Electronic Health Record Legal Settlements in the US Since the 2009 Health Information Technology for Economic and Clinical Health Act.

This cross-sectional study describes allegations of misconduct by electronic health record vendors.

HITECH to 21st century cures: clinician burden and evolving health IT policy.

Adoption and use of health information technology (IT) was identified as 1 solution to quality and safety issues that permeate the United States health care system. Implementation of health IT has accelerated across the US over the past decade, in part, as a result of legislative and regulatory requirements and incentives. However, adoption of these systems has burdened clinician users due to design, configuration, and implementation issues, resulting in poor usability, challenges to workflow integration, and cumbersome documentation requirements. The path to alleviating these clinician burdens requires a clear understanding of the intent and evolution of pertinent regulations and the context in which they exist. This article reviews the Office of the National Coordinator of Health Information Technology's efforts, documents current regulatory actions, and discusses additional policy opportunities that can further improve clinician satisfaction and effectiveness in providing health care with health IT that is an asset, not an obstacle.

The effectiveness of electronic health record promotion for healthcare providers in the United States since the Health Information Technology for Economic and Clinical Health Act: An empirical investigation.

The US Government has embarked on the largest initiative to date to encourage widespread use of electronic health records (EHRs). Up to now, it is not yet clear that what the actual effectiveness of EHR promotion is like since the Health Information Technology for Economic and Clinical Health (HITECH) Act. As a response, this study analyzes the EHR conversion at the primary stage (sign-up EHR→go-live EHR) and the advanced stage (go-live EHR→meaningful use of EHR) for different types of healthcare providers in the United States. With the data from the Office of National Coordinator for Health Information Technology-Regional Extension Centers Program, this study finds that healthcare providers have achieved progress in the EHR conversion at both the primary and advanced stage. However, the levels of progress made at different stages of EHR conversion vary for different providers. For rural and underserved healthcare settings, the progress made at the advanced stage is smaller than that at the primary stage, contrary to the case for other kinds of providers. Moreover, although the greater progress has been made at the advanced stage for some kinds of providers, the overall level of EHR conversion for various healthcare providers is far greater at the primary stage than at the advanced stage.

Optimizing health IT to improve health system performance: A work in progress.

BACKGROUND: Despite significant investments in health information technology (IT), the technology has not yielded the intended performance effects or transformational change. We describe activities that health systems are pursuing to better leverage health IT to improve performance. METHODS: We conducted semi-structured telephone interviews with C-suite executives from 24 U.S. health systems in four states during 2017-2019 and analyzed the data using a qualitative thematic approach. RESULTS: Health systems reported two broad categories of activities: laying the foundation to improve performance with IT and using IT to improve performance. Within these categories, health systems were engaged in similar activities but varied greatly in their progress. The most substantial effort was devoted to the first category, which enabled rather than directly improved performance, and included consolidating to a single electronic health record (EHR) platform and common data across the health system, standardizing data elements, and standardizing care processes before using the EHR to implement them. Only after accomplishing such foundational activities were health systems able to focus on using the technology to improve performance through activities such as using data and analytics to monitor and provide feedback, improving uptake of evidence-based medicine, addressing variation and overuse, improving system-wide prevention and population health management, and making care more convenient. CONCLUSIONS AND IMPLICATIONS: Leveraging IT to improve performance requires significant and sustained effort by health systems, in addition to significant investments in hardware and software. To accelerate change, better mechanisms for creating and disseminating best practices and providing advanced technical assistance are needed.

Reconsidering hospital EHR adoption at the dawn of HITECH: implications of the reported 9% adoption of a "basic" EHR.

