Evolution of Health Information Technology in the Modern Era

History of Health Information Technology in the U.S. Evolution of Health IT: The Modern Era Lecture a The Environment This material (Comp 5 Unit 2) was developed by the University of Alabama at Birmingham, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number 90WT0007. This work is licensed under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. To view a copy of this license, visit http://creativecommons.org.

Evolution of Health IT: The Modern Era Learning Objectives Discuss factors that led to increasing clinical use of computers from 1990 to the present, including the HITECH Act of 2009. and the Affordable Care Act of 2010 Discuss key influences on health IT developments including the Internet, HIPAA, and the Institute of Medicine reports Discuss the focus of health IT in the late 90s up to the present Discuss the role of health IT in clinical and translational research and precision medicine Discuss why there is more receptivity to the use of health IT now than during the previous 50 years 2

Recap 1980s Efforts at cost containment Continued standardization of medical practice Informatics applications to support systematic, scientific practice Growing professionalism within informatics Children began using computers in school 3

General Environment in the Modern Era Consumer emphasis Source: (Association of American Physicians and Surgeons, Inc., 1995) 4

General Environment 1 Internet, World Wide Web 5

General Environment 2 Computer specialists Continued increase in computer use 6

General Environment 3 Computer vendors increase, but then consolidate Increasing technological change 7

General Environment 4 Graying of the Baby Boomers Source: (2010 Census Briefs) 8

Healthcare Environment 1 Efforts to contain costs Managed care 9

Healthcare Environment 2 Efforts to contain costs Capitation 10

Healthcare Environment 3 Physician supply Source: (Nicholson, 2009) 11

Healthcare Environment 4 Physician supply Early retirement of baby boomers Sources: (Staiger et al., 2010, Dorsey et al., 2005, Kletke et al., 1998) 12

Healthcare Environment 5 Physician supply More women physicians Source: (Dorsey et al., 2005) 13

Healthcare Environment 6 More equality of physician - patient relationships, PHRs Source: (Tang et al., 2006) (US Air Force photo/James Spellman Jr) 14

Healthcare Environment 7 Quality of care concerns Increase in clinical guidelines and protocols 15

Healthcare Environment 8 Graying of the baby boomers Increase in care for elderly, chronic conditions Telehealth home healthcare 16

Healthcare Environment 9 Continued competition for NIH funding Human Genome Project: 1990 to 2000 Sequencing of human genome Precision Medicine Bioinformatics Data Science and Big Data Source (National Institutes of Health) (Courtesy National Human Genome Institute) 17

Healthcare Environment 10 Clinical and translational science Speeding discoveries from bench to bedside, and then to the community More interest in accessing clinical data for research Strong emphasis on the role of informatics 18

Healthcare Environment 11 Increased interest in IT for quality of care and patient safety IOM Reports Leapfrog Group Increased scrutiny of physician practices (Courtesy: The Leapfrog Group) 19

Healthcare Environment 12 Increase in clinical computing Increased privacy concerns HIPAA: 1996 o Privacy Law implemented in 2003 20

Landmark Years for Health IT 2004 US President pushes for EHR for everyone by 2014 Office of the National Coordinator for Health IT Certification Commission for Healthcare Information Technology (CCHIT) Source: (Bush, 2004) 21

Landmark Years for Health IT 2 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act 2010 Patient Protection and Affordable Care Act 22

Evolution of Health IT: The Modern Era Summary Lecture a Rapid technological change Patient empowerment Continued pressure to decrease healthcare costs Growing concerns about quality of care General public using computers Growing, but slower, use of computers in healthcare 23

Evolution of Health IT: The Modern Era References Lecture a References Age and Sex Composition: 2010. 2010 Census Briefs. Available from: www.census.gov Association of American Physicians and Surgeons, Inc. Patients Bill of Rights. 1995. Available from: www.aapsonline.org Bush GW. State of the Union Address to Congress. 2004 Jan 20. Available from: frwebgate.access.gpo.gov Dorsey ER, Jarjoura D, Rutecki GW. The influence of controllable lifestyle and sex on the specialty choices of graduating U.S. medical students, 1996-2003. Acad Med. 2005 Sep;80(9):791-6. Kaiser Family Foundation, Summary of the Affordable Care Act, April 25, 2013. Downloaded on December 9, 2015 from: kff.org Kletke P, Escarce J, Polsky D, Wozniak GD. Trends in physician retirement. Abstr Book Assoc Health Serv Res Meet. 1998; 15:91. National Institutes of Health. (n.d.). Precision Medicine Initiative Cohort Program. Retrieved April 27, 2016, from Precision Medicine Initiative: www.nih.gov Nicholson S. Changes in health care financing and organization. Will the United States have a shortage of physicians in 10 Years? Academy Health. 2009 Nov. Available from: www.academyhealth.org 24

Evolution of Health IT: The Modern Era References 2 Lecture a References Staiger DO, Auerbach DI, Buerhaus PI. Trends in the work hours of physicians in the United States. Health Serv Res. 2010 Dec;45(6 Pt 1):1614-29. Tang PC, Ash JS, Bates DW, Overhage JM, Sands DZ. Personal health records: definitions, benefits, and strategies for overcoming barriers to adoption. J Am Med Inform Assoc. 2006 Mar- Apr;13(2):121-6. Images Slide 5, 9-13: Available from: Microsoft Clip Art Used with permission of Microsoft Slide 8: Mass Communication Specialist Seaman Brandon Myrick, Available from: commons.wikimedia.org US Navy Slide 14: Spellman, James Jr., Military Family Available from: www.af.mil US Airforce Slide 17: DNA double helix, www.genome.gov Source: National Human Genome Institute Slide 19: The Leapfrog Group, Logo of the Leapfrog Group, Used with permission from The Leapfrog Group 25

History of Health IT in the US Evolution of Health IT: The Modern Era Lecture a This material was developed by the University of Alabama at Birmingham, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number 90WT0007. 26