· Recovery and Reinvestment Act of 2009 (ARRA) was

·       Inyour opinion, what are the current problems in health IT?The first and most importantproblem facing health IT in US is low adoption rate of EHR among doctors andhospitals. The known current problems/challenges facing Health InformationTechnology (HIT) are usability, interoperability, and quality 1–3.

The usability defined as “the learnability, efficiency and satisfaction with whichusers achieve a specific set of tasks in a particular environment.” 3. The interoperability isdefined by HIMSS as “the ability of different informationtechnology systems and software applications to communicate, exchange data, anduse the information that has been exchanged.” 4.

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The goals of the significant governmentinvestments in health information technology (HIT), are reducing cost andimproving health outcomes through HIT. These goals can’t be achieved withoutmeaningful use of HER data, thus quality is an outcome of meaningful use ofdata.    ·       Whatis being done to address these issues?To address the low adoptionrates of health IT and usability, the stimulus bill — the American Recovery andReinvestment Act of 2009 (ARRA) was considered as a historic milestone inhealthcare legislation. ARRA is supported with unmatched $19 billion program tostimulate health information technology (HIT) and particularly electronichealth records (EHRs) adoption and use 2. The stimulus package known asHITECH- Health Information Technologyfor Economic and Clinical Health Act. HITECH is “a government act to enable coordination andalignment within and among states, establish connectivity to the public healthcommunity in case of emergencies, and assure the workforce is properly trainedand equipped to be meaningful users of EHRs” 5. The package involves financialincentives and penalties for the meaningful use of HIT.

 The interoperability issue wasaddressed by the establishment of the Office of the National Coordinator ofHealth Information Technology (ONCHIT) within the Department of Health andHuman Services (DHHS) with executive authority as a leadership structure toguide federal HIT policy2. The ONC is responsible forthe standards setting and certification of the EHR to ensure theinteroperability.  To address the qualityissues, HITECH Act of 2009 support a pathway to meaningful use of data with billionsof dollars3.   ·       Whatare barriers for the HIT adoption?Blumenthal has mentioned fourmain barriers to HIT adoption and use. The list of barriers includes the following: 1.

     their substantial cost,2.     the perceived lack of financialreturn from investing in them, 3.     the technical and logisticchallenges involved in installing, maintaining, and updating them, and 4.     consumers’ and physicians’concerns about the privacy and security of electronic health information2.

 ·       Whatis being done to promote the HIT adoption?Topromote the adoption of HIT in US the following has been done:o  Regulations – the American Recoveryand Reinvestment Act of 2009 (ARRA) and Health Information Technology forEconomic and Clinical Health Act (HITECH)2.o  Government leadership and Standards- the establishment of the Office of the National Coordinator of HealthInformation Technology (ONCHIT) to guide the federal policy and certify EHRsoftware. o  Strict timeline for the implementationof the government requirements – the ONC leadership and deadlines.  o  Financial incentives – the $17billion financial incentives for doctors and hospitals to adopt and use EHRs aspart of HITECH incentive program2.  o  Financial penalties – HITECH introducepenalties by 2015 for doctors and hospitals who don’t use HER meaningfully. Theywill lose Medicare and Medicaid fees progressively2.

   ·       Howto improve the interoperability? Interoperabilitywas negatively affected by the absent of standards when different vendorsdeveloping their own health information systems. I can’t agree more with Jana andAlberto in their conclusion that government deadlines and financial incentives contributesto the creation of data silos, thereby hindering the goal of high-levelinteroperability1. The current interoperability challengesare due to rapid development to meet the Meaningful Use stages requirements,and extensive development of EHR software by different vendors prior to themandate for integration among multiple systems1,4.  Thenational health infrastructure created Islands, and data silos not highways.

Meaningfuluse stage III must require sharing full clinical data in common format amongEHRs, EDWs and analytics systems3. Interoperability can be improved byhealthcare legislations affecting EHR development; potential financial impact (costreduction, incentives and penalties); and use of existing and new standards1.    ·       Isthere more that should be done?According to Riskin et althere are three policy changes that can address the current HIT challenges.

Forusability, the suggested policy change is to “Slow and reduce EHR and analyticsfunctionality requirements and increase usability requirements in MU3”. To improvethe inter-operability Riskin et al advice to “Shift to require sharingof full clinical data, not just patient summaries, in MU3”. While toenhance quality the group suggestion is to “Restore alignment of CQMs withcare guidelines rather than feasibility Institute meaningful accuracy requirementsin MU3” 3   ·       Whatare the limitations?Thereare mainly three limitations to realize the goals of HIT in USA:1.     The federal infrastructure tosupport the adoption and use of HIT was lagging behind the requirements. Becauseinnovative federal programs take long time to develop and implement and the DHHSand ONCHIT were working on strict schedule, thus meeting the plan deadlines waschallenging. 2.

     Many of certified EHRs are not user-friendlyand not designed to meet HITECH’s aspiring goals of improving quality of care andthe efficiency of the healthcare system. Although the ONCHIT outsourced thecertification of EHRs to a private organization, the Certification Commissionfor Health Information Technology, but it is basically depending on the federalgovernment’s skill in defining the two critical terms: “certified EHR” and”meaningful use.”3.

     The current payment system doesn’tmotivate providers to use HIT potential capabilities. There is a need to changethe overall payment incentives in the health care system, so providers -doctorsand hospitals- benefit from improving the quality and efficiency of theservices they provide rather than payment for service provision3.