Electronic health records (EHR) are as common in the modern health care landscape as needles and syringes. This is thanks in large part to the Health Information Technology for Economic and Clinical Health Act (HITECH), created in 2009. HITECH pressured providers with a scheme of financial incentives and penalties to individually adopt EHR systems with “meaningful use” requirements. HITECH’s definition of meaningful use focused on the functionality of EHR systems inside the four walls of the provider and has done nothing to regulate the landscape of the emerging industry or the companies that would come to dominate it. Consequently, HITECH’s meaningful use provisions do not encourage interoperability across platforms, nor have they met provider expectation of reduced exposure to malpractice liability. Now, 10 years since HITECH initially incentivized the health care industry to adopt EHR and meaningful use of health information technology (HIT), the question must be asked: is additional regulation of the HER/HIT industry necessary to achieve truly meaningful use and circumvent the creation of an EHR monoculture?

The inception of HITECH brought with it wide-ranging expectations, from increasing access to care, reducing adverse events and decreasing health care costs, to streamlining clinician workflow. All of these expectations were both created and regulated by the meaningful use provision of HITECH which outline the quality of use indicators eligible physicians must achieve in order to both receive financial incentives for meaningful EHR adoption and avoid penalties for inadequate usage. Subsequently, the impact of HITECH on the modern health care landscape is absolutely quantifiable. In 2008, the year before HITECH was passed, just 4 percent of physicians reported having a fully functional electronic records system. In the years subsequent, the International Medical Informatics Association (IMIA) Yearbook of Informatics reports hospitals and participators have spent more than $30 billion on EHR systems.

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