Robert Wood Johnson Foundation
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A new Health Policy Brief from Health Affairs and the Robert Wood Johnson Foundation looks at the issue of health information exchange. The Health Information Technology for Economic and Clinical Health (HITECH) Act was signed into law at the very beginning of the Obama administration, bringing with it significant investments in health information technology (IT)--$26 billion to date. While the adoption of electronic health records (EHRs) has increased considerably since 2009, there is very little electronic information sharing among clinicians, hospitals, and other providers. New models of care delivery, designed to improve quality and reduce costs, require both interoperable EHRs and electronic information sharing to be effective. This Health Policy Brief looks at the efforts the federal government has made to improve interoperability and increase the level of electronic information sharing, as well as the barriers to achieving these goals.
Topics covered in this brief include:
What's in the law? The HITECH Act sets out requirements and milestones for different types of providers to demonstrate meaningful use of EHRs. A majority of the federal government's investments in health IT have been incentive payments through the Centers for Medicare and Medicaid Services (CMS). These payments are awarded to hospitals and eligible providers that "meaningfully use" EHRs that have been certified through programs overseen by the Office of the National Coordinator for Health Information Technology (ONC). The brief outlines the different stages and compliance requirements for providers to receive these payments and for EHR products to achieve ONC certification and it explains how parts of the original timeline for each successive stage to take effect have been extended. These delays could potentially affect how soon providers share electronic information.
What are the implementation barriers? As the brief explains, the primary barrier to health information exchange and interoperability is the lack of a "business case" -- that there is little incentive to share information. The business case will become clearer as CMS continues to impose penalties on hospitals for excessive readmission rates and requires providers to share data electronically and as ONC implements requirements for interoperability of EHR technology. The federal government's continued movement toward payment models that reward outcomes rather than volume will also play a key role in increasing the level of information exchange and interoperability. As the brief explains, the Department of Health and Human Services (HHS) has sought input on potential policy and program changes to advance health information exchange and interoperability across systems. However, as the policy brief notes, to date, HHS has implemented few of these program changes.
What's next? As the implementation of EHRs moves forward, ONC recently released a ten-year vision and plan, outlining the building blocks for achieving a nationwide interoperable health information infrastructure. Other recent reports, detailed in the brief, summarize new options for achieving interoperability and electronic information sharing.
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