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Progress report: Electronic health records and HIT in the United States


What an exciting time to be a healthcare provider in the United States. All types of providers, along with their patients, are realizing the power of health information technology (HIT) as a tool to assist each person’s journey toward better health and better care at lower cost. From where I sit in the Office of the National Coordinator for Health Information Technology, I’m encouraged every day by the leadership and clinical innovation occurring across the nation in this time of profound change—especially among nurses.

So let’s look at how we got to where we are today. Passage of landmark healthcare reform legislation, including the Health Information Technology for Economic and Clinical Health (HITECH) component of the American Recovery and Reinvestment Act in 2009 and the Affordable Care Act (ACA) in 2010, has changed the landscape of the U.S. healthcare industry forever. HITECH created the Electronic Health Record (EHR) Incentive Program, administered by the Centers for Medicare & Medicaid Services and the Office of the National Coordinator for Health Information Technology. The program provides fi¬nancial incentives to eligible professionals and hospitals that im-plement, adopt, and meaningfully use certified EHRs.

The program has worked. In 4 short years, EHR adoption has risen dramatically. As of July 2013, 60% of eligible professionals (312,072 of 521,600) and 81% of eligible hospitals (4,051 of 5,011) were participating in the voluntary program and had received a Medicaid or Medicare EHR incentive payment for either meeting the meaningful use criteria or fulfilling the requirements for adoption, implementation, or upgrade of a certified system.

The Obama Administration encouraged EHR adoption with the passage of HITECH in 2009, because EHRs are an integral element to drive healthcare quality and efficiency improvements and are foundational to the healthcare delivery and payment reform needed to transform the industry. Thus, EHRs are critical to the broader healthcare improvement efforts that are part of the ACA. These efforts—improving care coordination, reducing duplicative tests and procedures, focusing on high-quality outcomes, and rewarding providers for keeping patients healthier—are all made possible by widespread use of EHRs and data sharing among EHRs through health information exchange. EHRs manage health information in ways that are patient centered and give all providers the ability to better coordinate care, consistently deliver best practices, and reduce errors and readmissions that can cost more money and leave patients less healthy.

From silos to interconnectedness

During this transformation from disconnected, inefficient, paper-based “silos” of care delivery to an interconnected, interoperable data system driven by EHRs, the importance of nurses and nursing informatics has become increasingly evident. For decades, nurses have contributed proactively to the development, use, and evaluation of information systems. Today, they constitute the largest group of healthcare professionals working in HIT and are integrally involved in EHR selection, implementation, and optimization. Nurses serve on national committees and initiatives focused on HIT policy, terminology and standards development, health information exchange, and EHR adoption. In their frontline roles, they are having a profound impact on healthcare quality and costs, and are serving as leaders in the effective use of HIT to improve the safety, quality, and efficiency of healthcare services. Yes—it’s a remarkable time to be a nurse in the United States.

Judy Murphy is Deputy National Coordinator for Programs and Policy at the Office of the National Coordinator for Health Information Technology, U.S. Department of Health and Human Services.

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