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Agency outlines barriers, progress in adoption of nationwide electronic health information system :

March 7, 2019

Health information technology (IT) tools such as electronic medical record (EMR) systems and patient portals have become an integral part of the health care landscape, including in pediatric care.

These tools were supposed to make providing, receiving and participating in high-quality health care easier and more efficient, particularly for sharing and accessing health information. Many pediatricians would say that promise has yet to be fulfilled.

“A lot remains to be done to enable various end users — patients, health care providers and payers — to seamlessly access health data,” said Srinivasan Suresh, M.D., M.B.A., FAAP, a member of the AAP Council on Clinical Information Technology Executive Committee.

In its 2018 Report to Congress, the Office of the National Coordinator for Health Information Technology (ONC) describes ongoing barriers, actions taken and recommendations for full, effective adoption of a nationwide system for electronic health information use and exchange.


Barriers associated with health IT capabilities and data-sharing include:

  • Technical barriers: lack of standards, data quality and data matching.
  • Financial barriers: costs associated with development, implementation and optimization of health IT to comply with health care program requirements that change frequently.
  • Trust barriers: competitive environments within health care systems and health information networks that inhibit helpful and meaningful exchange of data.

Barriers associated with health care providers’ experience with health IT include:

  • Federal documentation and administrative requirements that prioritize billing and payment over patient care.
  • Federal reporting requirements that prioritize quality measures that are not meaningful or relevant.
  • Health IT system design and usability issues, including unrealistic clinical workflows and lack of standardization across different systems.

Actions taken

The federal government has taken steps to address the barriers outlined above. Some that are particularly relevant to pediatric care include:

  • Providing incentives for technology companies, health IT developers and health care organizations to prioritize collaboration as they innovate.
  • Making 2015 Certified EHR Technology available to health care systems and providers. The technology includes functionalities to improve interoperability and data exchange.
  • Launching the Agency for Healthcare Research and Quality (AHRQ) Clinical Decision Support (CDS) Connect, which allows users to share interoperable CDS tools. The site includes a tool to support obesity care in pediatric patients (see resources).
  • Renaming the EHR Incentive Program (meaningful use) to the Promoting Interoperability Program, and launching stage 3 with new measures to prioritize interoperability and patient access to health information.

In addition, the Department of Health and Human Services is working with health care providers, payers and other stakeholders to reduce administrative and regulatory burdens in health care, including decreasing patient encounter documentation requirements; simplifying program reporting requirements; looking at how to harmonize reporting requirements to align with existing health IT data; and identifying best practices to improve efficiency, experience, workflow and satisfaction for all health IT users, including patients.

“Though the report summarizes information technology initiatives, there is no specific mention of programs that will be of additional value to pediatricians, such as a unified and standardized immunization record, data standards for school health personnel to access or obtain information from EHRs and a nationwide consensus on adolescent confidentiality issues,” Dr. Suresh said.


The ONC and partner agencies will continue to prioritize, emphasize and incentivize collaboration and innovation as progress continues toward a nationwide system for electronic use and exchange of health information.

ONC’s general recommendations for health IT stakeholders at all levels include:

  • Continue to improve technical functionalities for patients to access, use and share their own health information.
  • Continue to improve technical capacity for health care providers to send, receive and analyze individual and population-level patient data.
  • Continue to increase transparency in data-sharing and improve payer access to population-level clinical data to improve cost efficiency.
  • Prioritize reduction of administrative and documentation burden by aligning those tasks more closely with clinical workflow and allowing clinicians to focus on their patients.
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