Since enactment of the Health Information Technology for Clinical and Economic Health Act (HITECH Act) as part of the American Recovery and Reinvestment Act (ARRA), adoption and use of electronic health records in the United States has dramatically increased. Adoption of EHRs that met the criteria for a basic EHR system by office-based physicians grew by over 80% between 2009 and 2012, from 22% in 2009 to 40% in 2012. Among nonfederal acute care hospitals, adoption of at least a basic EHR system has increased by over 260% since 2009, from 12% to 44%, according to a recent notice in the Federal Register.
Adoption of many of the computerized functionalities associated with Meaningful Use has substantially increased among both office-based physicians as well as hospitals. For example, physician adoption of five core Meaningful Use functionalities—ranging from e-prescribing to clinical decision support–has grown by at least 66% since HITECH in 2009.
While HHS has taken major steps to expand the functionality and utility of EHRs to providers and patients, the agency also seeks to engage other policy areas within HHS jurisdiction to promote routine sharing of information among health care providers across settings of care to support care coordination and delivery system reform. The agency, however, recognized that economic and regulatory barriers may impair the development of a patient centered, information rich, high performance health care system where a persons’ health information follows them wherever they access health care services.
The Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs and Office of the National Coordinator (ONC) for Health IT (HIT) Certification Program are increasing standards based health information exchange (HIE) across health care providers and settings of care to support greater coordination of health care services.
However, this alone will not be enough to achieve the widespread interoperability and electronic exchange of information necessary for delivery reform where information will routinely follow the patient regardless of where they receive care. With fee-for-service reimbursement and other business motivations often being the stronger influencer of provider behavior, both providers and their vendors do not yet have a business imperative to share person level health information across providers and settings of care.
For example, in 2011, 4 in 10 hospitals electronically sent laboratory and radiology data to providers outside their organization; however, only 1/4 of hospitals could exchange medication lists and clinical summaries with outside providers. In addition in 2011, only 31 percent of physicians are exchanging clinical summaries with other providers. Only 6 percent of long-term acute care hospitals, 4 percent of rehabilitation hospitals, and 2 percent of psychiatric hospitals have a basic electronic health record system. Close to 1/3 of all Medicare beneficiaries discharged from acute care hospitals are discharged to post-acute care settings such as rehabilitation hospitals but there is little capacity in the system today to support HIE across these setting.
As a result, the Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC) released a Request for Information (RFI) on HIE, outlining several potential new policies using existing authorities and programs – such as requiring or encouraging Medicare Accountable Care Organizations (ACOs) to exchange health information as a part of coordination of care across aligned providers or patient engagement strategies – to accelerate interoperability and exchange of patient health information across care settings. The RFI also sought public input about policies that will “strengthen the business case” for electronic exchange across providers. Comments were due on April 21, 2013.
As part of its 2013 plan to foster HIE, the agencies also note that they intend to promote the Meaningful Use program and the federal Blue Button initiative – through which Medicare beneficiaries can access their online health information – and take steps to strengthen program integrity. In announcing the RFI, HHS said it will:
Set aggressive goals for 2013: HHS is setting the goal of 50 percent of physician offices using electronic health records (EHR) and 80 percent of eligible hospitals receiving meaningful use incentive payments by the end of 2013.
Increase the emphasis on interoperability: HHS will increase its emphasis on ensuring electronic exchange across providers. It will start that effort by issuing today a request for information (RFI) seeking public input about a variety of policies that will strengthen the business case for electronic exchange across providers to ensure patients’ health information will follow them seamlessly and securely wherever they access care.
Enhance the effective use of electronic health records through initiatives like the Blue Button initiative: Medicare beneficiaries can access their full Medicare records online today. HHS is working with the Veterans Administration and more than 450 different organizations to make health care information available to patients and health plan members. HHS is also encouraging Medicare Advantage plans to expand the use of Blue Button to provide beneficiaries with one-click secure access to their health information.
Implement Meaningful Use Stage 2: HHS is implementing rules that define what data must be able to be exchanged between Health IT systems, including how data will be structured and coded so that providers will have one uniform way to format and securely send data.
Underscoring program integrity: HHS is taking new steps to ensure the integrity of the program is sound and technology is not being used to game the system. For example, it is conducting extensive medical reviews and issuing Comparative Billing reports that identify providers.
The goals build on the significant progress HHS and its partners have already made on expanding health information technology use. EHR adoption has tripled since 2010, increasing to 44 percent in 2012 and computerized physician order entry has more than doubled (increased 168 percent) since 2008.
“The 2014 standards for electronic health records create the technical capacity for providers to be able to share information with each and with the patient,” said Dr. Mostashari. “Through the RFI, we are interested in hearing about policies that could provide an even greater business case for such information sharing.”
In addition to seeking public input, the RFI also discusses several potential new policies and ideas to accelerate interoperability and exchange of a patient’s health information across care settings so that they can deliver better and more affordable care to their patients