Picking up where I left off, I will discuss some of the challenges or barriers to HIT adoption.
It would be easy to compile a long list of challenges to the adoption of HIT. Nonetheless, I'll limit my discussion to a brief review of two general areas that I believe are of greatest importance: stakeholder attitude and technology challenges.
If the goals set forth by the HITECH Act are to be realized, healthcare providers must make the transformation from paper to digital records - no small feat. Thus far, the transformation has been met with considerable resistance. As reimbursement for services continues to decline along with increasing overhead expenses, efficiency and productivity must be maximized. Many stakeholders feel that the workflow changes needed in order to achieve Meaningful Use are burdensome and counter-productive. In addition, some question the value of the information gained from the Meaningful Use objectives. The consensus is that at the very least, the use of EHR is more time consuming than traditional charting methods. Statistics show that adoption of EHR and achievement of MU has grown substantially since the Program's inception in 2009 to date. Nonetheless, measurable achievement of the aforementioned goals arguably, has yet to be realized. Accordingly, there is no shortage of skepticism among stakeholders whether there is a direct correlation between achieving Meaningful Use and enhancing health care quality and efficiency. Additionally this attitude contributes to the perception that adopting CEHRT lacks value.
In order to overcome these barriers, it is essential that organizations establish a culture of trust. I would expect that those organizations most successful transitioning to CEHRT had already established a culture of trust and encountered the least resistance to change. While I am not aware of any such studies substantiating my expectation, it may be an interesting study worth pursuing.
"The HITECH Act seeks to improve patient care and make it patient-centric through the creation of a secure, interoperable nationwide health information network. A key premise is that information should follow the patient, and artificial obstacles -- technical, bureaucratic, or business related -- should not be a barrier to the seamless exchange of information. Therefore, secure information exchange needs to occur across institutional and business boundaries so that the appropriate information is available to improve coordination, efficiency, and quality of care." ("How does information exchange")
Although there has been a proliferation of local, regional and state Health Information Exchanges (HIE the noun) to facilitate information sharing, for the most part, data remains siloed in disparate EHR systems.
Most industry leaders would agree that in spite of a greater prevalence of structured data, primary obstacles include a lack of standardization and a lack of a nationwide interoperability infrastructure to facilitate Health Information Exchange (HIE the verb). Adding fuel to the fire so to speak, are accusations that information blocking has contributed to the challenge of establishing nationwide interoperability. The seriousness of these accusations prompted a request by Congress for the ONC to produce a report on the extent of health information blocking and a comprehensive strategy to address it. It was also requested that "the report should cover the technical, operational and financial barriers to interoperability, the role of certification in advancing or hindering interoperability across various providers, as well as any other barriers identified by the Policy Committee."
According to the REPORT TO CONGRESS, APRIL 2015 - Report on Health (ONC, 2015) (pp.15-16) as a result of current economic and business incentives, some stakeholders have knowingly and unreasonably interfered with the exchange of electronic health information by limiting its availability or use. The Report goes on to say that "ONC's understanding of information blocking is informed in part by a substantial body of complaints and other anecdotal evidence. However, this evidence has significant limitations that prevent ONC from confirming individual cases of information blocking. Identifying and confirming specific instances of information blocking is a difficult and highly fact-specific task. Empirical data on information blocking is also limited at present. There is little quantitative data available with which to reliably identify and measure the extent of information blocking." Finally the report suggests that "successful strategies to prevent information blocking will likely require congressional intervention".
Dr Marvin Boren is the Meaningful Use Program Coordinator at Akron Children's Hospital (Akron, OH) which has successfully attested for Stage 2 Meaningful Use. He formerly practiced podiatry in Canton, OH and has over five years of experience consulting in Electronic Health Records. He is currently working on a Master of Science degree in Health Informatics at Kent State University. He can be reached at marvboren at google.com
1. The Office of the National Coordinator for Health Information Technology (ONC) Department of Health and Human Services (April 10, 2015). Report to Congress on Health Information Blocking. Retrieved from https://www.healthit.gov/sites/default/files/reports/info_blocking_040915.pdf
2. EHR incentives & certification, How to attain Meaningful Use. Retrieved from https://www.healthit.gov/providers-professionals/how-attain-meaningful-use
3. How does information exchange support the goals of the HITECH Act? Retrieved from http://www.healthit.gov/policy-researchers-implementers/faqs/how-does-information-exchange-support-goals-hitech-act
4. The Office of the National Coordinator for Health Information Technology (ONC) Office of the Secretary, United States Department of Health and Human Services (September 21, 2015). Federal Health IT Strategic Plan 2015-2020. Retrieved from: https://www.healthit.gov/sites/default/files/federal-healthIT-strategic-plan-2014.pdf