National Academy of Medicine
Discussion Paper

Information Technology Interoperability and Use for Better Care and Evidence: A Vital Direction for Health and Health Care

By Jonathan B. Perlin, Dixie B. Baker, David J. Brailer, Douglas B. Fridsma, Mark E. Frisse, John D. Halamka, Jeffrey Levi, Kenneth D. Mandl, Janet M. Marchibroda, Richard Platt, and Paul C. Tang
September 19, 2016
About the Vital Directions for Health and Health Care Series

Vital DirectionsThis publication is part of the National Academy of Medicine’s Vital Directions for Health and Health Care Initiative, which called on more than 100 leading researchers, scientists, and policy makers from across the United States to provide expert guidance in 19 priority focus areas for U.S. health policy. The views presented in this publication and others in the series are those of the authors and do not represent formal consensus positions of the NAM, the National Academies of Sciences, Engineering, and Medicine, or the authors’ organizations.
Learn more: nam.edu/VitalDirections

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 site sof 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. Read more >>

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Note

Disclaimer: The views expressed in this Perspective are those of the authors and not necessarily of the authors’ organizations, the National Academy of Medicine (NAM), or the National Academies of Sciences, Engineering, and Medicine (the National Academies). The Perspective is intended to help inform and stimulate discussion. It has not been subjected to the review procedures of, nor is it a report of, the NAM or the National Academies. Copyright by the National Academy of Sciences. All rights reserved.