The Evolution of Health Information Technology for Enhanced Patient-Centric Care in the United States: A comprehensive look at enhanced interoperability, electronic prescribing, public health reporting, and patient access to health information (Preprint)

Abstract

Health information technology has revolutionized health care in the United States. Interoperable clinical care data exchange, e-prescribing, electronic public health reporting, and electronic patient access to health information have improved care and outcomes.

This objective of this analysis is to examine progress and the Office of the National Coordinator for Health IT’s (ONC’s) mission to enhance health care through data access and exchange.

This analysis leverages data on end-users of health IT to capture trends in engagement in interoperable clinical care data exchange (ability to find, send, receive, and integrate information from outside organizations), e-prescribing, electronic public health reporting, and capabilities to enable patient access to electronic health information. Data were primarily sourced from the American Hospital Association Annual Survey Information Technology Supplement (2008 to 2023), Surescripts e-prescribing utilization data (2008 to 2023), the National Cancer Institute's Health Information National Trends Survey (2014 to 2022), and the National Center for Health Statistics' National Electronic Health Records Survey (2009 to 2023).

Since 2009, there has been a remarkable 10-fold increase in EHR use among hospitals and 5-fold increase among physicians. This rapid digitization enabled the interoperable exchange of electronic health information, electronic prescribing, electronic public health data exchange, and the means for patients and their caregivers to access crucial personal health information digitally. Now, 70% of hospitals are interoperable, with many providers seamlessly integrated within EHR systems. Notably, nearly all pharmacies and 92% of prescribers possess e-prescribing capabilities, marking an 85-percentage point increase since 2008. In 2013, 40% of hospitals and a third of physicians allowed patients to view their online medical records. Patient empowerment has increased, with 97% of hospitals and 65% of physicians possessing EHRs that enable patients to access their online medical records. As of 2022, three-quarters of individuals report being offered online access to portals, and over half (57%) report actively engaging with their health information through their patient portal. Electronic public health reporting has also had an uptick, with most hospitals and physicians actively engaged in key reporting types.

Federal incentives have served as catalysts for the widespread adoption of electronic health records (EHRs) and the rapid digitization in health care. We found tremendous growth in health IT capabilities. Interoperability initiatives have gained considerable momentum and have fostered collaboration across health care entities. However, challenges persist in achieving nationwide interoperability, stemming from technical, organizational, and policy challenges and optimizing the benefits of these technologies. Enhanced data standardization, governance structures, and the establishment of robust health information exchange networks are crucial steps forward. Interoperable clinical care data exchange, e-prescribing, electronic public health reporting, and patient access to health information have grown substantially over the past quarter-century and have been shown to improve health care outcomes. However, interoperability hurdles, usability issues, data security, and equitable patient access persist. Addressing these demands will require collaborative efforts among stakeholders, refining standards, and enhancing policy frameworks.