With health care costs and quality assurance taking central roles in health reform, attention is being directed towards the potential of health information technology (HIT) to lower health care spending and to improve efficiency, quality and safety of medical care delivery. Although a host of private and public organizations have prioritized the expansion of HIT, the best models and implementation strategy are still being debated . This issue module focuses on major advances in health IT, some of the roles for technology in health care delivery, and how government legislation may support widespread transition to electronic medical systems.
Key Advances in Health IT
While there are many opportunities to expand the use of technology in the health care system, there has been concerted attention on the development of electronic records to allow consumers, health providers, and health systems to communicate electronically.
Personal Health Records (PHRs) allow individuals to collect, view, manage, or share their health information electronically. These include online resources like GoogleHealth that allow health consumers to manage their own records as well as those that are linked with other health information systems. Over 200 PHR products are available varying in regards to format, features, functionality and degree of integration with other health information systems.
Electronic Medical Records (EMRs) are an adapted version of the patient record in an electronic format primarily intended for health care providers and stored within a given institution or organization such as hospital or health delivery system. Unlike PHRs, which are owned and used by the patient, EMRs store health information (drug allergies, diagnoses, treatments, medical history) at the hospital or delivery organization level.
Electronic Health Records (EHRs) have a similar structure to EMRs, but can be shared cross-institutionally to link data from various providers. EHRs are generally more patient-focused than EMRs in that they allow interactive patient access, particularly when a PHR is “tethered” to the EHR.
Implementation and Costs
To date, it is estimated that only 20% of doctors and 10% of hospitals currently use EHRs. HIT proponents argue that the development and adoption of health records that can be uploaded in an “interoperable” universal format will reduce fragmentation of care and administration delays by enhancing communication, coordination, efficiency and decision support in health care settings. EMRs and EHRs are said to be “interoperable” if they can both exchange and receive data, and if the coding of the health records is in a standard format that is recognizable across systems.
A lack of a uniform appropriate EHR has become a significant barrier to widespread use. With many EHRs competing on the market, providers and health care organizations purchase different products, limiting the ability to share data across systems. The costs associated with initial implementation of electronic health systems are formidable for providers. In addition to purchasing a system, there are costs associated with training personnel to navigate, maintain and upgrade the new systems. Not surprisingly, certain kinds of hospitals, such as those in urban areas, teaching hospitals, and more profitable hospitals, use more health IT than smaller, less financially stable hospitals.
Privacy has also emerged as a top concern regarding a range of health IT advances. Concerns about insufficient data security and the possibility of inappropriate access to medical records have been debated. The Health Insurance Portability and Accountability Act (HIPAA) of 1996 established regulations for the use and disclosure of information about health status, provision of health care, and payment for health care that can be linked to an individual.
Proponents claim that widespread use may improve reporting of diseases, monitoring outbreaks and hospital-acquired infections, and tracking adverse effects of drug therapies. However, a number of studies found that implementation of EHRs in healthcare settings did not necessarily improve quality and may increase medical errors during the phase of implementation.   More research will be necessary to study how the transition and implementation of EHRs affect quality of care.
Despite the difficulties of implementation, proponents of health IT cite the potential of drawing significant long-term savings to the health care system with widespread adoption of electronic systems. One estimate projects that universal transition to EHRs can lead to a potential efficiency savings averaging more than $77 billion per year. These include reduction of costs associated with medication errors, communication and documentation of clinical care test results, staffing and paper storage.
In April 2004, President Bush set a broad goal to expand the reach of health IT over ten years, and established the Office of the National Coordinator for Health Information Technology in the U.S. Department of Health and Human Services. In February 2009, President Obama signed the Health Information Technology for Economic and Clinical Health (HITECH) Act, a component of the American Recovery and Reinvestment Act of 2009, which has become the guiding framework for expansion of HIT in the US. The legislation includes multiple components aimed at encouraging and supporting providers in the adoption of HIT, namely authorizing $19.2 billion for enhanced Medicaid and Medicare payments to providers who adopt “meaningful use” of HIT into their practices between 2011 and 2015, while helping to establish what “meaningful use” should be. The Congressional Budget Office projects the incentives will result in the adoption of comprehensive EHRs by 90% of physicians and 70% of hospitals by 2019.
Guidelines call for gradual implementation of EHRs, to evaluate standards and use of the technology. The term “meaningful use” refers to the standards that EHRs must meet, including electronic recording of basic demographic data, use of electronic prescriptions and tracking of medication, lab test coordination, patient reminders, and electronic communication between providers. A number of hospitals and medical facilities have been identified to adopt EHRs over the next few years, with evaluations in place to study the impact and cost-effectiveness. To help with the cost of maintaining the new technology, HITECH established Regional Extension Centers that providers can turn to for advice in choosing and troubleshooting of EHRs. The Act also provides funds to states to develop their technologic capabilities, particularly to improve collection and sharing of Medicaid and public health data. There will also be fines issued under Medicare for physicians and hospitals not yet converted to EHRs by 2015.
The March 2010 Patient Protection and Affordable Care Act (ACA) signed by President Obama also included requirements that the federal and state governments establish new electronic systems for enrolling individuals who will purchase insurance in insurance-based exchanges starting in 2014. They emphasize transparency of the online process, guidance to making informed decisions, accommodations for a range of users, privacy and security, and inclusion of private and public insurance options.
In the years ahead, many will be watching how providers and states use funds to develop their HIT infrastructures and assess their impact on quality of care and health system costs.
Acknowledgements: This issue module was prepared by Esme Cullen, Usha Ranji, and Alina Salganicoff of the Kaiser Family Foundation.
Updated: February 2011
 Jha AK.. “A progress report on electronic health records in US hospitals, Health Affairs 2010.
 Buntin, M. 2010. Health IT: Laying the Infrastructure for National Health Reform. Health Affairs, 29;6:1214-1216.
 Chaudhry B, Wang J, et al. “Systematic Review: Impact of Health Information Technology on Quality, Efficiency, and Costs of Medical Care” Annals of Internal Medicine, 2006;144:742-752.
 American Hospital Association. 2007. Continued Progress: Hospital Use of Information Technology.
 National Quality Forum.“Privacy: From Barrier to Enabler of Health Information Technology” Issue Brief, 2010
 Centers for Medicare & Medicaid, HIPAA Overview, December 14, 2005.
 McCullough J, 2010.“The Effect of Health Information Technology on Quality in US Hospitals.”Health Affairs, 29 (4):647-654.
 Lindlar, J. “Electronic Health Record Use and the Quality of Ambulatory Care in the US” Arch Intern Med. 2007;167(13):1400-1405
 Hartzbard P “Off the record—avoiding the pitfalls of going electronic” New England Journal of Medicine 2008;258:1656-16598.
 Hillestad, R., J. Bigelow, A. Bower, et al. Oct 2005. Can Electronic Medical Record Systems Transform Health Care? Potential Health Benefits, Savings, and Costs. Health Affairs 24(5):1103–1117.
 Blumenthal, D. February 2010. Launching HITECH. New England Journal of Medicine 362(5):382-385.
 Steinbrook, R. March 2009. Health Care and the American Recovery and Reinvestment Act. New England Journal of Medicine 360(11):1057-1060
 Blumenthal, D. et al “The “Meaningful Use” Regulation for Electronic Health Records” New England Journal of Medicine, 2010;363:501-504.
 Pear, Robert. “Standards issued for Electronic Health Records” New York Times, July 2010.