OBJECTIVE: In 2009, a prominent national report stated that 9% of US hospitals had adopted a "basic" electronic health record (EHR) system. This statistic was widely cited and became a memetic anchor point for EHR adoption at the dawn of HITECH. However, its calculation relies on specific treatment of the data; alternative approaches may have led to a different sense of US hospitals' EHR adoption and different subsequent public policy. MATERIALS AND METHODS: We reanalyzed the 2008 American Heart Association Information Technology supplement and complementary sources to produce a range of estimates of EHR adoption. Estimates included the mean and median number of EHR functionalities adopted, figures derived from an item response theory-based approach, and alternative estimates from the published literature. We then plotted an alternative definition of national progress toward hospital EHR adoption from 2008 to 2018. RESULTS: By 2008, 73% of hospitals had begun the transition to an EHR, and the majority of hospitals had adopted at least 6 of the 10 functionalities of a basic system. In the aggregate, national progress toward basic EHR adoption was 58% complete, and, when accounting for measurement error, we estimate that 30% of hospitals may have adopted a basic EHR. DISCUSSION: The approach used to develop the 9% figure resulted in an estimate at the extreme lower bound of what could be derived from the available data and likely did not reflect hospitals' overall progress in EHR adoption. CONCLUSION: The memetic 9% figure shaped nationwide thinking and policy making about EHR adoption; alternative representations of the data may have led to different policy.

Integrating Rules for Genomic Research, Clinical Care, Public Health Screening and DTC Testing: Creating Translational Law for Translational Genomics.

Human genomics is a translational field spanning research, clinical care, public health, and direct-to-consumer testing. However, law differs across these domains on issues including liability, consent, promoting quality of analysis and interpretation, and safeguarding privacy. Genomic activities crossing domains can thus encounter confusion and conflicts among these approaches. This paper suggests how to resolve these conflicts while protecting the rights and interests of individuals sequenced. Translational genomics requires this more translational approach to law.

Association of the Meaningful Use Electronic Health Record Incentive Program With Health Information Technology Venture Capital Funding.

Importance: Although the Health Information Technology for Economic and Clinical Health (HITECH) Act has accelerated electronic health record (EHR) adoption since its passage, clinician satisfaction with EHRs remains low, and the association of HITECH with health care information technology (IT) entrepreneurship has remained largely unstudied. Objective: To determine whether the passage of the HITECH Act was associated with an increase in key measures of health care IT entrepreneurship. Design, Setting, and Participants: This economic evaluation of venture capital (VC) activity in the US from 2000 to 2019 examined funding trends in health care IT, EHR-related companies, and all VC investments before and after the passage of HITECH. A difference-in-differences analysis compared investments in health care IT companies with those of companies in 3 categories: general health care (non-IT), IT (non-health care), and all US VC transactions. Data were analyzed from September 2018 to August 2019. Exposures: Venture capital funding received by US companies before and after the HITECH Act. Main Outcomes and Measures: Venture capital investment in health care IT companies and the proportion of those investments going to seed-stage companies, a proxy for very early-stage entrepreneurship and innovation. Results: The data included 70 982 investments, of which 9425 (13.3%) were seed stage, 10 706 (15.1%) were early stage, and 50 851 (71.6%) were growth stage. After passage of the HITECH Act, investment in both health care IT companies and EHR-related companies increased at a rate much faster (13.0% and 11.4%, respectively) than VC as a whole (6.9%). In addition, the proportion of investments going to seed-stage health care IT companies increased compared with both overall VC investments and non-IT health care investments. Health care IT companies saw increased probabilities of transactions being seed-stage of 5.1% (SE, 2.2%; 95% CI, 0.8% to 9.3%; P = .02) compared with the entire sample of VC transactions and 13.6% (SE, 1.9%; 95% CI, 9.9% to 17.2%; P < .001) compared with non-IT health care VC transactions. Health care IT had essentially 0 increased probability of a transaction being seed stage compared with IT companies outside health care (-0.8% probability; SE, 2.4%; 95% CI, -5.4% to 3.9%; P = .75). Conclusions and Relevance: Although widespread clinician dissatisfaction with EHR systems remains a challenge, the HITECH Act's incentive program may have catalyzed early-stage entrepreneurship in health care IT, suggesting an important role for incentives in promoting innovation.

The health IT special issue: enduring barriers to adoption and innovative predictive methods.

Electronic health record systems have the potential to significantly improve care coordination and, ultimately, clinical care delivery. Still, it is clear that these systems are not silver bullets that will automatically result in better coordination of care and quality.

Supplemental Nutrition Assistance Program Participation Improves Children's Health Care Use: An Analysis of the American Recovery and Reinvestment Act's Natural Experiment.

