Post-HITECH HIT: Still Waiting

By MICHAEL PAINTER, MD

When it comes to health information technology in the United States, are you an optimist or pessimist?

Do you think it’s likely people who want health information will soon have routine, seamless digital access to it?

Most physicians and hospitals have at least some sort of electronic health record, yet big adoption gaps remain among physicians as just over half now have electronic health records. We can declare success and move on, right?

Hardly.

Most of us still cannot get health information when we want or need it. Health professionals and care systems trying to implement value-based payment and delivery reforms struggle to get the information they need to do that transformation. Communities trying to improve the health of their citizens have trouble getting the data they need and turning it into useful information.

Last week, the Robert Wood Johnson Foundation released its latest and last in a 10 year series of health information technology reports. The title of this year’s report is: “Health Information Technology in the United States, 2015: Transition to a Post-HITECH World”. Like previous editions, this one is an independent assessment of the state of our national health information technology infrastructure. It examines the progress, mishaps and many of the remaining challenges.

Although, we do not yet have that health information infrastructure, we do have a range of opinions about what has gone right and wrong over the last 10 years. There’s even a wide range of opinion among past and current national HIT coordinators. This year’s RWJF report includes an interview with all of them. Their comments range from: if we hadn’t acted we’d basically still be “Waiting for Godot” to we did act and ended up creating a sort of Eisenhower-like HIT “military industrial complex”.

Farzad Mostashari:

“’Oh, the marvels of technology that would have emerged had the government not stepped in. Oh, you should have just waited.’ So, first of all, waited until when? We waited 20 years, right? Waited for what? Second of all, where’s the counterfactual? You know what the counterfactual is? Behavioral health. You know what the counterfactual is? Long‐term care. Show me the beautifully innovative technology that’s now easily adopted by long‐term care health professionals. It doesn’t exist.”

David Brailer:

“Three things are clear. First, there was significant uptake in adoption before HITECH because the industry knew it was time and desperately wanted improvements. They simply needed the government, as the biggest payer for health care, to lead. Second, a vast amount of expensive public capital has been spent in HITECH, largely as a substitute for private capital, and the market will be wary of new investments if there is ever the potential for new government money to pay for it. Third, HITECH left us with an unwieldy, confused regulatory scheme that will slow down or block the innovations of the future.”

Our HIT reality is probably somewhere in between. At this year’s Washington, DC RWJF report release event, current national coordinator, Karen DeSalvo, provided some wise glass-is-half-full leadership: We are making enormous progress. We also face hard challenges. Now is not the time to let up.

Personally, I remain a guarded optimist about this epic quest for our health information infrastructure. On the other hand, I’m also an avid cyclist who lives to ride two or three hundred miles a week precisely because it hurts so much.

What say you?

Michael Painter is a senior program officer with the Robert Wood Johnson Foundation.