Health information technology (HIT) has been seen as a vehicle for improving the quality and safety of health care, for gaining more accountability and value in purchasing, for advancing the role and engagement of consumers in prevention and health decisions, for accelerating discovery and dissemination of new treatments, and for sharpening public-health monitoring and surveillance. HIT has had high priority in the health care system under two presidential administrations, and it continues to enjoy strong bipartisan support at the state and federal levels.
When the federal HIT effort was launched in 2004 (The White House, 2004), four overriding national priorities were articulated: providing information tools, such as electronic health records (EHRs), to clinicians for use in patient care; connecting health information so that it follows patients throughout care and can be aggregated to advance health care delivery; supporting consumers with information to help them to manage their care; and advancing public health, clinical trials, and other data-intensive activities. The 2004 HIT plan has been updated three times (in 2009, 2011, and 2015), but the core priorities remain similar.
The first national goal for HIT has been largely realized. Nearly all hospitals use EHRs to manage patient care, as do growing numbers of physician practices, ancillary care facilities, and other sites of care. There is widespread recognition that it is infeasible to operate a complex health care business today without having EHRs and other point-of-care information tools available for clinicians.
The other three goals of the HIT plan have not been realized. Efforts to aggregate and share information for specific patients longitudinally among providers have been aggressively pursued with some success but have been hindered by financial conflicts, proprietary barriers, legacy technology, obsolete regulations, and other challenges. Personalized consumer health information, although enjoying some advances in the form of portals and other online access tools, has not become widely used by consumers for a variety of reasons, including a lack of functionality and interoperability. Likewise, data-intensive sectors of health care— such as clinical trials, public-health surveillance, and quality measurement—have not transformed their methods and rules to take advantage of the ubiquity of electronic health information.