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History of Health Information Technology in the U.S.
Evolution of Health IT: The Modern Era
Lecture a – The EnvironmentThis material Comp5_Unit2 was developed by The University of Alabama Birmingham, funded by the Department of Health and
Human Services, Office of the National Coordinator for Health Information Technology under Award Number 1U24OC000023
Evolution of Health IT: The Modern Era
Learning Objectives
2
• Discuss factors that led to increasing clinical use of computers from 1990 to 2009
• Discuss key influences on health IT developments including the Internet, HIPAA, and the Institute of Medicine reports
• Discuss the focus of health IT in the late 90s up to the present
• Discuss the role of health IT in clinical and translational research and personalized medicine
• Discuss why there is more receptivity to the use of health IT now than during the previous 50 years
Health IT Workforce Curriculum Version 3.0/Spring 2012
History of Health Information Technology in the U.S. Evolution of Health IT: The
Modern Era Lecture a
Recap — 1980s• Efforts at cost containment• Continued ‘standardization’ of medical
practice• Informatics applications to support
systematic, scientific practice• Growing professionalism within informatics• Children began using computers in school
Health IT Workforce Curriculum Version 3.0/Spring 2012
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History of Health Information Technology in the U.S. Evolution of Health IT: The Modern Era Lecture
a
General Environmentin the Modern Era
• Consumer emphasis
Source: (Association of American Physicians and Surgeons, Inc., 1995)
Health IT Workforce Curriculum Version 3.0/Spring 2012
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History of Health Information Technology in the U.S. Evolution of Health IT: The Modern Era Lecture
a
General Environment
• Consumer emphasis• Internet, World Wide Web
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History of Health Information Technology in the U.S. Evolution of Health IT: The
Modern Era Lecture a
General Environment
• Consumer emphasis• Internet, World Wide Web• Computer specialists• Continued increase in computer use
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History of Health Information Technology in the U.S. Evolution of Health IT: The
Modern Era Lecture a
General Environment
• Consumer emphasis• Internet, World Wide Web• Computer specialists• Continued increase in computer use• Computer vendors increase, but then
consolidate• Increasing technological change
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History of Health Information Technology in the U.S. Evolution of Health IT: The
Modern Era Lecture a
General Environment
Graying of the ‘Baby Boomers’
Source: (2010 Census Briefs)
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History of Health Information Technology in the U.S. Evolution of Health IT: The
Modern Era Lecture a
(Photo: US Navy)
Healthcare Environmentin the Modern Era
• Efforts to contain costs
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History of Health Information Technology in the U.S. Evolution of Health IT: The
Modern Era Lecture a
Healthcare Environment
• Efforts to contain costs– Managed care
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History of Health Information Technology in the U.S. Evolution of Health IT: The
Modern Era Lecture a
Healthcare Environment
• Efforts to contain costs– Managed care– Capitation
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History of Health Information Technology in the U.S. Evolution of Health IT: The
Modern Era Lecture a
Healthcare Environment
• Efforts to contain costs• Physician supply
Source: (Nicholson, 2009)
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History of Health Information Technology in the U.S. Evolution of Health IT: The
Modern Era Lecture a
Healthcare Environment
• Efforts to contain costs• Physician supply
– Early retirement of baby boomers
Sources: (Staiger et al., 2010)(Dorsey et al., 2005)(Kletke et al., 1998)
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History of Health Information Technology in the U.S. Evolution of Health IT: The
Modern Era Lecture a
Healthcare Environment
• Efforts to contain costs• Physician supply
– Early retirement of baby boomer physicians– More women physicians
Source: (Dorsey et al., 2005)
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History of Health Information Technology in the U.S. Evolution of Health IT: The
Modern Era Lecture a
Healthcare Environment• Efforts to contain costs• Physician supply• More equality of physician - patient
relationships, PHRs• Source: (Tang et al., 2006)
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History of Health Information Technology in the U.S. Evolution of Health IT: The
Modern Era Lecture a
(US Air Force photo/James Spellman Jr)
Healthcare Environment
• Efforts to contain costs• Physician supply• More equality of physician - patient relationships,
PHRs• Quality of care concerns
– Increase in clinical guidelines and protocols
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History of Health Information Technology in the U.S. Evolution of Health IT: The
Modern Era Lecture a
Healthcare Environment
• Efforts to contain costs• Physician supply• More equality of physician - patient relationships,
PHRs• Quality of care concerns
– Increase in clinical guidelines and protocols• Graying of the baby boomers• Increase in care for elderly, chronic conditions• “Telehealth” home healthcare
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History of Health Information Technology in the U.S. Evolution of Health IT: The