OBJECTIVE: To examine the impact of increased Supplemental Nutrition Assistance Program (SNAP) benefit levels as provided by the American Recovery and Reinvestment Act (ARRA) beginning in April 2009 on the health care use and health care needs of participating children. METHODS: Difference-in-differences analysis compared changes in health care use and needs between children in SNAP-eligible households and those in low-income but SNAP-ineligible households before and after ARRA's implementation, using data from the nationally representative National Health Interview Survey (NHIS). Survey respondents reported on children's health care use and outstanding health care needs. Our sample included approximately 38,500 children in low-income households who completed the core NHIS, and a subsample of 15,000 sample children who reported additional information. RESULTS: Approximately 6% of low-income children had delayed care due to cost. Three percent and 4% of children in low-income households and low-income single-parent households, respectively, reported needing health care but not being able to afford it. The increase in SNAP benefits was associated with a 65% reduction in outstanding medication needs due to affordability among SNAP-eligible children, relative to low-income, ineligible children. There was also a reduction in the likelihood that children had seen a general doctor in the last year. Among children in single-parent households, SNAP benefit expansion was associated with a 3.2 percentage point decrease in needing but not being able to afford health care. CONCLUSIONS: Findings suggest that even a small increase in household resources leads to reductions in outstanding health care needs due to affordability, particularly among children.

Impact of the American Tax Payer Relief Act on stereotactic radiosurgery utilization in the United States.

INTRODUCTION: Single-fraction stereotactic radiosurgery (SRS) is delivered predominantly via two modalities: Gamma Knife, and linear accelerator (LINAC). Implementation of the American Tax Payer Relief Act (ATRA) in 2013 represented the first time limitations specifically targeting SRS reimbursement were introduced into federal law. The subsequent impact of the ATRA on SRS utilization in the United States (US) has yet to be examined. METHODS: The National Cancer Database from 2010-2016 identified brain metastases patients from non-small cell lung cancer throughout the US having undergone SRS. Utilization between GKRS and LINAC was assessed before (2010-2012), during (2013-2014) and after (2015-2016) ATRA implementation. RESULTS: In 2013, there was a substantial decrease of LINAC SRS in favor of GKRS in non-academic centers. Over the 3-year span immediately preceding ATRA implementation, 39% of all eligible SRS cases received LINAC. There was a modest decrease in LINAC utilization over the 2 years immediately following ATRA implementation (35%), followed by an increase over the next two years (40%). SRS modality showed differences over the three time periods (unadjusted, p = 0.043), primarily in non-academic centers (unadjusted, p = 0.003). CONCLUSIONS: ATRA implementation in 2013 caused an initial spike in Gamma Knife SRS utilization, followed by a decline to rates similar to the years before implementation. These findings indicate that the ATRA provision mandating Medicare reduction of outpatient payment rates for Gamma Knife to be equivalent with those of LINAC SRS had a significant short-term impact on the radiosurgical treatment of metastatic brain disease throughout the US, serving as a reminder of the importance/impact of public policy on treatment modality utilization by physicians and hospitals.

Food insecurity and dietary intake by Supplemental Nutrition Assistance Program participation status among mainland US Puerto Rican adults after the 2009 American Recovery and Reinvestment Act.

OBJECTIVE: The 2009 American Recovery and Reinvestment Act (ARRA) increased monthly Supplemental Nutrition Assistance Program (SNAP) benefits and expanded SNAP eligibility, yet limited evidence exists on the potential impact of ARRA on dietary intake among at-risk individuals. We aimed to examine pre-/post-ARRA differences in food insecurity (FI) and dietary intake by SNAP participation status. DESIGN: Pre/post analysis. SETTING: Boston, MA, USA. PARTICIPANTS: Data were from the longitudinal Boston Puerto Rican Health Study (2007-2015). The US Department of Agriculture ten-item adult module assessed FI. A validated FFQ assessed dietary intake. Diet quality was assessed using the Alternate Healthy Eating Index-2010 (AHEI-2010). Self-reported pre-/post-ARRA household SNAP participation responses were categorized as: sustained (n 249), new (n 95) or discontinued (n 58). We estimated differences in odds of FI and in mean nutrient intakes and AHEI-2010 scores post-ARRA. RESULTS: Compared with pre-ARRA, OR (95 % CI) of FI post-ARRA were lower for all participants (0·69 (0·51, 0·94)), and within sustained (0·63 (0·43, 0·92)) but not within new (0·94 (0·49, 1·80)) or discontinued (0·63 (0·25, 1·56)) participants. Post-ARRA, total carbohydrate intake was higher, and alcohol intake was lower, for sustained and new participants, and dietary fibre was higher for sustained participants, compared with discontinued participants. Scores for AHEI-2010 and its components did not differ post-ARRA, except for lower alcohol intake for sustained v. discontinued participants. CONCLUSIONS: Post-ARRA, FI decreased for sustained participants and some nutrient intakes were healthier for sustained and new participants. Continuing and expanding SNAP benefits and eligibility likely protects against FI and may improve dietary intake.

