INTR

ODUCTION T

O THE

ELECTR

ONIC H

EALTH

RECORD

CH

AP

TE

R 1

OBJECTIVES

Brief understanding of the history of electronic health records

Learn about the development and functionality challenges associated with creating electronic health records

Develop a familiarity with meaningful use objectives

KEY CONCEPTS

Electronic health record

Closed system

Certification Commission for Health Information Technology

Health Information Technology for Economic and Clinical Health Act

Meaningful use

American Recovery and Reinvestment Act

Authorized testing and certification bodies

HISTORY

1960s –first form of EHR

Developed by: Lockheed/Technicon for a hospital in California

Early systems evolved from another health care information technology system

Some were added to the front end of billing systems

Others were modified versions of a lab or imaging system

Many early EHRs solved only part of physician's needs for patient’s health care information due to complexity and variety of health care data needed

CLOSED SYSTEM

Most EHR systems are closed-system

Data structures and programming code are proprietary to the company that developed them

Information is privately held by inventors and considered their intellectual property

This approach leads to lack of health care data exchange(interoperability)

Systems do not connect making it difficult near impossible for physicians to share clinical information

CERTIFICATION COMMISSION FOR HEALTH INFORMATION TECHNOLOGY-CCHITReviews and certifies the functionality of EHR

systems

Developed standard definition of what an EHR should contain

Rates the usability of an EHR

Developed in response to the hundreds of choices on the market

CCHIT now recognized by the federal government as a certifying body

First organization of its kind

HEALTH INFORMATION TECHNOLOGY FOR ECONOMIC AND CLINICAL HEALTH-HITECHHealthcare political leaders recognized importance for our

nation to have improved health care and pushed hard for legal solutions

2009-U.S. federal government passed HITECH

Requires physicians to use an electronic health record system in order to treat patients whose care is paid by Medicare or Medicaid

Government to help pay for some of the costs over a five-year period

As long as physicians are using the certified EHR solutions they can get reimbursement from federal government by providing required documentation

If eligible physicians can receive as much as $44,000 over five years from Medicare or 63,750 over six years from Medicaid.

Hospitals may receive millions

MEANINGFUL USE

Set of health care quality measures that physicians need to capture using a certified EHR system.

Measures vary by patient volume and visit type

Using a certified EHR helps physicians to improve patient care, which will improve overall health of our nations population

IMPROVING PATIENT/NATION HEALTH CAREImproving Patient Care: Accurate, complete information

about a patients health in order to give best possible care in routine or emergency situation. Ability to better coordinate care they give. Share information securely with patients, family caregivers over Internet, for those that would like this option. Patients can take more of a part in their health care. Information to help physicians diagnose health problems sooner, reduce medical errors and provide safer care at lower cost.

Improving the Nation’s Health: Can make our health care system more efficient, reduce paperwork for patients and physicians, expand access to affordable health care, and build a healthier future for our nation.

AMERICAN RECOVERY AND REINVESTMENT ACT-ARRAThe office of the National Coordinator for

Health Information Technology set up a process to approve companies as Authorized Testing and Certification Bodies (ATCBs)

Review EHRs based on a set of testing criteria for each of the core and menu measures.

MEANINGFUL USE OBJECTIVES FOR AMBULATORY CARECenters for Medicare & Medicaid Services (CMS)

describes qualifications for incentive payments for meaningful use;

EP (eligible professional)Physician must participate in Medicare and Medicaid EHR Incentives Programs

20 of 25 objective must be met

All 15 core objective for ambulatory meaningful use must be met

Five of menu objectives for ambulatory meaningful use must be met

CORE OBJECTIVES FOR AMBULATORY MEANINGFUL USE1. Use Computerized Provider Order Entry (CPOE)

2. Implement Drug/Allergy Interaction Checking

3. Maintain Problem List

4. Generate ePrescriptions

5. Maintain Active Medication List

6. Maintain Active Medication Allergy List

7. Record Demographics

8. Record Vital Signs

9. Record Smoking status

10.Report Ambulatory Quality Measures

11.Implement Clinical Decision Support

CONT.…CORE OBJECTIVES FOR AMBULATORY 12. Provide patients with EHR Copy

13. Provide Clinical Summaries

14. Exchange Key Clinical Information

15. Protect Electronic Health Information

MENU OBJECTIVES FOR AMBULATORY MEANINGFUL USE1. Drug Formulary Checks

2. Clinical Lab Test Results

3. Patient Lists

4. Patient Reminders

5. Timely Access

6. Patient-Specific Education Resources

7. Medication Reconciliation

8. Summary Care Record

9. Immunizations Registries

10.Syndromic Surveillance Data

EXCLUSIONS

Certain objectives provide exclusions.

If an EP meets the criteria for exclusions, then EP can claim that exclusions during attestation

If exclusions is not provided, of if EP does not meet the criteria for an existing exclusion, then the EP must meet the measure of the objective in order to successfully demonstrate meaningful use and receive an EHR incentive payment

Failure to meet the measure of an objective or to qualify for exclusion for the objective will prevent the EP from successfully demonstrating meaningful use and receiving an incentive payment

Hospital core and menu objectives apply to inpatient settings which are not covered in this textbook. Hospitals have additional objectives that the ambulatory setting does not