Is the HITECH Act a Success?

The country was reeling. A crushing economic downturn had bled out jobs and retirement accounts. Healthcare, too, was suffering. So when lawmakers enacted the Health Information Technology for Economic and Clinical Health (HITECH) Act in 2009, they hoped it would drive both innovation and the markets.

The law earmarked tens of billions of dollars in incentives for hospitals and physicians to move from paper to electronic health records (EHR). Leaders intended for this migration to improve quality of care and lower costs. Now, just shy of a decade later, a natural question emerges: Did it work?

The answer is not so simple. Different experts hold different opinions, and they point to different parts of the HITECH Act and to debate its effects. A panel of industry leaders tackled the issue this morning during a healthcare technology discussion presented by the business journal NJBIZ in Somerset, New Jersey, highlighting what went right—and wrong—since the law went live.

For starters, it succeeded in inciting a sprawling and speedy move to EHRs. Tom Gregorio, MBA, senior executive director of the New Jersey Innovation Institute, said the Garden State’s EHR adoption rate among physicians jumped from 15% to 85%. Nationally, the adoption rate of basic systems spiked from 9.4% in 2008 to 83.8% in 2015, according to the Office of the National Coordinator for Health Information Technology.

“Is that important? Significantly,” Gregorio said, “because you need to be able to track information and be able to measure it for population health.”

But the spread of EHR is just 1 way to measure the success of the HITECH Act.

Morey Menacker, DO, vice president of Hackensack Meridian Health’s physician division, said many in the tech field decided to treat EHR systems as if they were word-processing programs. Instead of writing a note, they thought, doctors would simply type it. The ability to transfer information between providers and practices never entered the original discussion, he said. Rather, policymakers and healthcare types “assumed” it would naturally occur.

“The concept was brilliant,” Menacker said. “The problem is, it was an unregulated process, meaning that all you needed to do was show that you were moving to an [EHR] in order to be able to get compensated.”

Companies promised free EHR technologies to physicians in exchange for billing contracts, he said. Physicians then received government money—and, in many cases, an EHR system that offered little or no value for patient care management, he added.

Joseph A. Carr, CPHIMS, chief information officer of the New Jersey Hospital Association and moderator of today’s talk, backed up that point. He said he and his colleagues were “blown away” by how healthcare organizations allocated resources on new record systems with no connectivity.

It is still too early to judge the results of the HITECH Act, said Omar Baker, MD, co-president, chief quality and safety officer, and director of performance improvement for the Jersey-based Riverside Medical Group.

Healthcare costs remain a sizeable chunk of the gross domestic product, he said, and the industry has yet to achieve value in the way it wants. Most people visit the doctor only when they’re sick, leading to higher costs, he noted.

EHR systems, meanwhile, now provide physicians with red flags that identify gaps in care, chronic disease issues, and looming medication errors. Data gathering and analysis have improved, yielding actionable insights, Baker said.

But patients do not yet own their data. That falls on hospital systems, doctors, and insurance companies, he said. “If somebody owned their own data, and it was up over there in the cloud, that’s the solution to true interoperability and true integration and decreasing the fragmentation of care and minimizing the duplication of care,” he said.

And the HITECH Act, Baker said, has not changed a simple truth about healthcare: It’s a business. That means providers, insurers, and other players are fighting for premium dollars. Until everyone gets on the same page—“where it’s consumer-driven, patient-driven”—healthcare will not realize the success it could one day attain, he said.