The HITECH Era – A Patient-Centered Perspective

Note: This blog adds a third perspective to those recently published by (1) National Coordinators Vindell Washington, Karen DeSalvo, Farzad Mostashari and David Blumenthal, and by (2) John Halamka and Micky Tripathi, in the New England Journal of Medicine on September 7, 2017.

We appreciate the recent perspectives published in the New England Journal of Medicine on the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 and the positive impact that it and resulting health IT policies have had on U.S. health care.1,2 The perspectives highlighted the remarkable increase in adoption and use of electronic health records (EHRs) over the past eight years, thanks to the HITECH Act and to ONC’s and CMS’s implementation of it with major advice and help from the multi-stakeholder HIT Policy and Standards committees.

While those perspectives focused on the role of institutions, clinicians, and policymakers in health IT, we believe that there is an additional, indeed central, perspective—that of patients and consumers. While EHR adoption by the vast majority of hospitals and physician practices has brought us a long way from paper records, much of one’s health and care occurs outside the 15-minute clinical office visit in settings such as homes, community centers, and social service organizations. We increasingly recognize that 85-90 percent of one’s health status is explained by social and environmental determinants outside the clinical setting.3 The greatest promise from digital transformation may come from its impact outside of traditional health care settings. Harnessing the full potential of health IT will require new focus on people and their data collected outside the walls of the hospital and doctor’s office, and on uses and interventions that help patients as they are living their lives.

Viewing the evolving health IT landscape through the lens of the person and patient at the center of health and care, rather than the EHR, tells a different story. For example:

• Access: Patients’ access to their health information has dropped from 30-90 days under the Health Insurance Portability and Accountability Act (HIPAA)—which seems glacial in today’s always-on environment—to access electronically in 36-48 hours under the Meaningful Use program (Stage 3) and MACRA’s Advancing Care Information performance category.
• Online Access and Use: According to national surveys, the fraction of patients with online access to their own health information doubled from 2011 to 2014, from 26 percent to 50 percent.4
• Mobile Access and Use: Consumers today expect mobile, digital access to their information and services. Just as the ATM and online banking revolutionized financial transactions, ONC’s 2015 Edition of certified EHR technology now requires mobile access for patients (and providers) through mobile applications using open APIs...