The Robert Wood Johnson Foundation surveys the state of a digitizing health system in a new report, taking stock of the meaningful use program's successes and limitations -- and forecasting emerging healthcare trends.

In the study, Health Information Technology in the United States, 2015: Transition to a Post-HITECH World, RWJF (along with researchers from Mathematica, Harvard School of Public Health and University of Michigan, School of Information) looks back on "highlights and milestones of the past eight years" – and tries to assess how well the HITECH stimulus program has positioned the industry for a challenging future.

Meaningful use has been both a boon and for adoption and something of a bother for many of the providers trying to keep pace with its mandates, the report shows.

"The most recently available survey data finds approximately three-quarters of U.S. nonfederal acute care hospitals have at least a basic electronic health record system, according to RWJF. "While this represents a significant increase from the prior year, many fewer hospitals appear to be ready to meet Stage 2 meaningful use criteria and may be subject to penalties."

While a huge motivators for that $27 billion investment in electronic health records was to boost data exchange, and while "HIE efforts operate in the vast majority of states and should, in theory, be broadly available to health professionals within those states," the RWJF report finds "substantial challenges" of the  "technical, financial, governance, human resources, privacy and security and patient consent" variety.

In its assessment of big HITECH initiatives such as regional extension centers, the State Health Information Exchange Program, the Health Information Technology Workforce Development Program and others, the RWJF study finds that, while HITECH "helped to initiate significant progress" on health IT adoption and use, "in general, it fell short of  achieving its overarching goals to establish a highly effective and efficient healthcare system enabled by the advanced use of HIT."

Its verdict, nearly seven years after the law was passed as part of the American Recovery and Reinvestment Act, is that "the ambitious goals of HITECH, while optimistic, overlooked  barriers that were beyond the scope of the legislation and the programs it authorized."

As the U.S. continues to work toward health IT-enabled optimization, the "successes, barriers and lessons learned through the HITECH cooperative agreement programs will continue to shape these efforts," according to the report.

Looking forward, RWJF forecasts an industry poised for transformation by big data (but offers a "realistic assessment" of its place in healthcare). It explains why payment reform and interoperability are both essential to the coming years of change and must follow similar routes to innovation. It compares and contrasts three landmark report on the evolution of a nationwide health IT infrastructure, and asks former national coordinators to reflect on the office's accomplishments.

Read the full report here.