There is (finally) a digital revolution underway in the field of health care with regards to electronic health records (EHRs) and tapping into their potential that is intended to increase quality, reduce waste and duplication, while driving down costs. This field is referred to as Health Information Technology or HIT. For clarity’s sake, I want to define a few terms that may make this easier to understand with all of the confusing acronyms:
- EHR – electronic health record: a digital health record that can exchange information with other providers
- EMR – electronic medical record: a digital health record that usually is only electronically available to one clinician or to their practice (i.e. no interconnectivity with other systems). The term EMR is somewhat falling out of favor for EHR since the assumption is that all records will be interconnected.
- PHR – personal health record: a health record that patients have the ability of uploading information to and reviewing their records online. Examples of PHRs are Google Health (now defunct) and Microsoft Health Vault.
The push to become electronic was fueled in part by the HITECH Act. The Office of the National Coordinator (ONC) is charged with guiding implementation of HIT while also assisting clinicians make the transition. (It is amazing to think that in 2011, the majority of documentation is still largely paper and pen based.) This is exactly the reason why these programs are in place. The programs will first incetivize Medicare and Medicaid providers and institutions by offering monetary credits for adoption but starting in 2015, will penalize providers and institutions if they haven’t made the transition. EHRs are not only about making health information available electronically. For example, having paper records simply scanned and available for viewing on-line will not suffice. EHRs must be used meaningfully. Enter meaningful use. Meaningful use as defined by the Centers for Medicare & Medicaid Services:
“…means providers need to show they’re using certified EHR technology in ways that can be measured significantly in quality and in quantity.” (https://www.cms.gov/ehrincentiveprograms/30_Meaningful_Use.asp#BOOKMARK
For providers, there are 15 core measurements and a menu set of objectives (there are 10 total but 5 only need to be selected) that must be met in order to qualify for the incentive. Therefore, 20 of the 25 measures must be met. (Click here for a detailed listing of meaningful use measures. Note that institutions have slightly different measures than individual providers.)
Some examples of core objective are maintaining active medication lists or active medication allergy lists.
This is important since virtually all primary care providers are affected by this. (Note that nurse practitioners can qualify for Medicaid incentive payments but not Medicare payments at this time). For NP students in clinicals, you will likely be exposed to the various EHRs that are out there. One particular challenge are the many different EHRs and while they do things similarly, their interface and format will vary. In addition, the security and protection of this information is paramount so providers and institutions need to have the highest standards and procedures in place.
As mentioned, the ultimate goal is to utilize these tools to improve clinical outcomes. While there will eventually be electronic clinical decision support for clinicians, they will not replace what clinicians do. There have been some critical studies regarding EHRs questioning whether they improve quality and may actually drive health care costs up. However, there have been some methodological issues with those studies. The future of healthcare is to have robust data available electronically to improve the quality of care and reduce waste and duplication. One of the building blocks of health reform begins with this important initiative.