Health Information Technology in the Era of Care Delivery Reform

Abstract

THE PROPER USE OF INFORMATION TECHNOLOGY IN health care remains widely debated. The notion that health information technology (HIT) can improve care is not new: since the 1960s, HIT has been examined as a tool to aid diagnosis and archive medical records. Half a century later, academics and policy makers continue to debate whether HIT tools such as electronic health records (EHRs) will save money or improve care. Advocates point to many studies demonstrating the benefits of EHRs. Critics argue that the best data come from a few leading institutions with locally developed systems, whereas data from commercial products in nonleading institutions are equivocal. This debate is anachronistic and misses the current issues facing the transition toward greater use of HIT. The urgency to focus on key issues in HIT adoption has increased since the passage of the Health Information Technology for Economic and Clinical Health (HITECH) Act, which provides nearly $30 billion in incentives for physicians and hospitals to adopt EHRs. The question is no longer whether information technology will be used in health care. It will be. The HITECH Act creates a mix of incentives and penalties that will induce a large proportion of physicians and hospitals to move toward EHR systems by the end of this decade. The discussion should now focus on whether HIT will support the models of care delivery that will help achieve broader policy goals: safer, more effective, and more efficient care. The inspiration for a better approach to HIT can best be described by the concept popularized by the Bauhaus school of architecture: “form ever follows function.” Applied to HIT, this suggests beginning with the “function” of integrated, efficient, team-oriented care and following with the “form,” or design of the IT. However, much of HIT today is designed to track billable episodes of care and focuses on maximizing revenue under fee-for-service payment systems. These EHR systems generally do not facilitate integrated, team-oriented, cost-conscious care. System Needs for HIT Applications That Can Drive Accountability