New Reviews Reflect Critically on HITECH Implementation

Mary Ellen Cagnassola

"We gave clinicians suboptimal cars, didn’t build roads, and then blamed them for not driving,” the authors said of the transition’s nearsightedness.

The Health Information Technology for Economic and Clinical Health (HITECH) Act was designed in hopes of shepherding US healthcare into the digital age. But eight years later, its unforeseen failures are burdening frustrated clinicians, whose impaired workflow has led to data blockage.

A review published in The New England Journal of Medicine points to five key areas — usability, workflow, innovation, interoperability, and patient engagement — critically affected by HITECH’s shortcomings. The manifestation of these deficiencies stems from aggressive “meaningful use” criteria, which was intended to ensure that Medicare and Medicaid saw the benefits of their investment in HITECH on an ambitious timeline.

Instead, the review argues, meaningful use created a strenuous onus on physicians to transform paper-based workflows to electronic health records (EHRs), on top of their duties to provide quality care to patients. For each short appointment, physicians were tasked with entering the structured data elements according to meaningful use, implementing security protections for that data, learning new billing codes and distributing new HIPAA privacy notices, all while convincing patients of the security of patient portals and e-mail.

“In a sense, we gave clinicians suboptimal cars, didn’t build roads, and then blamed them for not driving,” the authors of the review said of the transition’s nearsightedness.

Meaningful use criteria squeezed EHR vendors, too, thanks to financial and opportunity costs imposed by complex certification requirements.

The poor usability and lack of actionable information of EHR, according to another NEJM review published simultaneously, has amounted to the allowance of proprietary standards and data blocking in the market, resulting in subpar data sharing. In other words, the insufficient accessibility of these hastily implemented systems — and the subsequent stress that the transition from paper-based workflow put on clinicians — is blocking the flow of data, stymying HITECH’s long-term goals.

“Instead of recognizing the work that needed to be done on these foundational items, some policymakers invented the myth of ‘information blocking’ as the root cause for lack of data flow. Our 50-plus combined years in the health IT industry have taught us that when technology, policy, and business needs are aligned, data flow,” the authors of “The HITECH Era in Retrospect” claim.

HITECH, despite its downfalls, was a necessary piece of legislation for the implementation of EHRs in the U.S and beneficial for the health care industry overall. Today, decision-making power must be returned to customers, developers, and multi-stakeholder collaborations to take some of the pressure off clinicians.

“Policymakers and the private sector now have an opportunity to ensure that the burgeoning health IT infrastructure engenders an equitable learning health system that leads to high-quality care, lower costs, and a healthy and engaged population,” the authors of “The HITECH Era and the Path Forward” said in their review.

Moving forward, a four-step approach, beginning with the simplification of meaningful use requirements, can help patch the policy holes. EHR certification should also shift focus to interoperability capabilities via a public test server and reporting on EHR vendors’ success in reading and writing medical records on it.

The remaining work to be done, according to “The HITECH Era in Retrospect,” involves encouraging interoperability through market action over regulation.

“Finally, we could offer incentives for the adoption of open industry application programming interface (API) standards, such as FHIR, for provider-patient, provider-provider, provider-payer, and payer-patient interactions,” the authors recommended.