week 1 healthcare IT

3

Susa

The 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act is part of the American Recovery and Reinvestment Act (ARRA), designed to stimulate the economy after the 2008 recession. The HITECH Act allocated 30 billion dollars (about $92 per person in the U.S.) toward implementing health information technology (HIT) to improve patient outcomes (Rittenhouse et al., 2017). One of the focuses of HITECH is the implementation of electronic health records (EHRs). EHRs, in theory, allow for better communication between patient care providers and, therefore, decrease the chances of drug interactions and medical errors (Gans, 2016).  

Following the passing of the HITECH Act, the Centers for Medicare & Medicaid Services (CMS) adopted the EHR Incentive Program in 2011 (Rittenhouse et al., 2017). Through this program, physicians were financially rewarded for the meaningful use of EHRs and financially penalized for non-compliance. Meaningful use of EHRs included giving patients access to EHRs, reporting the patient experience, and improving patient-provider communication through messaging, mobile health (mHealth), and educational resources (Wagner, 2021).  

Despite the incentives, the adoption of EHRs had been slow going. Hospital adoption of EHRs increased only 4 percent from 2009 to 2010 (The Office of the National Coordinator for Health Information Technology (ONC), 2019). Office-based physicians' use of EHRs increased slightly more during the first year of the HITECH Act from 22% to 28% (ONC, 2019). However, by 2019 hospital use of EHRs far surpassed that of office-based physicians. In 2019, 96% of hospitals used EHRs compared to only 72% of office-based physicians (ONC, 2019).  

It should also be noted that there is a significant variance between single and smaller group practices and larger practices regarding compliance. Studies have demonstrated that larger practices, often owned by organizations, have a higher compliance rate (Rittenhouse et al., 2017). In part, this can be attributed to the fact that larger organizations, especially ones that obtain a sizable portion of revenue from Medicare and Medicaid patients, are more likely to embrace HIT as they also participate in pay-for-performance and reporting incentives (Rittenhouse, 2017). The variance in compliance among various size practices can also be attributed to the cost of implementing and maintaining EHRs. The average cost for a solo or small physician practice implementing an EHR system is about $35,000 (Menachemi & Collum, 2011). In addition, there are costs associated with maintaining EHRs, especially as technology advances. Lastly, time constraints and limited personnel resources for smaller practices play a role in adopting EHRs. These physicians' time, already stretched thin, can affect their ability to implement an EHR program. Physicians are likely to suffer a loss in revenue by diverting their time toward implementing an EHR system (Menachemi & Collum, 2011).  

Another variance in compliance can be noted between primary care physicians versus specialty care physicians. Primary care physicians (PCPs) have a higher compliance rate in comparison (Rittenhouse et al., 2017). The ONC reported that by 2016 internal medicine, general practitioners (family physicians), primary care, OBGYN/gynecology, geriatric, and pediatrics practices were better than 90% compliant (The Office of the National Coordinator for Health Information Technology (ONC), 2016). Specialty physicians, however, were lagging at 78% (ONC, 2016). Higher compliance among PCPs is because EHRs enable PCPs to provide high-quality medical care (Rittenhouse et al, 2017).  

The implementation of the HITECH act has led to additional policy adaptations. One such policy is The Medicare Access and CHIP Reauthorization Act (MACRA), which is designed to pay physicians for quality care over quantity. This payment model is also known as pay-for-performance, and it rewards physicians financially for positive patient outcomes.  

Interestingly, this information demonstrates the meaningful relationship between HIT and healthcare reform in the U.S. As technology advances, so does healthcare and vice versa. It will be interesting to see where the future of this relationship takes us. 

References 

Gans, D. (2016). EHRs: Practices spend more on IT and enjoy it less. MGMA Connection, 16(4), 33–35. 

Menachemi N, & Collum T. (2011). Benefits and drawbacks of electronic health record systems. Risk Management and Healthcare Policy, 2011, (N/A), 47–55.  https://doaj.org/article/a4926d100c4544309e782a9705bc2f47  

Rittenhouse, D., Ramsay, P., Casalino, L., McClellan, S., Kandel, Z., & Shortell, S. (2017). Increased health information technology adoption and use among small primary care physician practices over time: A national cohort study. Annals of Family Medicine, 15(1), 56–62.  https://doi-org.ezproxy.umgc.edu/10.1370/afm.1992  

Office of the National Coordinator for Health Information Technology (ONC). (2016). Percent of REC enrolled physicians by specialty live on an EHR and demonstrating meaningful use. ONC.  https://www.healthit.gov/data/quickstats/percent-rec-enrolled-physicians-speciality-live-ehr-and-demonstrating   

The Office of the National Coordinator for Health Information Technology (ONC). (2019). National trends in hospital and physician adoption of electronic health records. ONC.  https://www.healthit.gov/data/quickstats/national-trends-hospital-and-physician-adoption-electronic-health-records  

Wagner, S. (2021). The United States healthcare system: Overview, driving forces, and outlook for the future. AUPHA/HAP Book. 

