The drive toward health information technology: Where are we heading?
by Government Relations Staff
July 17, 2008 — With rapid development toward a nationwide health information network, practicing psychologists are concerned about privacy rights and professional obligations. The APA Practice Organization has developed this basic article on health information technology (HIT) with a focus on the federal government's role in driving the evolution toward widespread application of HIT.
What is HIT?
Health Information Technology (HIT) involves moving the current, mainly paper-based health records, system to an electronic national health records system. HIT is intended to allow for comprehensive management of health information and its secure exchange between patients, health professionals and other entities that use health records through one nationwide interoperable system.
HIT is intended to improve health care quality, prevent medical errors and reduce costs through decreased paperwork and increased administrative efficiency. HIT should help patients maintain their records and share them securely with their health care providers. For health professionals, records will be immediately accessible in a standard, electronic format for clinical decision making and for payment purposes. Public benefits include early detection of disease outbreaks, improved chronic disease management and evaluation of the quality of care through data from the record that does not identify the patient.
A major concern associated with HIT development is that health records in a centralized system could be more susceptible to intentional or negligent disclosure on a large scale, causing a loss of privacy and other related problems for many individuals at once.
HIT development in the health system
Health care systems, insurers and other entities have been working toward a standardized, national electronic health records system for some time, more recently through private-public partnerships. Certain distinct and insular health systems, such as the Veterans Affairs health care system, already have universal electronic health records in place.
Many believe that the administrative, quality-of-care and other efficiencies associated with HIT will result in substantially lower health care costs across the system and allow for coordinated care among a patient's health providers. However, implementing HIT appears to be expensive, particularly for larger entities such as hospitals and insurers. There may also be cost concerns for solo and small-group practitioners. Government incentives are being recommended to offset the cost of implementation, including for health care professionals in individual and small practices.
HIPAA versus HIT
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) was the first major federal initiative to encourage an electronic national records system. Through HIPAA, Congress authorized the Department of Health and Human Services to write rules regarding standards for the electronic exchange of health information. The two most significant rules concerned the privacy (generally effective April 2001) and security of health information.
Compared to HIT, which envisions a national electronic health information network concerning all aspects of patient records, HIPAA is limited in scope. HIPAA involves only the electronic exchange of health information and applies only to health plans, providers and health care clearinghouses. Future HIT legislation will have to address other entities that are involved in the national records system.
Federal government involvement since HIPAA
President George W. Bush issued an executive order on April 27, 2004 to provide federal leadership for the development and national implementation of an interoperable HIT infrastructure by 2014. The President established the Office of the National Coordinator for Health Information Technology (ONC) to achieve this end. ONC helps manage and support the American Health Information Community (AHIC), a federally-chartered advisory committee that makes recommendations to HHS on how to make records interoperable (will work with other systems without reprogramming), encourage private health system HIT adoption and ensure the privacy and security of the records.
AHIC initially created four "breakthrough" groups (a breakthrough being a use of HIT that is of a tangible and specific value to the patient and can be realized in a two to three year period) to promote HIT. These groups concerned: consumer empowerment, chronic care, bio-surveillance and electronic health records. A Confidentiality Privacy & Security group was added in May 2006.
What is ONC doing now to promote HIT?
ONC efforts are ongoing in four areas:
HIT certification. Health care professionals are unlikely to adopt an HIT system into their practice unless it is functional, secure and interoperable. A certification process is being developed so that health care providers can make purchase decisions knowing that their adoption of HIT meets these criteria.
Promotion of well-defined interoperability standards. This means harmonizing different information standards and systems, networks, and software applications so they "speak the same language" and work together in one national network. A public-private stakeholder panel is currently developing these standards.
Privacy and security. State and federal activities are underway. State-level activities have centered on bringing states together to discuss privacy and security challenges and to identify business practice and state law variations that affect information exchange. Federal activities include the work of the AHIC privacy and security workgroup, and an ONC contract to the Research Triangle Institute International to work with the Agency for Healthcare Research and Quality (AHRQ) to address privacy and quality issues within the HIT interoperability framework.
Development of an NHIN prototype. IBM is leading a project to create models for a NHIN as a prototype for eventual adoption of an NHIN nationwide. An NHIN is a secure, nationwide, interoperable infrastructure that will connect providers, patients and others in the healthcare system. Information will follow the patient, be available for clinical decisions, and support appropriate use of records beyond the patient and provider.
Current Congressional action
Legislative efforts reflect a reaction to current private market activities related to HIT and Administration efforts rather than innovations for HIT formation. Leading bills would establish congressional recognition of and funding for ONC and AHIC, provide for public-private partnerships to offer input into the development of a nationwide HIT infrastructure and provide for grants to encourage use of HIT technologies in the health care system.