Health Information Technology: Problems and System Goals

Problems

Interoperability between health IT systems is limited

Current health IT is built on disparate, fragmented, and outdated existing information systems. Health IT vendors have developed idiosyncratic systems using proprietary formats, language, and code, rather than common standards or open-source models. Health care delivery systems have developed their IT systems to meet proprietary and local needs, not the larger values or goals of a woman- and family-centered maternity care system.

Data and health IT systems cannot be linked across time, settings, and providers

Even where health systems now have EHRs, those for maternity care lag behind other areas of health and are not designed to improve care coordination across locations and caregivers.

Recent efforts have been made to improve in-hospital coordination through EHRs in the intrapartum period, but they are not interoperable with external providers or integrated with other hospital clinical systems. Thus, documentation remains fragmented.

Most health care systems have also developed idiosyncratic identifiers for individual patients. The failure to widely disseminate and implement effective (and yet privacy protective) patient matching techniques is a significant barrier to interoperability and linkage across health IT systems, making it difficult to link patient information across provider entities and to develop population-based databases from multiple data sources. The failure to deploy effective patient matching techniques results in duplicative data collection across disease registries, and limits the capacity to understand and treat various conditions.

Content needed by various users is not yet available through health IT systems

Even as health IT systems become more widespread, they still may not provide information that key stakeholders need. Health care purchasers need performance and cost information about clinicians, facilities, and other health system components to be prudent purchasers of care for their employees or beneficiaries. Consumers need decision support tools and information on performance and value to select a clinician or care facility, evidence that health IT improves the quality of care they receive, and assurances that their privacy is protected.

Many priority performance measures, including those assessing crucial outcomes of care, cannot be systematically evaluated at present, owing to a lack of standardized data collection tools. Data elements that are critical to assess the performance of the health care system for populations at risk (including race, ethnicity, primary language, and socioeconomic indicators such as education and income, and environmental exposures) are also not routinely collected according to consistent standards in EHRs.

Implementing health IT is costly

Investments in IT systems to improve patient care over the long run may not be a financial priority for care systems or providers. Short-term business imperatives can derail multiyear projects, making it difficult to develop a large, sophisticated, and inter-connected IT system. Even with current federal subsidies to promote health IT adoption, it can be hard to make costly investments in an economic recession when benefits accrue over time and cannot be precisely estimated.

System Goals

  • Better systems for the management and exchange of health information are developed to improve the quality and value of maternity care.
  • Successful adoption and use of health IT increases as women and families better understand its role in improving the quality and value of maternity care and trust that their personal information is private and secure.
  • The development of health IT systems is coordinated with development of priority performance measures, and payment reform to align payment with the provision of quality maternity care.
  • Health care delivery systems play a central role in developing and using health IT.
  • To realize their full potential as tools for high-quality, high-value maternity care EHRs and other components of health IT achieve interoperability.

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