Is the United States Ready for theImplementation of ElectronicHealth Records?Shamaree CromartieHIMA 5060December 5, 2012
Electronic Health RecordsDefinition• The HITECH Act provided the first federal definition for EHRs. “an electronic record of health related information on an individual that is created, gathered, managed, and consulted by authorized health care clinicians and staff”. 2,8• The American Health Information Management Association’s E-HIM Workgroup defines EHRs as “a longitudinal electronic record of patient health information generated by one or more encounters in any care delivery setting. Included in this information are patient demographics, progress notes, problems, medications, vital signs, past medical history, immunizations, laboratory data and radiology reports.” 2,8
Attempts of Implementation ofEHRs in the United States• Institute of Medicine issued report in 1991 calling for EHRs.• Bush Administration- Office of National Coordinator for Health Information Technology (ONCHIT) in 2004 in order to improve the nation’s health information technology, including EHRs, by 2014. 4,7 • Was unable to get Congress to pass the appropriation to support the efforts of ONCHIT.• Obama Administration- The Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009, a part of the American Recovery and Reinvestment Act of 2009, has provided $20 billion in incentive payments to speed up the adoption of EHR.
Benefits of EHR• Improve quality of care• Reduces medical errors• Increases sharing of data between physicians• Improve health of the community • Overall organization of the healthcare delivery improved • Patients adhering to medical guidelines • Supports surveillance activities
Drawbacks to EHRs• Expensive • High start up and ongoing maintenance costs• Decreases workflow • Physicians spending too much time figuring out system, which shortens patients’ visits• Privacy • Patients worried that information will not be safe• 2014 deadline too optimistic • Physicians are rushing and ending up with systems that are dissatisfied with• Criteria unrealistic • Guidelines are not clear and could end up with systems that are not compatible
Solution• Revise HITECT definition of EHR or use the one from the American Health Information Management Association’s E- HIM Workgroup• Provide clearer guidelines so systems will work together and physicians will not have to pick and choose from the criteria given to meet “meaningful use” criteria• Incorporate training of systems in already existing meetings for physicians to learn
References• Hsiao CJ, Decker SL, Hing E, Sisk JE. Most physicians were eligible for federal incentives in 2011, but few had EHR systems that met meaningful-use criteria. Health Aff (Millwood). 2012;31(5):1100- 1107. doi: 10.1377/hlthaff.2011.1315.• Menachemi N, Collum TH. Benefits and drawbacks of electronic health record systems. Risk Manag Healthc Policy. 2011; 4:47-55. Doi: 10.2147/RMHP.S12985.• Simon SR, McCarthy ML, Kaushal R, et al. Electronic health records: Which practices have them, and how are clinicians using them? J Eval Clin Pract. 2008;14(1):43-47. doi: 10.1111/j.1365- 2753.2007.00787.x.• Tomes JP. Avoiding the trap in the HITECH acts incentive timeframe for implementing the EHR. J Health Care Finance. 2010;37(1):91-100.• Tejero A, de la Torre I. Advances and current state of the security and privacy in electronic health records: Survey from a social perspective. J Med Syst. 2012;36(5):3019-3027. doi: 10.1007/s10916-011-9779-x.