Health Information Technology

Using health information technology (health IT) to strengthen patient safety and quality improvement efforts, and to facilitate the alignment of quality measures and payment policies has long been a national goal. Significant advances toward these goals have been made within the last few years

Background. In April 2004, President Bush laid out a plan to change healthcare: to make it more consumer centric and improve the quality and efficiency of healthcare. The President's plan is based on the following tenets:

  • Medical information will follow consumers so that they are at the center of their own care,
  • Consumers will be able to choose physicians and hospitals based on clinical performance results made available to them,
  • Clinicians will have a patient's complete medical history, computerized ordering systems, and electronic reminders,
  • Quality initiatives will measure performance and drive quality-based competition in the industry,
  • Public health and bioterrorism surveillance will be seamlessly integrated into care, and
  • Clinical research will be accelerated and post-marketing surveillance will be expanded.

In 2004, President Bush signed two executive orders requiring the Department of Health and Human Services (HHS) to help advance efforts to achieve the administration’s goal for most Americans to have access to secure electronic health records by 2014, and requiring HHS, the Department of Defense, the Department of Veterans Affairs and the Office of Personnel Management to adopt interoperable health information-technology standards, adopt quality-improvement measures, and be more transparent regarding healthcare prices.

Current. The Obama administration subsequently signed into law two major pieces of legislation designed to further these goals: (1) the Health Information Technology for Economic and Clinical Health Act (HITECH) within the larger American Recovery and Reinvestment Act of 2009 (ARRA) and (2) the Patient Protection and Affordable Care Act (PPACA), signed in 2010.

The HITECH Act provides billions of new dollars to clinicians and hospitals for the “meaningful use” of certified health information technology, as well as for comparative effectiveness research and privacy protections for medical records. Beginning in 2015, however, physicians and hospitals that do not use certified products in a meaningful way will be penalized. The Act also codified the Office of the National Coordinator for Health Information Technology, provides $2 billion for discretionary spending, and establishes a goal of “utilization of a certified electronic health record for each person in the United States by 2014.”

PPACA uses several mechanisms designed to drive improvements in medical care and stem rising health care costs by linking quality of care and payment. Both incentives and penalties are used in new payment and delivery models, value-based purchasing programs, mandated quality reporting. The act also establishes the Center for Medicare and Medicaid Innovation (CMI). In addition, PPACA provides for the eventual linkage of the CMS value-based purchasing program, Physician Quality Reporting Initiative (PQRI) to the CMS EHR incentive program for clinicians and hospitals for the meaningful use of electronic health records (EHRs).

ACEP is actively engaged in the multiple processes that brought these new laws about, and continues to look for new ways to advance the interests of emergency medicine as these programs evolve.

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