Rob

Since its adoption in 2009, The Health Information Technology for Economic and Clinical Health (HITECH) Act has helped providers with barriers to implementing an EHR in their practice and move away from paper records (Cohen, 2016, p. 143). As of 2019, 72% of office-based physicians had implemented a certified EHR (Office of the National Coordinator for Health Information Technology [ONC], 2022).                         Providers in smaller practices have been difficult to motivate to implement EHRs into their practices as there have been financial barriers, lack of staff able to implement these programs, and fear that regulations will again change after choosing a program (Cohen, 2016, p. 144). Smaller practices are concerned about these factors leading to another increase in costs and loss of productivity (Cohen, 2016, p. 144). Initially, ONC used three Meaning Use stages to incentivize providers to invest into a certified EHR system (Cohen, 2016, p. 144). Meaningful Use incentives were a large motivator for small physician offices to invest in a EHR in the early years of enrollment; however, this was not the case as much for larger offices or offices associated with hospitals (Cohen, 2016, p. 149).             In 2015, The Medicare Access and CHIP Reauthorization Act (MACRA) was passed. One part of MACRA was The Merit-based Incentive Payment System (MIPS), which now directed providers how to fulfill Medicare requirements for EHR implementation (Office of the National Coordinator for Health Information Technology [ONC], 2021). Meaningful Use was no longer the standard (ONC, 2021). The initial research motivating the push towards EHR implementation included to improve patient safety, decrease medication errors, and better control healthcare costs (Schilling, n.d.). Now, MACRA was meant to expand the requirements placed on physicians to improve quality in patient care (ONC, 2021). The providers not motivated by financial gain from the original Meaningful Use incentives, were motivated with the ideas of improving patient care (Schilling, n.d.).                         According to the ONC, Medicare eligible providers that do not switch to a certified EHR and fulfill Meaningful Use requirements would be penalized after 2015 (Office of the National Coordinator for Health Information Technology [ONC], 2013). The penalty would be that the “Medicare physician fee schedule amount for covered professional services will be adjusted down by 1% each year” (ONC, 2013). The pressure would continue to be placed on Medicare providers collectively, as 1% would be increased to a maximum of 5% by 2018 if the compliance rate of all Medicare providers was less than 75% (ONC, 2013). While there were some providers that could be exempt from these penalties under the Recovery Act, this protection only was allowed for up to five years (ONC, 2013).             ONC has continued to develop more resources to assist physicians with meeting the requirements to increase compliance rates (Schilling, n.d.). In 2016, the 21st Century Cures Act was passed partly to provide more guidance, and necessities, for practices regarding EHR (ONC, 2021). With a 72% reported rate of compliance from private physicians, barriers still exist for providers to implement new technologies into their practices. The fragmentation of the U.S. healthcare system has also created confusion for providers trying to meet government requirements (Schilling, n.d.). As technology continues to be increasingly important in healthcare and to demonstrate proof of quality care for reimbursements, providers will need to invest into these programs for their patients.               

References: Cohen, M. F. (2016). Impact of the HITECH financial incentives on EHR adoption in small, physician-owned practices. International Journal of Medical Informatics, 94, 143-154.  https://doi.org/10.1016/j.ijmedinf.2016.06.017 Office of the National Coordinator for Health Information Technology (ONC). (2021, June 8). Health IT legislation. HealthIT.gov.  https://www.healthit.gov/topic/laws-regulation-and-policy/health-it-legislation

Office of the National Coordinator for Health Information Technology (ONC). (2022, March). National trends in hospital and physician adoption of electronic health records. HealthIT.gov.  https://www.healthit.gov/data/quickstats/national-trends-hospital-and-physician-adoption-electronic-health-records

Office of the National Coordinator for Health Information Technology (ONC). (2013, January 15.) Are there penalties for providers who don’t switch to electronic health records (EHR)? HealthIt.gov.  https://www.healthit.gov/faq/are-there-penalties-providers-who-dont-switch-electronic-health-records-ehr Schilling, B. (n.d.). The federal government has put billions into promoting electronic health record use: How is it going? Commonwealth Fund.  https://www.commonwealthfund.org/publications/newsletter-article/federal-government-has-put-billions-promoting-electronic-health