Health Information Technology

The United States government has created a system wherein medical and health information must be stored on the internet.

Health Information Technology for Economic and Clinical Health Act

The 2009 HITECH Act (enacted by the American Recovery and Reinvestment Act of 2009) created an incentive structure that pushed hospitals and providers toward electronic records keeping. Non-compliance leads to a penalty on Medicare payments: 1% in 2015, 3% in 2018.

So-called Health Information Technology (HIT) must meet a standard of "meaningful use" which was defined by implementing a certified records management system and using it for all of the following:

1. Use computerized order entry for medication orders.
2. Implement drug-drug, drug-allergy checks.
3. Generate and transmit permissible prescriptions electronically.
4. Record demographics.
5. Maintain an up-to-date problem list of current and active diagnoses.
6. Maintain active medication list.
7. Maintain active medication allergy list.
8. Record and chart changes in vital signs.
9. Record smoking status for patients 13 years old or older.
10. Implement one clinical decision support rule.
11. Report ambulatory quality measures to CMS or the States.
12. Provide patients with an electronic copy of their health information upon request.
13. Provide clinical summaries to patients for each office visit.
14. Capability to exchange key clinical information electronically among providers and patient authorized entities.

15. Protect electronic health information (privacy & security)

Apart from these "core requirements" there are additional "menu requirements" of which half must be met.

21st Century Cures Act

The 2016 Cures Act prohibited health information blocking. Information blocking can be any of: (1) use of an electronic records system that is not interoperable with other systems; (2) failing to provide health information on request.

The minimum standard for 'interoperability' is support of standardized data exports and support of the Fast Healthcare Interoperability Resources API, which is governed by the non-profit HL7. Rather than dictate the export standard, hospitals and providers must instead specify the standard being used with publicly-accessible internet documentation.

These forms of electronic records must be made readily available, as per the United States Core Data for Interoperability (USCDI):

• consultation notes
• discharge summary notes

• history & physical

• imaging narratives
• laboratory report narratives
• pathology report narratives
• procedure notes
• progress notes

The Cures Act also created an exemption from FDA regulation for medical software including electronic records systems.

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