In enacting the Health Information Technology for Economic and Clinical Health (HITECH) Act, the Obama administration has devoted unparalleled resources to incentivize “the adoption and meaningful use of health information technology.” One important reason for this revolutionary legislation is the notion that information technology can improve health safety, quality, and efficiency. The vehicle of this transformation, electronic health record systems, promises a singular, standardized and universally accessible source of information, enabling data sharing across entities vested in patient care. Electronic health records facilitate abstraction of large quantities of information for research or quality improvement, modernize billing processes, and impact patient care by both reducing complications during hospitalization and lowering readmission rates. They also can serve important roles in the monitoring, measuring, and reporting of quality, safety, and efficiency. (1, 2, 3)
Despite these tangible benefits, perhaps the strongest support for the HITECH Act comes from the burgeoning health care information-exchange crisis. To state it bluntly, physicians simply communicate poorly. For example, many primary care physicians fail to receive crucial discharge information from their physician counterparts in the hospital. Patients thus frequently fail to understand medication changes or follow-up plans, lack insight as to when or whom to call for help, and do not have access to vital data after discharge as a result of poor information relay.(4) Even perilous (and preventable) events such as hospital readmissions or medical errors have been associated with a lack of/poor physician communication.(5) In ratifying HITECH, we pin our hopes on technology to streamline these deficits, promote transparency, and homogenize the quality of our documentation. Is this a sensible decision?
Paradoxically, technology may widen the chasm of health information exchange. For instance, almost all major electronic record systems restrict access to providers at a site or health system, insulating accredited caregivers while isolating outsiders. Every electronic health record also employs proprietary technology, alienating providers operating on different platforms despite their common connection to patients. Electronic systems remain provider-oriented and arguably exclude the most important stakeholder, the patient, from data-sharing. Finally, no uniform standard exists to ensure that all electronic health record systems—irrespective of vendor, hospital size, provider, or location—have the ability to share information with each other. In sum, we may stand precariously poised on the edge of an electronic catastrophe.
Is there a way to transform the noble intent of HITECH into a reality that avoids these pitfalls? One revolutionary approach is to take the focus off electronic health records and instead, consider shifting the responsibility of health care communication from providers to patients. The online networking giant, Facebook, provides a conceptual outline for precisely such a schema.
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— Vineet Chopra, MD, FACP, FHM, Laurence F. McMahon Jr., MD, MPH
This article originally appeared in the June 2011 issue of The American Journal of Medicine.
