National Coordinator for Health Information Technology

The HITECH Vision

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Courtesy: Office of the National Coordinator for Health Information Technology

Regional Extension Centers

• Assist providers, especially small primary care practices, in implementation of EHRs for meaningful use

• As of March 2011, 62 funded RECs• Similar in principle to agricultural extension

centers • Staff deployed for short periods of time at a

given practice

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Lecture a

Health IT Workforce

• Increased deployment of clinical systems means more personnel needed – Technical support personnel to support/maintain the

systems– Health/medical informatics professionals to develop

new tools and devise better methods of information management

– Health IT managers to oversee implementation– Chief Medical/Nursing Informatics Officers to be

liaisons between the clinicians and IT staff

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New Roles for IT Professionals

• Clinician/Practitioner Consultant• Workflow Redesign Specialist• Implementation Manager• Implementation Support Specialist• Trainer• Technical Support Staff

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New/Expanded Roles

• Clinician/Public Health Leader• Health Management and Exchange Specialist• Health Information Privacy and Security

Specialist• Research and Development Scientist• Programmer/Software Engineer• Health IT Subspecialist

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Clinician Education

• Introduce clinical IT into the educational setting

• Current clinical education practices reinforce a culture that leads to resistance to appropriate use of information technology– Model of the doctor as “expert” – “House”– Inexperience with EHRs and Clinical Decision

Support

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The HITECH ActSummary – Lecture a

• Barriers to use of health IT• Skilled workforce• Regional extension centers

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The HITECH ActReferences – Lecture a

References

Blumenthal D. Stimulating the adoption of health information technology. N Engl J Med. 2009; 360;15:1477-9. Available from:

http://content.nejm.org/cgi/reprint/360/15/1477.pdf  Office of the National Coordinator.  Celebrating the first anniversary of the HITECH Act and looking to the future. 

2010.  Available from: http://healthit.hhs.gov/portal/server.pt/gateway/PTARGS_0_11673_911674_0_0_18/FINAL_ONC-HITECH-Anniversary.pdf

Images

Slides 12, 13: Courtesy of the Office of the National Coordinator for Health Information Technology. Available from: http://healthit.hhs.gov/portal/server.pt/gateway/PTARGS_0_11673_911674_0_0_18/FINAL_ONC-HITECH-Anniversaryf

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