title: Leveraging health information technology to achieve the "triple aim" of healthcare reform.
abstract: OBJECTIVE
  To investigate experiences with leveraging health information technology (HIT) to improve patient care and population health, and reduce healthcare expenditures.
  
  
  METHODS
  In-depth qualitative interviews with federal government employees, health policy, HIT and medico-legal experts, health providers, physicians, purchasers, payers, patient advocates, and vendors from across the United States.
  
  
  RESULTS
  The authors undertook 47 interviews. There was a widely shared belief that Health Information Technology for Economic and Clinical Health (HITECH) had catalyzed the creation of a digital infrastructure, which was being used in innovative ways to improve quality of care and curtail costs. There were however major concerns about the poor usability of electronic health records (EHRs), their limited ability to support multi-disciplinary care, and major difficulties with health information exchange, which undermined efforts to deliver integrated patient-centered care. Proposed strategies for enhancing the benefits of HIT included federal stimulation of competition by mandating vendors to open-up their application program interfaces, incenting development of low-cost consumer informatics tools, and promoting Congressional review of the The Health Insurance Portability and Accountability Act (HIPPA) to optimize the balance between data privacy and reuse. Many underscored the need to "kick the legs from underneath the fee-for-service model" and replace it with a data-driven reimbursement system that rewards high quality care.
  
  
  CONCLUSIONS
  The HITECH Act has stimulated unprecedented, multi-stakeholder interest in HIT. Early experiences indicate that the resulting digital infrastructure is being used to improve quality of care and curtail costs. Reform efforts are however severely limited by problems with usability, limited interoperability and the persistence of the fee-for-service paradigm-addressing these issues therefore needs to be the federal government's main policy target.
authors.affiliation: eHealth Research Group, Centre for Population Health Sciences, The University of Edinburgh, Edinburgh, UK Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston MA, USA Department of Medicine, Harvard Medical School, Boston MA, USA aziz.sheikh@ed.ac.uk.
authors.forename: Aziz
authors.initials: A
authors.lastname: Sheikh
authors.affiliation: Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston MA, USA.
authors.forename: Harpreet S
authors.initials: HS
authors.lastname: Sood
authors.affiliation: Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston MA, USA Department of Medicine, Harvard Medical School, Boston MA, USA.
authors.forename: David W
authors.initials: DW
authors.lastname: Bates
mesh_terms: D057171:American Recovery and Reinvestment Act; D001291:Attitude of Health Personnel; D001292:Attitude to Computers; D057286:Electronic Health Records; D018166:Health Care Reform; D007407:Interviews as Topic; D008490:Medical Informatics / Q000331:legislation & jurisprudence; D036301:Qualitative Research; D012051:Reimbursement Mechanisms; D014481:United States