Over the past seven years, the United States has seen a historic health IT transformation, moving from a primarily paper-based health system to one where virtually everyone has a digital footprint of their care because of the dramatic uptake of electronic health records (EHRs). Recent data have helped quantify just how rapidly technology has transformed clinical settings. Today, nearly all hospitals (96 percent) and nearly eight in 10 (78 percent) physicians use certified EHRs. This transformation is the result of 2009’s Health Information Technology for Economic and Clinical Health (HITECH) Act, when fewer than one in 10 hospitals and 17 percent of physicians used EHRs. This rapid uptake of technology reflects the unyielding effort by clinicians and health systems across the board who helped usher in this new era of medicine. The result of this effort is a vast amount of electronic health data now exists which simply did not seven years ago.
This transformation represents more than simply digitizing paper health records. It also puts us at a global competitive advantage and is leading to real-world impacts in the clinical setting. Systematic reviews of academic literature found that 84 percent of studies showed that certified EHRs had a positive or mixed positive effect on quality, safety, and efficiency of care. Other recent studies found that EHRs can reduce adverse events among cardiovascular, surgery, and pneumonia patients and that switching EHRs did not result in adverse safety events.
These results reflect the vision we laid out in two key documents last year when we collaborated with more than 35 federal partners to develop the Federal Health IT Strategic Plan 2015-2020, and joined forces with the private sector to develop A Shared Nationwide Interoperability Roadmap, which outlines milestones, calls to action, and commitments that public and private stakeholders should focus on achieving, particularly in the near-term, to continue making progress.
Creating a Learning, Person-Centered Health System
These plans recognize that the adoption of health IT is just the first step in ensuring health data flows seamlessly and securely. That is why, in addition to the impressive adoption statistics, we are equally excited that in 2015 more than eight in 10 hospitals electronically exchanged laboratory results, radiology reports, clinical care summaries, or medication lists with ambulatory care providers or hospitals outside their organization — double the percentage from 2008. Looking at advanced measures of exchange, approximately nine out of 10 hospitals that electronically send, receive, find, and integrate information routinely had clinical information they needed from outside sources or providers available at the point of care, which is about double the national average.
These plans also reflect an important shift in focus from adoption and use of EHRs, to their role in improving patient experiences and health outcomes. This focus reflects a more comprehensive and integrated use of federal payment, procurement, and policy levers to make electronic health information easily accessible and usable across the care continuum.
To that end, we have also observed increases in user satisfaction with EHR systems. In 2013, a survey from Black Book Market Research found more than nine in ten multispecialty groups expressed displeasure with EHR products and developers. When this group conducted a follow-up survey in 2015, they found a dramatic reversal. Last year, 84 percent of providers reported that their EHR is meeting or exceeding their expectations. This is particularly important, as EHR usability has been linked with physician satisfaction. Moreover, seven in eight administrative staff believed that they have seen improvements in the operational or financial capabilities of their practice management and EHR software.
Accelerating Interoperability of Health Information
Of course, we know there is more work to do before we realize our vision for truly seamless and secure flow of electronic health information for all clinicians, hospitals, and individuals. The Office of the National Coordinator for Health Information Technology (ONC) and our public and private partners have accelerated interoperability efforts by focusing on three key drivers of success:
- The use of common, federally recognized, national standards;
- Changing the culture around access to information — including combating data blocking; and,
- Building the business case for interoperability.
To achieve these goals, the Administration is leveraging impactful tools: delivery system reforms that drive a business case for interoperability; new guidance on the Health Insurance Portability and Accountability Act (HIPAA) to make providers and individuals aware of patients’ rights to access and transmit their data; and requiring publishing application programming interfaces (APIs) to enhance the connectivity between EHRs and provider and consumer applications.
Collaboration with states and the private sector is vital to this work. We have been working diligently with stakeholders, who we invited to sign a pledge indicating their commitment to advancing toward an interoperable community of health. The pledge covered three key commitments: help consumers easily and securely access their electronic health information, direct it to any desired location, learn how their information can be shared and used, and be assured that this information will be effectively and safely used to benefit their health and that of their community; securely and appropriately share individuals’ health information whenever permitted by law and not knowingly or unreasonably block the flow of electronic health information; and adopt federally recognized, national interoperability standards, policies, guidance, and practices for electronic health information, including those related to privacy and security.
We received an overwhelming response from the community. Companies that provide electronic health records used by 90 percent of U.S. hospitals, health care systems with facilities in 47 states, and over two dozen professional associations and stakeholder groups have agreed to implement these three core commitments that will help ensure that health information flows.
It will take this type of collaborative effort by the public and private sector to ultimately realize a new era of health that serves individuals and clinicians in the ways we all have become accustomed to in other sectors: where information is seamlessly and securely available when and where it is needed most.