Bridging the gap

The consequences of incomplete information at the point-of-care can be inconvenience, inefficiency, increased costss, and adverse, even life-threatening outcomes for patients.

Key Points


In 2004, President Bush set the goal of an interoperable electronic health record (EHR) system for all Americans by 2014 and established the office of the national coordinator for HIT (ONC). Initial progress towards the goal was slow until the passage of the American Recovery and Reinvestment Act (ARRA) of 2009, which included the Health Information Technology for Economic and Clinical Health (HITECH) Act. The HITECH Act funded multiple federal programs to promote the adoption of HIT, particularly EHR systems and HIE at the local, state, and national level.

The basic building block for this national strategy is the EHR, which inputs, processes, and stores digital health information for hospitals and outpatient practices. Health information organizations (HIOs) are the organizations that provide the governance, technology infrastructure, and security to exchange health information. A regional health information organization (RHIO) is simply an HIO that covers a defined geographic area, such as a city, region, state or multi-state area. HIOs have the ability to collect and aggregate health data from multiple organizations and electronically share information with EHRs.

The HITECH Act included a Medicare and Medicaid reimbursement program for eligible professionals who use certified EHRs and demonstrate "meaningful use." Stage 1 meaningful use included the general objectives of e-prescribing, structured data collection, quality reporting, clinical decision support, patient engagement, security assurance, and HIE. HIE is necessary to provide a hospital discharge summary, electronically exchange key clinical information among providers, report quality measures to Medicare/Medicaid or states, perform medication reconciliation, transmit electronic immunization data to immunization registries, and submit electronic syndromic surveillance data to public health agencies.

Currently, most HIE occurs as part of an existing HIO. HITECH funded a new option for statewide and interstate exchange known as the State Health Information Exchange Cooperative Agreement Program, discussed in a later section.

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