Health IT Taking Flight–What Is in Store for the Year Ahead

Dr. Farzad Mostashari | January 25, 2012

Earlier this month, I wrote about some of the most important and notable highlights in the world of health IT and ONC over the past year. The achievements of 2011 built on hard work and progress, which has been underway for many years.The HITECH Act is helping to accelerate this momentum—like a turbocharger in a racecar.

As we start the New Year, I am excited about what the future holds and want to share what I see as five big health IT trends for the year to come.

Meaningful Use Takes Off. We sometimes refer to the stages of Meaningful Use as an escalator because it will get more rigorous and sophisticated over time. We might equally call it the necessary foundation upon which to build a truly 21st Century health system where care is better coordinated, patient-centered, safer, and where we pay for the right care, not just more care. Successfully attesting to Meaningful Use will not by itself achieve these goals, but it does help ensure providers have the right information at the right time so patients get the right care.

As I mentioned in my previous blog, by the end of November 2011, more than 20,000 eligible professionals and 1,200 hospitals had received payments from the Medicare or Medicaid EHR Incentive Programs. These are pretty good numbers for the first year of a new program, especially when it involves doctors and hospitals making investments in new technology and changes to clinical workflow. There are other good signs that providers are taking up the challenge, including a survey indicating that attainment of Meaningful Use is a top priority for more than two-thirds of hospital executives and a five-fold increase in electronic prescribing by office-based physicians since 2000. My prediction is that at least 100,000 providers will receive Medicare or Medicaid EHR incentive payments by the end of 2012. But, in order for my prediction to come true, the entire health IT ecosystem, including technology vendors, physician and hospital leaders, Regional Extension Centers, state-level health IT coordinators, public health agencies, and many others need to pull together toward getting as many providers to Meaningful Use as possible. Let’s make 2012 the Year of Meaningful Use!

Health Information Exchange Turns a Corner. A key element of the Meaningful Use roadmap is the electronic exchange of important clinical information. With the foundation we have built in Stage 1, increasingly rigorous health information exchange requirements in Stage 2 and payment reform as a constant drumbeat, I think exchange will take off in 2012.

The Direct Project now provides a simple, secure, standardized way to send encrypted health information to trusted recipients over the Internet, enabling providers to meet Stage 1 Meaningful Use exchange requirements. Through intensive collaboration with on-the-ground implementers, the protocol went from concept, to specification, to pilot testing in just a few months, and now we are seeing widespread adoption by EHR and health information exchange  vendors. Increased use of Direct should go a long way toward replacing the slow and inefficient way most providers currently share information via phone, fax, and mail—ultimately improving patient care and outcomes. However, Direct is only the first step in achieving the health information exchange we will need in the future.

Standards development is now focusing on the Nationwide Health Information Network (NwHIN) since the health information exchange requirements will become more rigorous in Stage 2 of Meaningful Use in order to support the care coordination functions and advanced care processes that providers will need to succeed under new payment approaches. As the business value for exchange increases, our standards efforts will bear fruit, reducing the cost and complexity of implementing basic exchange functions like sending a care summary or receiving lab results. With increased value and lowered cost, information will start to flow. But, it will only move at the speed of trust. Here too, ONC efforts are critical. Robust policies that protect information and create public trust will galvanize rapid growth and innovation in health information exchange.

Connecting the Dots on Health IT and Payment Reform. It is widely recognized that fee-for-service payment for health care tends to reward volume while providing little incentive to furnish care in ways that drive toward improved health outcomes or efficiency. All that is changing before our eyes as more health systems move away from fee-for-service and toward payment models that incentivize care coordination, quality improvement, prevention, and more efficient use of resources. New payment models, such as accountable care organizations, patient-centered medical homes, bundled payments, and quality measurement/improvement initiatives may seem disconnected from each other, but they all have a common denominator: Success depends on better information about each patient’s health needs than paper records can provide.

As more providers adopt EHRs and go through the process of attesting to Meaningful Use, I believe they will increasingly see the direct connections between health IT, new payment models, and the ways in which the former can help them succeed with the latter. Moreover, EHRs, health information exchange, and other forms of health IT will increasingly be seen as key enablers within new payment models themselves. We are headed toward a virtuous cycle where payment reform improves the business case for using health IT and greater use of health IT improves the chances that new payment models will succeed.

Consumers Use eHealth to Get More Involved. I believe this year we will see consumers and patients use information technology to become better informed about their health and more engaged with their own care than ever before. In large part, this will happen because it’s becoming easier for consumers to electronically access their own information. Personal health records are becoming easier to use as more data holders make it possible to download information through tools like Blue Button. Many health care providers are setting up patient portals which are directly connected to their EHRs. The Medicare and Medicaid EHR Incentive Programs already require providers to give patients access to their electronic health information, and I anticipate future stages will build on that notion. And the work that is being done on standards and interoperability will help make consumer access to their health information more seamless and more useful.

In addition, developers are coming out with more apps for mobile devices that make it easier for consumers and patients to get information about different diseases and track their own health over time. Along those lines, several Beacon Communities have launched txt4health, a consumer engagement campaign that uses cell phone text messaging to deliver information about diabetes care and management. ONC will diligently keep encouraging the marketplace to develop mobile apps and other consumer-friendly platforms that get patients engaged by sponsoring challenges like the Healthy Apps Challenge. Once consumers start to see their own information, they will be more empowered to be partners in their own care and come to expect that providers will use health IT as a tool to help deliver high-quality care.

Innovation Drives Improvement. Innovation is the lifeblood of technology, whether we are talking about health IT or otherwise. For health IT, innovation is being driven on many fronts, including ways of making EHR systems easier and less expensive to install and maintain, such as software-as-a-service and web-based systems. Mobile devices such as smart phones and tablets are being directly integrated into health IT systems, and I expect this trend will continue to pick up speed as capabilities such as voice recognition are perfected. The growing emphasis on value-based payment models will help fuel innovation around products and services that help providers perform quality measurement/improvement and population health management. There will be increasing emphasis on data analytics and finding ways of using data to support population health management, as well as feed information back into EHRs in ways that support a learning health system.

Innovation will continue to influence and support all the other key factors I’ve mentioned here, and ONC will continue working with the market to foster innovation, including sponsoring challenges and encouraging focused collaboration. One particular aspect of health IT innovation to watch in 2012 is an increased emphasis on advancing the usability of EHRs. ONC has resources concentrated on promoting innovation while encouraging vendors and other stakeholders to learn systematically and act rapidly to continually improve usability.

In summary, I see 2012 as the year in which health IT truly comes of age. While much work still needs to be done, the groundwork is firmly in place for what promises to be a breakthrough year in the adoption and widespread use of health IT in ways that improve care for individuals, improve health outcomes for populations, and increase the value we get from our health care dollars.

I am excited to be a part of it and look forward to seeing these trends (as well as many others) unfold in the year and years ahead. I encourage each of you to get engaged now to help shape our bright future.

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