BOX 6-1

Challenges to Implementing a RLHS Identified by Workshop Speakers and Participants

  • More wide-scale implementation of EHRs

  • Data quality and completeness

  • Harmonization, standardization, and interoperability of datasets

  • Appropriate computational algorithms and statistical analyses of observational data

  • Data governance

  • Ensuring patient privacy and portability of data

  • More rapid reporting and translation of clinical and research findings into practice

  • Motivated stakeholders willing to collaborate and participate in a RLHS

  • Appropriate IT that fosters clinical improvements and meaningful use

  • Need for alignment of incentives and payment structures

tion of certified electronic health records, health information exchange, and quality reporting. Meaningful use will be tied to Medicare and Medicaid payment incentives and a policy process led by ONC. Initially, meaningful use will emphasize capturing and sharing data, but by 2013 a higher definition will emerge that emphasizes more advanced care processes, including sophisticated implementation of clinical decision support, which by 2015 will progress toward realization of improved outcomes through enhanced levels of technology. According to Friedman, meaningful use will likely not include the additional elements needed for a RLHS, including gridware, data stewardship, advanced intelligent methods, and means to aggregate information. Yet because these elements will eventually be superimposed on the infrastructure created by the basic elements of an EHR system it is critical that the foundation of EHRs be harmonious and compatible with the higher-level layers that will be added later.

ONC will use financial incentives to boost adoption of EHRs and will promote such adoption by creating a national system of regional extension centers to support providers in adopting and becoming meaningful users of HIT and by creating programs to enhance the number of health IT work-



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