The Paradigm Shift of Health Information Technology: Implementation in an Evolving Healthcare Landscape

Although there are contentions regarding its mechanisms, health policy and managed care authorities agree that the ultimate goal of healthcare reform is to increase access, improve quality, decrease costs, and measure progress. The initiative of further integrating digital health systems and implementing health information technology continues to receive substantial support and growth in a positive direction.

Healthcare reform has become a focal component of an ongoing debate to control rising national expenditures and widening fiscal gaps. In a coordinated effort to improve healthcare access, delivery, and quality, government bodies and health policy authorities have targeted programs such as Medicare and Medicaid, exploring mechanisms to further healthcare alignment and efficacy. Below are highlights from a seminar with Farzad Mostashari, MD, ScM, national coordinator for health information technology at the United States Department of Health and Human Services.

Dr Mostashari shared how digital healthcare systems and health information technology (HIT), such as electronic health records (EHRs), can advance and benefit the nation’s current healthcare environment. In 2009, basic EHR use across the nation totaled only 14%. However, that figure has more than doubled in 20 months, with more progress made now than within the previous 20 years. After 2012, the goal is to achieve more than 50% integration. Dr Mostashari cited the example of health information technology (HIT) implementation in Ohio: only 3 years ago, a mere 5% of physicians were using electronic prescriptions. Now, over 74% of physicians are doing so. He describes this time period as the “New, New Deal,” the under-recognized portion of the recovery timeline, the reinvestment phase. He declared that those within the healthcare community should “convene” and not “compete,” as there has been incredible progress in recent years.

Technology alone will not overhaul and create sweeping improvements across the healthcare system, but it’s an incredible tool that has generated substantial interest within the community. It allows practitioners to improve faster, learn faster, and intervene faster. The current objective is to implement and integrate HIT and EHRs to accomplish specific outcomes within specific populations, because “If we’re going to make progress, we need to focus on the things that matter most.” Meaningful use of advanced digital health systems involves collection of the necessary and relevant health information, construction of lists that can be organized, implementation of standardized coding, and the capability to measure standardized metrics that truly assess the quality of care being delivered. Dr Mostashari describes the reform movement as a community improvement activity that requires a clear signal of what needs to be accomplished.

There has been a paradigm shift regarding the role of technology, and the Centers for Medicare & Medicaid Services has seen a positive wave of change. Currently, over 50% of physicians have registered for their HIT programs. Dr Mostashari stated that even 70% of rural small practices have been working to attain HIT, and these practices are not typically associated with “jumping into change.” While cutting costs is an important component, so is improving healthcare quality. He asserted that the US healthcare system now has tools that were “never dreamed of 15 to 20 years ago,” and that more patients are being helped today who formerly could not be reached.

Dr Mostashari stated that 3 objectives need to be completed: (1) changes in how care is paid for; (2) redesign of how these changes are delivered in practice; and (3) improvement in patient engagement. He acknowledged that these goals are slowly being accomplished, but there are risks with this transition. For patients, if the transition takes too long, they can get caught in the gaps of changing care. It was difficult to create the momentum that is changing mentalities and approaches, and authorities should be concerned about the overwhelmingly increased burden and failure to align care. One example of how burden can be reduced is through administrative simplification. Dr Mostashari believes that better care and better health at lower costs will not occur without “tapping into the patients.” Rather than continuing a culture that walls patients from their healthcare records, he stated that health information should be “liberated” and patients should be granted access, thereby creating a context for conversation and an opportunity for engagement. HIT will grant the access and information that the healthcare system currently needs to assist patients in becoming more accountable.

AHIP 2012 Medicare and Medicaid Conference website

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