The document discusses electronic health records (EHRs), defining them as real-time health records that support clinical decision-making and data collection for various uses. It outlines pertinent legislation, including HIPAA and HITECH/ARRA, emphasizing goals like improving care quality and ensuring data privacy and security. The document also covers Medicare and Medicaid financial incentives for meaningful EHR use, alongside challenges and questions regarding implementation and the role of EHRs in public health.

1. Electronic Health Records
Katie Seeler

2. • Katie Seeler

3. Seeler, Katie
Acute Presentationitis
4/14/86 Female
Hospitalization: 1 day
Clonazepam
HHS defines an EHR as:
A real-time patient health record with access to
evidence-based decision support tools that can be
used to aid clinicians in decision making … The EHR
can also support the collection of data for uses other
than clinical care, such as billing, quality
management, outcome reporting, and public health
disease surveillance and reporting.

4. PROS CONS
• Decrease health care • Privacy and security of
costs protected health
• Improve quality of care information (PHI)
• Coordinate care to • Interoperability of EHR
reduce medical errors systems
• Improve public health • Cost (software, training,
downtime, etc.)
• Choosing an EHR
system (design your own
or readymade?)

5. Seeler, Katie
Acute Presentationitis
4/14/86 Female
Hospitalization: 1 day
Clonazepam
Legislation and EHRs:
• HIPAA (1996)
• Executive Order 13335 (2004)
• HITECH/ARRA (2009)

6. HIPAA (1996)
• Main objective when enacted: to “improve
portability and continuity of health insurance
coverage in the group and individual
markets.”1
• Several “rules”
– Administrative Simplification Rules
– Privacy Rule (2000)
– Security Rule (2003)
1 Health Insurance Portability and Accountability Act of 1996, H.R. 3103, 104th Cong., 2nd sess.

7. E.O. 13335 (2004)
• Created position of National Health
Information Technology Coordinator who
would oversee development of a nationwide
interoperable health information technology
infrastructure
• Currently known as Office of the National
Coordinator for Health Information
Technology (ONC)
2 President, Executive
Order, “Incentives for the Use of Health Information Technology and Establishing the Position of the National Health
Information Technology Coordinator,” Federal Register 69, no. 84: (April 2004).

8. E.O. 13335 (2004)
• Primary goals:
– improve health care quality,
– reduce medical errors,
– decrease health care costs resulting from
inefficiency, medical errors, inappropriate care,
and incomplete information,
– while ensuring the security of personally
identifiable health information.
2 President, Executive
Order, “Incentives for the Use of Health Information Technology and Establishing the Position of the National Health
Information Technology Coordinator,” Federal Register 69, no. 84: (April 2004).

9. HITECH/ARRA (2009)
• Health Information Technology for Economic
and Clinical Health Act (HITECH) was passed as
part of the American Recovery and
Reinvestment Act (ARRA) of 2009
50?
Remind me: how 35?
many billions did we
give to support & 75?
promote adoption of
HIT & EHRs? 90?
25?

10. HITECH/ARRA (2009)
• Provisions
– widen the scope of privacy and security
protections offered under HIPAA
– increase potential liability for non-compliance
– provides more enforcement
– amends Title XXX of the Public Health Service Act
by adding various opportunities to advance health
information technology

11. Seeler, Katie
Acute Presentationitis
4/14/86 Female
Hospitalization: 1 day
Clonazepam
Three new rules under HITECH:
• Notification requirements in event of
breach of unsecured PHI
• Medicare & Medicaid incentives for
meaningful use of EHRs
• Certification criteria for EHR
technology

12. Notification Requirements
• HITECH established the first national data
security breach notification law by requiring
covered entities to notify individuals whose
unsecured PHI has been disclosed as a
result of a privacy or security breach.
• In certain cases, the covered entity must also
notify the Secretary of HHS and the general
public.

13. Medicare Financial Incentives
• Incentive payments for eligible professionals, eligible hospitals, and CAHs
that demonstrate meaningful use of certified EHR technology.
– Participation can begin as early as 2011.
– Eligible professionals can receive up to $44,000 over five years. There's
an additional incentive for eligible professionals who provide services in
a Health Professional Shortage Area (HSPA).
– To get the maximum incentive payment, Medicare eligible professionals
must begin participation by 2012.
– Incentive payments for eligible hospitals and CAHs may begin as early
as 2011 and are based on a number of factors, beginning with a $2
million base payment.
• Important! For 2015 and later, Medicare eligible professionals, eligible
hospitals, and CAHs that do not successfully demonstrate meaningful use
will have a payment adjustment in their Medicare reimbursement (1-2% per
year)3
3 President, Executive
Order, “Incentives for the Use of Health Information Technology and Establishing the Position of the National Health
Information Technology Coordinator,” Federal Register 69, no. 84: (April 2004).

14. What is “meaningful use”?
• ARRA outlines three main components of
meaningful use:
– The use of a certified EHR in a meaningful
manner, such as e-prescribing.
– The use of certified EHR technology for
electronic exchange of health information to
improve quality of health care.
– The use of certified EHR technology to submit
clinical quality and other measures.

15. How is “meaningful use” measured?
• The criteria for meaningful use will be staged
in three steps over the course of the next five
years.
– Stage 1 (2011 and 2012) sets the baseline for
electronic data capture and information sharing.
– Stage 2 (expected to be implemented in 2013)
and Stage 3 (expected to be implemented in
2015) will continue to expand on this baseline
and be developed through future rule making.

16. Medicaid Financial Incentives
• Incentive payments for eligible professionals, eligible hospitals, and CAHs
as they adopt, implement, upgrade, or demonstrate meaningful use of
certified EHR technology in their first year of participation and demonstrate
meaningful use for up to five remaining participation years.
– The Medicaid EHR Incentive Program is voluntarily offered by individual
states and territories and may begin as early as 2011, depending on the
state.
– Eligible professionals can receive up to $63,750 over the six years that they
choose to participate in the program.
– Eligible hospital incentive payments may begin as early as 2011, depending
on when the state begins its program. The last year a Medicaid eligible
hospital may begin the program is 2016. Hospital payments are based on a
number of factors, beginning with a $2 million base payment.
• There are no payment adjustments under the Medicaid EHR Incentive
Program.

17. EHR Certification Criteria
• ONC has contracted with a private
organization, the Certification Commission
for Health Information Technology
(CCHIT), to certify EHRs as having
specific basic capabilities since 2005

18. EHR Certification Criteria
• Many of the EHRs currently certified are
difficult to use and are not designed to
meet ARRA's goals of improving quality
and efficiency in the healthcare system
• Providers must use certified EHR systems
in order to receive incentive payments

19. Question Time!
What crucial benefit of EHRs does Obama
neglect to mention in this clip?

20. More Questions
• What are some long-term public health
benefits of EHRs?
• What do you think is the biggest challenge
to implementing a federal infrastructure for
EHRs?

21. Another Question
• Given our current economic climate (debt
ceiling, partisan bickering and stalemate
over budget, etc.), do you think the
government should be providing financial
incentives to adopt EHRs? Does our
aging population influence this
consideration?
14 trillion or 211 trillion?

22. A Couple More
• Even with financial incentives, do you think it’s
feasible for every healthcare provider be required
to use EHRs? Should nonadopters be penalized?
• Do you think the
federal government
(and individual EHR
providers) have
done enough to
ensure the privacy
and security of PHI?

23. One last question!
• Do you think the timeframe for full-scale,
nationwide implementation of EHRs is realistic?