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Nowadays, almost every hospital in the US possesses a certified electronic health records (EHR) system; in particular, in 2014, 97% of them reported to do so (Gold & McLaughlin, 2016, p. 664). Does it imply that the EHR adoption is universal or near universal? Unfortunately, not: the possession of an EHR system does not presuppose its meaningful use, and some of the reasons for the ongoing struggle to digitize healthcare might include some difficult-to-track policy issues, which are for us to examine and resolve.
In the US, the legislation that is related to the digitization of healthcare includes the Health Insurance Portability and Accountability Act (HIPAA) of 1996 and the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 (Solove, 2013, p. 23).
The two laws provide the much-needed regulations that are related to the digitization of healthcare; both are particularly concerned with EHRs and their meaningful use. The two Acts may be predominantly aimed at healthcare professionals, but they are of importance to every American because they are instrumental to the national health (Gold & McLaughlin, 2016).
The concept of the meaningful use was developed with the understanding of the fact that the adoption of EHRs is a complex process, which is likely to require several stages. The first one the possession of a certified EHR system has been almost universally achieved by the eligible hospitals. However, the advancement towards superior stages proved to be more difficult than expected.
For example, Gold and McLaughlin (2016) report that 94% of hospitals and 73% of professionals received their monetary incentives for achieving the first stage by 2014, but only 33% of hospitals and 17% of professionals reached the second stage by 2015 (pp. 661-663). The outcome is especially underwhelming because the HITECH Act intended the second stage to be achieved by 2013 (Gold & McLaughlin, 2016, p. 661). In other words, the current approach to the meaningful use proved to be helpful for the first stage of EHR adoption, but it appears to be less effective during the next stages.
Why? Some of the reasons that are cited by the modern critics include general issues like the r vagueness of the legislation and more specific ones like the lack of the accommodation of the Acts to local policies (Gold & McLaughlin, 2016), which are valid views. However, the most important issue appears to be the lack of research and formal means of assessing the progress of HITECH-HIPAA compliance and the factors that affect it (Butler, 2014; Gold & McLaughlin, 2016). In other words, we do not know enough about the practice HIPAA and HITECH implementation, and this fact undermines our assessment of other mentioned issues. We need to know more to be able to accurately assess the situation and make appropriate conclusions on the future revisions of the Acts.
HIPAA was the first federal law that attempted to regulate the area of digital health, which made its journey particularly challenging. For example, the first years of HIPAA enforcement were met with minimal and often insufficient fines and slow investigation processes. These issues were criticized and eventually addressed through the HITECH Act, which provided new enforcement mechanisms (Solove, 2013, pp. 25-26, 28).
The development of a legislative document is a continuous process (Butler, 2014; Solove, 2013), and HIPAA and HITECH need criticism and analysis to continue to improve. Nowadays, the use of technology in healthcare is inevitable. Given the fact that HIPAA and HITECH are the key policy instruments in the area, we need to pay greater attention to them and their analysis in the nearest future.
References
Butler, M. (2014). Top HITECH-HIPAA compliance obstacles emerge: Analyzing lessons learned from six months of Omnibus Privacy Rule implementation efforts. Journal of AHIMA, 85(4), 20-24.
Gold, M., & McLaughlin, C. (2016). Assessing HITECH implementation and lessons: 5 years later. The Milbank Quarterly, 94(3), 654-687.
Solove, D. J. (2013). HIPAA turns 10: Analyzing the past, present, and future impact. Journal of AHIMA, 84, 22-28.
The Washington Post. (n.d.). Submit an Op-Ed. Web.
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