2. Definitions Electronic Medical Record - An electronic record of health-related information on an individual that can be created, gathered, managed, and consulted by authorized clinicians and staff within one health care organization. Electronic Health Record - An electronic record of health-related information on an individual that conforms to nationally recognized interoperability standards and that can be created, managed, and consulted by authorized clinicians and staff, across more than one health care organization. (EHRs are workflow tools for clinicians.) Personal Health Record - An electronic record of health-related information on an individual that conforms to nationally recognized interoperability standards and that can be drawn from multiple sources while being managed, shared, and controlled by the individual. (PHRs are lifetime clinical summary and workflow tools for the consumer.) An Enterprise Master Patient Index (eMPI) is a database that contains a unique identifier for every patient in the enterprise. This would include the medical center, outpatient clinics, practice offices and rehabilitation facilities. All registration systems would look to the eMPI to obtain patient information based upon several identifiers "Meaningful use" is demonstrating to the satisfaction of the Secretary (HHS) that the professional is using a certified EHR in a meaningful manner, which includes the use of e-prescribing, electronic HIE, and submission of information on clinical quality measures.
3. Health Information Technology Market There are 800,000 clinicians in the US. 17% have EHRs today. This leaves 664,000 who need EHRs. Over the next 5 years the early to mid-adopters will work hard to gain the full stimulus incentive amounts available in 2011-2012. Late adopters will gain the reduced stimulus available in 2013-2014. Resistors will begin receiving penalties in 2015. There are over 100 companies providing EHRs for small practices. The ambulatory market leaders are eClinicalWorks, Allscripts, NextGen, GE Centricity, and Meditech/LSS (for small practices tightly affiliated to a hospital using Meditech). Epic is a market leader but not for small practices.
4. HIE Services Typically Includes Patient identification and registry services within a directory structure; Consent management and enforcement of a user’s consent when collecting, storing, accessing, processing, and disclosing personal health information; Information for the patient about the HIE at the point of care and a business process to obtain consent that will be used for future exchange of data until changed by the individual.
6. Organizational Culture Barriers Culture of physical/paper records Culture of ownership of data and not sharing it Culture of market competition
7. Typical Use Case of an HIE Initiation of a request to the HIE service to determine if a person has relevant medical information within the HIE; A response is returned to the requesting organization, which would request to receive the relevant data. The HIE service would verify that the requesting organization is authorized, authenticated, and has access privileges to the information and that the person has provided consent for transmission of the given information; The approval along with supporting metadata is transmitted to the supplying organization who has the relevant information; The disclosing organization would supply the information as required by the underlying data sharing or HIE participation agreements.
8. Technology and Standards Barriers Technical challenge of user authentication Technical challenge of patient identification Information systems interoperability Data element standards
9. Trust Among HIE Participants Processes to ensure the integrity of patient data; Verifiability of data after transforming, storing and/or sending; Verification that the data source and data content are true; Organization (HIE or NHIN) can define standardized data values and a protocol format for sharing medical data.
10. Educational and Training Barriers General lack of understanding by health care staff of security issues around technology Lack of leadership for education of health care staff in health information security and privacy Consumer knowledge about Health Information Barriers
11. Implementation Requirements A data sharing agreements and policies to enable information sharing and make system usable; An Enterprise Master Patient Index (eMPI) which serves as a record locator; A balancing of data standardization (normalization) and physician freedom to have clinical control of the medical record while being efficient in their treatment of patients
