Determining the Success of the HITECH Act
After nearly seven years since the $35 billion HITECH Act was passed, some look at the slow pace of Meaningful Use, the relatively poor interoperability of EHR systems, and the physician workflow complaints and ask, “What has it actually accomplished?” A new study performed by Mathematica Policy Research and presented in The Milbank Quarterly seeks to answer that question and finds that it has successfully met at least some of its goals. According to the authors, HITECH drove widespread adoption of EHRs and helped create a large, competitive market for EHRs and health IT software, but its rushed implementation encouraged inefficiency, progress was slower than expected, and today, most providers still have a long way to go before their tech infrastructure can truly support significant care delivery reforms.
By any measure, the HITECH Act’s greatest success was the near-universal adoption of EHRs among hospitals and most provider groups in only a few years. Consistent with the Act’s intent, the billions in subsidies greatly expanded the market for EHRs, not only creating dozens of new vendors but also new jobs for people to install, maintain, and train personnel on new systems. Roughly 80 percent of all hospitals had successfully reached Meaningful Use Stage 1 by April 2013, a large figure given that only 17 percent of hospitals used an EHR in 2010. Today, 98 percent of hospitals and roughly 300,000 eligible professionals have successfully attested.
The HITECH Act also encouraged more hospitals to exchange health data, as shown in the chart below:
While the quick injection of billions in subsidies into the market made sense from an economic and political perspective, the large number of independent vendors and the relatively low requirements for achieving Meaningful Use Stage 1 created problems down the road. Some EHR systems were unable to accommodate the standards of Meaningful Use Stage 2, requiring providers to buy quickly developed add-ons or even install entirely new systems.
Interoperability between systems has also been an ongoing problem. Some of the early difficulties resulted from the abundance of vendors. As CMS pointed out in a 2012 post about forming the requirements for Stage 2, vendors had vastly different proprietary clinical codes and standards for data packing and organization. In addition, the study says that some vendors actively discouraged users from sharing information with competitors’ systems in order to protect their market position by making their products less compatible. As an example of the difficulty of data transfer, the average rate of successful transmission of summary of care records between organizations for Stage 2 hospitals in 2014 was only 36 percent, according to Definitive Healthcare data. Though hospitals only needed to meet or exceed 10 percent, the Stage 2 requirement was originally set at 50 percent, in which case roughly three quarters of the hospitals would have failed the measure. Various federal initiatives such as the Direct Project and health committees have established a growing set of industry standards and required functionality for EHRs, but the progress is slow and HHS’ Shared Nationwide Interoperability Roadmap proposes ongoing changes through 2024.
The study’s most critical finding is that current EHR and related health IT infrastructure is not suited for longer-term goals like payment reform and quality-driven healthcare delivery. Several health system officials interviewed in the study said that providers today are charged with both perfecting models of care and developing the health IT necessary to support them. As a result, many organizations do not fully utilize the quality and cost data in an effective way. Improvement in certain patient engagement measures has also been sluggish in part because of technological constraints or poor data utilization. Among physicians who have attested to Stage 2, only about a quarter were able to provide timely access to health information to more than half of their patients, according to Definitive Healthcare data. In addition, only 390 out of the roughly 1,800 hospitals meeting Stage 2 had more than 20 percent of their patients view information about hospitalization online.
To properly assess the HITECH Act, it’s important to remember the time when it was passed. As part of the American Recovery and Reinvestment Act, HITECH had to balance the goals of laying groundwork for universal adoption of health IT with spending money quickly to stimulate the economy. Given the scale of the task, it’s not surprising that the goal of a fully integrated, national health IT infrastructure with seamless data sharing has not yet been realized after seven years. Such a huge effort requires time, but HITECH appears to have been a good start.
Definitive Healthcare has the most up-to-date, comprehensive and integrated data on over 7,800 hospitals, 1.4 million physicians, and numerous other healthcare providers. It includes extensive information on Meaningful Use and other Medicare initiatives affecting hospitals and providers.