Modern Era Lecture a
Healthcare Environment
• Continued competition for NIH funding• Human Genome Project: 1990 to 2000
– Sequencing of human genome– Personalized Healthcare– Bioinformatics
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History of Health Information Technology in the U.S. Evolution of Health IT: The
Modern Era Lecture a
(Courtesy National Human Genome Institute)
Healthcare Environment
• Continued competition for NIH funding• Human Genome Project: 1990-2000
– Sequencing of human genome– Personalized healthcare– Bioinformatics
• Clinical and translational science– Speeding discoveries from ‘bench to bedside,’
and then to the community– More interest in accessing clinical data for
research– Strong emphasis on the role of informatics
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History of Health Information Technology in the U.S. Evolution of Health IT: The
Modern Era Lecture a
Healthcare Environment
• Increased interest in IT for quality of care and patient safety – IOM Reports– Leapfrog Group – Increased scrutiny of physician practices
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History of Health Information Technology in the U.S. Evolution of Health IT: The
Modern Era Lecture a
(Courtesy: The Leapfrog Group)
Healthcare Environment
• Increased interest in IT for quality of care and patient safety – IOM Reports– Leapfrog Group – Increased scrutiny of physician practices
• Increase in clinical computing• Increased privacy concerns
– HIPAA: 1996• Privacy Law implemented in 2003
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History of Health Information Technology in the U.S. Evolution of Health IT: The
Modern Era Lecture a
Landmark Years for Health IT
• 2004– US President pushes for EHR for everyone by 2014– Office of the National Coordinator for Health IT – Certification Commission for Healthcare Information
Technology (CCHIT)
Source: (Bush, 2004)
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History of Health Information Technology in the U.S. Evolution of Health IT: The
Modern Era Lecture a
Landmark Years for Health IT
• 2004– US President pushes for EHR for everyone by 2014– Office of the National Coordinator for Health IT – Certification Commission for Healthcare Information
Technology (CCHIT)
• 2009– Health Information Technology for Economic and
Clinical Health (HITECH) Act
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History of Health Information Technology in the U.S. Evolution of Health IT: The
Modern Era Lecture a
Evolution of Health IT: The Modern Era
Summary – Lecture a
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• Rapid technological change• Patient empowerment• Continued pressure to decrease
healthcare costs• Growing concerns about quality of care • General public using computers• Growing, but slower, use of computers in
healthcare
Health IT Workforce Curriculum Version 3.0/Spring 2012
History of Health Information Technology in the U.S. Evolution of Health IT: The
Modern Era Lecture a
Evolution of Health IT: The Modern EraReferences – Lecture a
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History of Health Information Technology in the U.S. Evolution of Health IT: The
Modern Era Lecture a
References• Age and Sex Composition: 2010. 2010 Census Briefs. Available from:
http://www.census.gov/prod/cen2010/briefs/c2010br-03.pdf • Association of American Physicians and Surgeons, Inc. Patients’ Bill of Rights. 1995. Available from:
http://www.aapsonline.org/patients/billrts.htm • Bush GW. State of the Union Address to Congress. 2004 Jan 20. Available from:
http://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?dbname=2004_presidential_documents&docid=pd26ja04_txt-10.pdf
• Dorsey ER, Jarjoura D, Rutecki GW. The influence of controllable lifestyle and sex on the specialty choices of graduating U.S. medical students, 1996-2003. Acad Med. 2005 Sep;80(9):791-6.
• Kletke P, Escarce J, Polsky D, Wozniak GD. Trends in physician retirement. Abstr Book Assoc Health Serv Res Meet. 1998; 15:91.
• Nicholson S. Changes in health care financing and organization. Will the United States have a shortage of physicians in 10 Years? Academy Health. 2009 Nov. Available from: http://www.academyhealth.org/files/publications/HCFOReportDec09.pdf
• Staiger DO, Auerbach DI, Buerhaus PI. Trends in the work hours of physicians in the United States. Health Serv Res. 2010 Dec;45(6 Pt 1):1614-29.
• Tang PC, Ash JS, Bates DW, Overhage JM, Sands DZ. Personal health records: definitions, benefits, and strategies for overcoming barriers to adoption. J Am Med Inform Assoc. 2006 Mar-Apr;13(2):121-6.
Evolution of Health IT: The Modern EraReferences – Lecture a
26Health IT Workforce Curriculum Version 3.0/Spring 2012
History of Health Information Technology in the U.S. Evolution of Health IT: The
Modern Era Lecture a
Images
Slide 6: Three "W" computer keys Available from: Microsoft Clip Art Source Name: Used with permission of Microsoft Slide 9: Mass Communication Specialist Seaman Brandon Myrick, Available from:
http://commons.wikimedia.org/wiki/File:US_Navy_070607-N-6710M-034_Hospital_Corpsman_2nd_Class_Rolando_Samortin_dances_with_a_resident_of_Wesley_Mission%5Ersquo,s_elderly_home.jpg Source Name: US Navy
Slide 16: Spellman, James Jr., Military Family Available from: http://www.af.mil/photos/media_search.asp?q=Alice
Shepard&page=2 Source Name: US Airforce Slide 19: DNA double helix, http://www.genome.gov/pressDisplay.cfm?photoID=96 Source: National Human Genome
Institute Slide 21: The Leapfrog Group, Logo of the Leapfrog Group, Used with permission from The Leapfrog Group