Health information technology (IT) in the U.S has grown at an astonishing pace. From paper records to the cloud-based systems we now have—health IT has become more accessible and practical for a larger amount of people. To know where we’re going, we have to remember where we’ve been. We look back at key pieces of legislation that have shaped healthcare in the U.S.
1965: Social Security Amendments
Health insurance is the backbone of healthcare in the United States. The Social Security Amendments of 1965 created a system of federal health insurance targeted at the elderly and low-income, which we now call Medicare and Medicaid.
Our Health IT Takeaway: While Medicare and Medicaid both started as programs for the elderly and poor respectively, they are now used by millions of Americans.
1996: The Health Insurance Portability and Accountability Act (HIPAA)
HIPAA is a landmark piece of legislation that accomplished many things for US. healthcare. Title I of HIPAA provides health insurance coverage for employees and their family when they change or lose jobs. Title II requires the establishment of national standards for electronic health care transactions and national identifiers for providers, health insurance plans, and employers.
Our Health IT Takeaway: HIPAA established standards for privacy and security regarding protected health information (PHI). As electronic records (EHRs) are now the norm in U.S healthcare, we must be vigilant of the changes in technology and how they relate to privacy and security.
2003: The Medicare Prescription Drug, Improvement, and Modernization Act (MMA)
The Medicare Modernization Act is the largest overhaul of Medicare in the program’s history. The most important feature of the MMA is Medicare Part D, which subsidized the cost of prescription drugs and prescription drug insurance premiums.
Our Health IT Takeaway: Prescription drugs are an integral part of the health industry, but there is much to be done regarding its safe use. Improper electronic medication management, from patients to doctors to the pharmacy, is a growing problem in the U.S. Having an EHR that provides an accurate and informative interface for e-Prescription is vital to keeping a practice safe and efficient.
2005: The Patient Safety and Quality Improvement Act (PSIA)
The Patient Safety and Quality Improvement Act created a system of patient safety organizations and a national patient safety database. Patient safety organizations were created to encourage reporting and discussion of incidents that occur in health-related environments.
Our Health IT Takeaway: Patient safety organizations are an integral part U.S healthcare. They provide an avenue for data used in quality reporting systems (like Meaningful Use), to be transformed into actionable tasks. PSOs will play an important part in new healthcare analysis techniques (population health management), and facilitating reporting systems in the upcoming MACRA.
2009: The American Recovery and Reinvestment Act (ARRA) & the HITECH Act
Colloquially called the Stimulus or Recovery Act, the ARRA was a response to the Great Recession which crippled the U.S economy. The ARRA was a stimulus package designed to revitalize the various sectors of the U.S economy, including healthcare. Part of the ARRA was the Health Information Technology for Economic and Clinical Health (HITECH) Act, which promoted the adoption of health IT technology as well as standards of meaningful use.
Our Health IT Takeaway: The HITECH Act was quite possibly the most impactful IT-focused program to pass through Congress. It’s spurred the electronic health IT market areas of safety, accessibility, and accountability.
2010: Meaningful Use Stage 1
The Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs were established to encourage eligible professionals and eligible hospitals to adopt, implement, upgrade, and demonstrate meaningful use of certified EHR technology. Stage 1 set the foundation for the EHR Incentive Programs by establishing requirements for the electronic capture of clinical data, including providing patients with electronic copies of health information.
Our Health IT Takeaway: Meaningful Use Stage 1 was a step in the right direction towards improving the way we utilize EHR technology. Where it faulted was the hastiness of its implementation caused many a headache to providers.
2012: Meaningful Use Stage 2 and Beyond
Stage 2 expanded upon the Stage 1 criteria with a focus on ensuring that the meaningful use of EHRs supported the aims and priorities of the National Quality Strategy. Stage 2 criteria encouraged the use of health IT for continuous quality improvement at the point of care and the exchange of information in the most structured format possible. In October 2015, CMS released a final rule that specifies criteria that eligible professionals, eligible hospitals and CAHs must meet in order to participate in the EHR Incentive Programs in 2015 through 2017 (Modified Stage 2) and in Stage 3 in 2017 and beyond.
Our Health IT Takeaway: Following MU Stage 1, Stage 2 further laid the groundwork for the CMS’ view of how EHR technology should be used. While comprehensive and good-willed, providers still did not have enough time or resources to fully take advantage of the incentive programs.
2015: Medicare Access & CHIP Reauthorization Act (MACRA)
The Medicare Access & CHIP Reauthorization Act overhauls Medicare by doing 3 things: repeal the Sustainable Growth Rate (SGR), combine existing quality programs into MIPS, and incentivizes alternative payment programs (APMs).
Our Health IT Takeaway: MACRA is the latest in the government’s effort in reforming healthcare. We are seeing a major shift from fee-for-service type plans to value-based care. MACRA is very exciting because it plans to fully integrate health information technology into the all facets of the health industry.
To the Future—Where We’re Going
Taking into account the latest in healthcare legislation and technology, we are moving towards a more data-driven, interoperable future. There are still major hurdles we need to overcome, such as the ability for different information systems to talk to each other, but steps are being made in the right direction. MACRA conjoins the future of healthcare with technology, with an increased focus on electronic health records (EHRs) and telemedicine. What we expect in the future is the increased intersection between healthcare innovation (telemedicine, population health management, mobile applications) and health legislation.