Paper, electrons and red tape: Regulatory barriers to adopting health information technology

Moving health information from paper files to electronic records has promised improvements in health care, ranging from increased efficiency to improving information sharing. For example, electronic health information (EHI) that is used to help a physician treat a patient can be reused to provide public health officials information on potential threats or give researchers a way to evaluate treatment effectiveness. However, the health care industry has been slower to adopt these technologies than other fields. Medical practitioners cite the complex and confusing body of EHI-related laws as a major obstacle to using such tools. Understanding this framework of rules and regulations around the country is a critical first step to addressing legal barriers to health data use.

A research team led by Cason Schmit, JD, research assistant professor in the Department of Health Policy and Management at the Texas A&M School of Public Health, dug into this complex legal environment to gain a better understanding of the laws and uncover how regulations might affect health care and public health goals, such as patient care and public health reporting. Their study, published in the journal Public Health Reports, searched legal databases to find laws in the 50 U.S. states, Guam, Puerto Rico, the U.S. Virgin Islands and the District of Columbia that were related to electronic information and individual health.

Schmit and his colleagues found more than 2300 EHI-related laws on the books as of January 2014. Of these, 145 laws were from Texas alone, the largest number from a single jurisdiction.

“Electronic health information laws are numerous and highly fragmented. Every state regulates health information differently, and many states have different laws to regulate different uses, such as treatment, health care payment, health information exchange and vital statistics,” Schmit said. “For many practitioners in health care or public health, it is incredibly difficult to understand which law applies to them, much less the added difficulty of understanding whether the law authorizes or prohibits an activity.”

In addition to the sheer number of laws, many regulations overlap with each other, further complicating matters. This complexity affects more than health care providers, hospitals and public health departments. For instance, health information software developers would need to analyze, understand and comply with regulations in each jurisdiction where their software would be used. This serves as an obstacle to innovation in a field that would otherwise grow and adapt rapidly.

“Regulatory complexity fosters misconceptions about laws and can lead to overly conservative policies that minimize legal risk but severely limit the usefulness of the technology,” Schmit said.

Although consistent with other research findings, the study was limited because it only examined laws that specifically refer to EHI. Other laws and regulations that do not explicitly mention EHI could also affect the use of health information technology, which warrants further research. Additionally, future research will need to compare specific types of laws across jurisdictions to see whether some laws are more effective than others in promoting health care and public health goals.

“Despite the study’s limits, the findings help shed light on the complex EHI legal environment, serving as a starting point for understanding why information technology adoption has been slower in health care than in other fields,” Schmit said. “A better understanding of laws and their effects—intended and unintended—is key to accelerating innovation in health care technology and more effective use of health data.”