Updating HIPAA for the electronic medical record era.

With advances in technology, patients increasingly expect to access their health information on their phones and computers seamlessly, whenever needed, to meet their clinical needs. The 1996 passage of the Health Insurance Portability and Accountability Act (HIPAA), modifications made by the Health Information Technology for Economic and Clinical Health Act (HITECH), and the recent 21st Century Cures Act (Cures) promise to make patients' health information available to them without special effort and at no cost. However, inconsistencies among these policies' definitions of what is included in "health information", widespread variation in electronic health record system capabilities, and differences in local health system policies around health data release have created a confusing landscape for patients, health care providers, and third parties who reuse health information. In this article, we present relevant regulatory history, describe challenges to health data portability and fluidity, and present the authors' policy recommendations for lawmakers to consider so that the vision of HIPAA, HITECH, and Cures may be fulfilled.

Introduction: selected extended articles from the 2nd International Workshop on Semantics-Powered Data Analytics (SEPDA 2017).

In this editorial, we first summarize the 2nd International Workshop on Semantics-Powered Data Analytics (SEPDA 2017) held on November 13, 2017 in Kansas City, Missouri, U.S.A., and then briefly introduce 13 research articles included in this supplement issue, covering topics such as Semantic Integration, Deep Learning, Knowledge Base Construction, and Natural Language Processing.

Public Policy and Health Informatics.

OBJECTIVES: To provide an overview of the history of electronic health policy and identify significant laws that influence health informatics. DATA SOURCES: US Department of Health and Human Services. CONCLUSION: The development of health information technology has influenced the process for delivering health care. Public policy and regulations are an important part of health informatics and establish the structure of electronic health systems. Regulatory bodies of the government initiate policies to ease the execution of electronic health record implementation. These same bureaucratic entities regulate the system to protect the rights of the patients and providers. IMPLICATIONS FOR NURSING PRACTICE: Nurses should have an overall understanding of the system behind health informatics and be able to advocate for change. Nurses can utilize this information to optimize the use of health informatics and campaign for safe, effective, and efficient health information technology.

The Hyperbaric Oxygen Therapy Registry: Driving quality and demonstrating compliance.

OBJECTIVE: To provide an update on the status of provider participation in the US Wound Registry (USWR) and its specialty registry the Hyperbaric Oxygen Therapy Registry (HBOTR), which provide much-needed national benchmarking and quality measurement services for hyperbaric medicine. METHODS: Providers can meet many requirements of the Merit-Based Incentive Payment System (MIPS) and simultaneously participate in the HBOTR by transmitting Continuity of Care Documents (CCDs) directly from their certified electronic health record (EHR) or by reporting hyperbaric quality measures, the specifications for which are available free of charge for download from the registry website as electronic clinical quality measures for installation into any certified EHR. Computerized systems parse the structured data transmitted to the USWR. Patients undergoing hyperbaric oxygen (HBO2) therapy are allocated to the HBOTR and stored in that specialty registry database. The data can be queried for benchmarking, quality reporting, public policy, or specialized data projects. RESULTS: Since January 2012, 917,758 clinic visits have captured the data of 199,158 patients in the USWR, 3,697 of whom underwent HBO2 therapy. Among 27,404 patients with 62,843 diabetic foot ulcers (DFUs) captured, 9,908 DFUs (15.7%) were treated with HBO2 therapy. Between January 2016 and September 2018, the benchmark rate for the 1,000 DFUs treated with HBO2 was 7.3%, with an average of 28 treatments per patient. There are 2,100 providers who report data to the USWR by transmitting CCDs from their EHR and 688 who submit quality measure data, 300 (43.6%) of whom transmit HBO2 quality data.