Modernizing and redesigning the U.S. health and wellness information, communications, and technology infrastructure is vital for advancing the health and well-being of individuals and communities across the nation. In today's connected society, a variety of sources, platforms, and settings generate electronic health information that can inform health goals, behaviors, and decisions. These information sources extend well beyond traditional health care services to create a more expansive, continual pool of salient information.
These sources and information types include self-generated information collected through an individual's mobile device, and non-clinical information collected by communities, including air and water quality from work and physical environments, potential toxin exposure, and availability of transportation and social services. To unlock the full power of information to improve individual health and well-being, essential electronic health information must be available when and where it matters most.
Improving the secure availability and use of pertinent health information allows individuals to take ownership of their health, partner with their health care providers and others on care preferences and decisions, and reach their health and quality of life goals. It bolsters the delivery of health care and long-term services and supports, allows communities to reduce health disparities, and improves public health agencies' ability to detect, track, manage, and prevent illness outbreaks and individual harm.
Information also fuels research and innovation, spurring advancements in scientific discovery. As the information and technology demands continue to evolve, opportunities for the federal government exist to create pathways for the private sector to innovate and to design programs and policies that do not impede the marketplace's progress. It is imperative for government to address this new electronic health information and health IT paradigm to improve the health of the nation.
Improving Health and Well-Being
Empowering individuals to make healthy choices can improve their quality and longevity of life. Information is central to setting and accomplishing individual and systemic goals and improvement plans; however, information alone - even when electronically generated and shared - cannot improve the nation's health. It will take the collective efforts of many stakeholders using electronic health information in meaningful and effective ways, alone and in partnership with one another, to help achieve the nation's full health potential.
An individual can take many steps to improve his or her health, including lifestyle and wellness choices, actively managing his or her health care, and receiving necessary immunizations, preventive care, and long-term services and supports. Engaged individuals are more likely to be proactive in practicing wellness, prevention, and disease management behaviors.2 However, health care providers and health insurers offered fewer than three in ten individuals electronic or online access to their medical record in 2013.3
Individuals and caregivers often want to increase their care engagement and health management, but many challenges and deficiencies make it difficult for them to play a proactive role and respond to the information and resources available to them. Many providers are also struggling to engage effectively with their patients and determine what, and how much, information would be beneficial, and how best to establish processes, tools, and methods to facilitate this engagement as mutually supportive partners.
For example, health care providers sometimes find it difficult to build and maintain partnerships with their patients and their caregivers due to cost pressures, lack of pertinent patient information, time limitations, cultural differences, communication and language barriers, and dissatisfaction with the usability of their technology systems. High-participation partnerships may require real sacrifices from providers that can decrease productivity and reimbursement.
In turn, these partnerships require patients to be engaged and active in their own health and health care - an effort that takes time and resources that patients and their caregivers may not necessarily be able to commit - even when they understand the value it could provide. Individuals and their caregivers often seek care from multiple providers who have incomplete access to essential information about that person and limited financial incentives to coordinate care carefully. Individuals and caregivers often serve as care coordinators and information transporters, and frequently select providers based on limited knowledge of the care quality they offer.
In the current fee-for-service payment environment, providers are reimbursed for each service provided rather than by the quality or value of care and its outcome. This focus on individual patient encounters may not motivate providers to seek additional information from outside sources, including individuals' non-clinical quality of life information. Partnering with individuals can help providers make decisions to better coordinate the patient's care, emphasize care quality, and accommodate patient preferences.
Better health and more personally meaningful health and care plans will further require recognition that individual well-being is impacted by many factors outside of traditional health care. Many health and social determinants outside of care delivery influence individuals' health and well-being, and the federal government can play an important role to guide the inclusion of these determinants into the electronic information stream for decision-making by individuals, providers, and communities, as well as the organizations and technology developers that support them.
For example, economic, social, and physical environments have an extensive effect on an individual's health. Some individuals live in communities where healthy food is hard to find, air quality is poor, and access to affordable and quality health care, transportation, and social services are limited.
Communities have a responsibility to help individuals lead healthy and productive lives, and protect them from harm. Home- and community-based organizations, as well as social and human service organizations can play an integral role in assisting individuals to achieve their health potential. Many individuals, however, do not receive the services they need or qualify for due to systemic deficits in communication and information systems between the health care community and social services community.
Integrating primary health care services and public health efforts, including linking to community prevention services, can promote efficiency, positively affect individual wellness, and improve population health. The Affordable Care Act of 2010 provides a unique opportunity to maximize the value of health investments by integrating population health approaches and health care service delivery.
Together with other strategic initiatives, health IT can facilitate improved public health surveillance, collect more complete and accurate data, and link clinical care and supportive community-based services and policies. Applying innovative health IT in these efforts will improve the ability to reach high-risk populations and support the delivery of comprehensive, culturally and linguistically appropriate, and easily navigated services.
Public health entities also have a crucial role in keeping individuals and communities safe and healthy. Too often, there is asymmetry between the information public health entities have access to and the information required for conducting real-time public health surveillance, for developing comprehensive situational awareness, and for informing the allocation of limited resources.
There is also a shortage of public health workers with the technological and data analytics skills necessary to analyze complex information from multiple and disparate sources, to inform strategic decision-making, and to apply health IT and clinical information to community needs assessments and other responsibilities.
Providers and researchers share a goal of having high quality, reliable data that is useful across organizations and databases. Currently, data quality and reliability are highly variable and could be enriched to enhance its use for research and to improve care.
A focus on continuous quality improvement, for both the data and application tools, is necessary to enhance the existing and emergent data for routine use for many purposes, including improved care or research. An approach that embraces federal and private sector collaboration to determine how to improve data quality and utility for various health and research needs can help the learning health system fully integrate continuous quality improvement.
Alignment with Complementary Strategic Plans & Initiatives
Although this Plan focuses on how the federal government will foster an interoperable4 electronic health IT infrastructure to support the nation's efforts to achieve high-quality care, lower costs, and healthier and engaged people, the Plan aligns closely with other federal-directed plans that address health and social determinants that information and technology alone cannot solve. A list of many complementary plans and initiatives are included at the end of the document.
The Plan purposefully includes interrelated strategies and objectives where health IT can help accomplish the vision of national goals highlighted in those plans and initiatives. These plans focus on health, quality, safety, prevention, health disparities, health literacy, interoperability, infrastructure, and security.
Additionally, this Plan aligns with key initiatives that seek to advance a connected health IT infrastructure, or initiatives that require a strong health IT infrastructure to succeed. This Plan includes brief synopses of priority federal initiatives that include health IT as a component critical to their success. Future Plan progress reporting activities will assess how health IT has assisted in advancing these initiatives' goals.
The graphic below highlights primary accomplishments and results, tied to existing national priorities, which the U.S. health IT infrastructure should work to support. To be most effective, the health IT infrastructure also needs to support the specific goals of communities, providers, and individuals. For example, if a provider has the goal of improving medication adherence among her diabetic patients with hypertension, then health IT should support her ability to pull a report to identify patients who have not filled their prescriptions.
Further, health IT can present information that signals whether certain individuals may have trouble paying for their medications, getting to the pharmacy, or are showing cognitive declines. If an individual sets a goal to lose weight, health IT solutions should assist with goal attainment by allowing him to monitor his daily steps and calorie consumption, and provide community resources to connect with nutritionists or wellness activities nearby.