Necessary But Not Sufficient: The HITECH Act and Health Information Technology’s Potential to Build Medical Homes

June 2010
AHRQ Publication No: 10-0080-EF
Prepared For:
Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services, 540 Gaither Road, Rockville, MD 20850, www.ahrq.gov

Contract Number: HHSA290200900019I TO2
Submitted By: Mathematica Policy Research 600 Maryland Avenue, SW Suite 550 Washington, DC 20024-2512
Authors: Lorenzo Moreno, Ph.D., Deborah Peikes, Ph.D., Amy Krilla, M.S.W.
Table 4. Potential unintended consequences of the HITECH Act and their relation to the PCMH Model
 
Source: Mathematica‘s analysis, with input from the expert panel. Key: EHR = electronic health record; RECs = Regional Extension Centers
  • Promotion of EHRs as the solution to physician practice problems, such as suboptimal processes, may result in squandering resources on ineffective changes.
  • If physicians oppose HITECH’s EHR Incentive Program, PCMH adoption may be unwittingly slowed.
  • If certified EHRs don’t address aspects of running a practice not specifically defined by meaningful-use criteria, hedging the practice’s transformation into the PCMH model on health IT could be more challenging.
  • The EHR Incentive Program could crowd out some private investment by practices who would have used their own resources to adopt EHRs.
  • The resources (both money and time) needed to implement EHRs may supplant resources that might otherwise have been directed at quality improvement activities.
  • The “digital divide” among providers might paradoxically broaden if large practices, or those that have sufficient expertise and interest in technology or have already taken some steps toward EHRs, use the incentives to increase use of this technology, while other practices that are smaller or lack the technical expertise or financial resources do not use them.
  • Replacement of the integrated EHR model with modular applications that are either Web-based or hosted in mobile communications devices (such as smart phones) could undermine the feasibility of the business models likely to be used by RECs, which would likely charge fees and promote certain types of EHRs.
  • If the process for collecting data on EHR meaningful use is administratively and financially burdensome to practices, or if the use measures are not clinically relevant and evidence based, there could be a backlash against the incentive program.
  • Failure to include behavioral health disorders in the meaningful-use criteria would perpetuate the segregation between general medical care and care for behavioral and substance use disorders.
  • If other transformations are required of practices during the learning-curve period, the adoption of the PCMHmodel could be delayed several years or abandoned in favor of more pressing priorities.