Health Information Technology:
"The purpose of medicine is to prevent significant disease, to decrease pain and to postpone death... Technology has to support these goals-if not, it may even be counterproductive."
—Dr. Joel J. Nobel
Health Information Technology (HIT) is a broad term that covers several different types of computerized systems, primarily:
- Computerized Physician Order Entry (CPOE)—A system that allows pharmacy orders, lab orders, etc., to be ordered at the point of care or off-site, provides error checking for duplicate or incorrect doses or tests, tracks inventory, and enables rapid posting of charges.
- Bar Code Medication Administration (BCMA)—Scanner technology designed to ensure medications are being given to the correct patient at the right dose at the right time by the right route.
- Electronic Medical Records (EMRs)—Computerized clinical records that include patient health information, demographics, progress notes, problems, medications, vital signs, past medical history, immunizations, laboratory data and radiology reports.
- Electronic Health Records (EHRs)—Although often used interchangeably, there is, in fact, a difference between EHRs and EMRs. An EMR is a record of health information on an individual that is created and managed by a single institution—for example, the hospital where the patient is being treated. The EHR is a record of all information related to the individual's health status from all institutions and/or providers who have treated him or her.
At the moment, the primary focus is on Electronic Medical Records. Although relatively few hospitals and physician practices use EMRs at present, the number is expected to grow exponentially by 2015 because of a provision in the "bailout bill" (the American Reinvestment and Recovery Act) that's meant to drive adoption. The law calls for both incentives and penalties to be used in an effort to spur rapid change.
From now until 2015, physician practices that adopt EMRs will be eligible for federal grants to help finance the change. Early adopters could receive as much as $44,000. Hospitals that switch to EMRs may receive a bonus of $2 million the first year, plus a bump in their Medicare payment rates that together could total $6.3 million. Additional increases in Medicare reimbursement would keep going until 2015.
These bonuses are not automatic, however. In order to receive them, hospitals and physician practices have to demonstrate that their systems meet federal criteria for "interoperability" and "meaningful use."
"Interoperability" has to do with technical specifications—standardization of formatting and the system's ability to exchange information among different providers.
"Meaningful use" is more complex. Hospitals and physician practices can't just install EMRs to improve billing or administrative efficiency. EMRs have to be used in a way that "improves quality, safety and efficiency of healthcare delivery, reduces healthcare disparities, engages patients and families, improves care coordination, improves population and public health, and ensures adequate privacy and security protections for personal health information." The Office of the National Coordinator of Health Information Technology has already defined some of the things hospitals must do to meet these standards. For examples, see:
In 2015, the incentives stop and the penalties begin. Both physician practices and hospitals that have not made the switch by 2015 will begin to receive smaller and smaller annual increases in their Medicare payment rates. They will continue to lose money until they make the transition.
For more details and to learn more about the Regional Extension Centers that are to provide training for the new systems, visit the Office of the National Coordinator of Health Information Technology website.
Health Information Technology has the potential to radically transform our healthcare system in positive ways by:
- greatly expanding the data available for research on treatments and procedures;
- enabling people to carry their medical histories with them wherever they go; and
- creating structures that facilitate better teamwork among providers.
Whether those goals are accomplished or not depends on whether frontline workers have a meaningful voice in design and implementation, whether improving patient care stays at the center of the process, and whether the workflow is well-designed. Computer technology doesn't fix broken systems. Technologies that are built on inefficient work designs for which workarounds have already been developed create permanent problems. In order for the systems to do what they're supposed to, the clinicians and others who use the system have to be involved in decisions at every step of the process. For ideas on how to ensure your system and your "go-live" are the best they can be, see the AFT's statement on best practices for the implementation of HIT and visit the other sections on this website.