| By |
| Irfan Iqbal |
| Sequel Systems, Inc. |
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| Computerization of health records vis-à-vis Electronic Health Records (EHR) or Electronic Medical
Records (EMR) is arguably the most important health care information technology trend these days.
Although health care information management arena has been relatively slow in catching up to
technology, physicians and others in the health care industry are starting to see the impact that
information technology has had on other industries and they are ready utilize technology as a tool as well.
As paper begins to disappear, utilizing technological devices to provide secure, timely and logically
organized access to clinical information will become more realistic and imperative. Of course, with
President Obama’s economic stimulus package offering monetary incentives for adoption and use of EHR
through the HITECH act, there is no doubt healthcare information technology has received a much
needed boost. |
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| On Feb 17th President Obama signed the 2009 American Recovery and Reinvestment Act (ARRA) into
law that qualifies hospitals and physicians for $17 billion worth of incentive payments from Medicare and
Medicaid over a five-year period. Under the ARRA, specifically the Health Information Technology for
Economic and Clinical Health (HITECH) Act, $40-$60K may be available for each physician proving
“meaningful use” of an EHR. |
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| “It's an investment that will take the long overdue step of computerizing
America's medical records to reduce the duplication and waste that costs
billions of health care dollars and medical errors that cost thousands of
lives each year.” |
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| [President Obama’s Remarks at Stimulus Bill Signing Tue Feb 17th 2009] |
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| While the exact definition of “meaningful use” is yet to be determined by the HHS (Health and Human
Services) Secretary, the legislation outlined three requirements: |
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E-Prescription: The EHR must include e-prescribing. |
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Electronic Exchange of Health Information: The EHR must provide electronic exchange of health
information. |
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Report Clinical Quality Measures: The EHR must allow submission of clinical quality measures. |
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| In the words of David Blumenthal, M.D., the national coordinator for health information technology, “this is
the beginning of a conversation that will continue for some time," adding that "there is a long way to go"
before a final definition of meaningful use is achieved. The task of defining “meaningful use” is assigned
to the Meaningful Use Workgroup, which presented its initial recommendations to the HIT Policy
Committee on June 16th, 2009. The key goals postulated in the initial recommendations released on June
16, 2009 vis-à-vis a three-page preamble to the report and a well-defined, simple to understand matrix
are: |
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Improve quality, safety, efficiency, and reduce health disparities |
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Engage patients and their families |
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Improve care coordination |
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Improve population and public health |
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Ensure privacy and security protections for personal health information |
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| The Workgroup has clearly developed the foundation of an inspiring and comprehensive definition that
sets the groundwork for a tangible and substantial vision of transforming health care delivery while
highlighting that this is a progressive undertaking focused on results and not merely an exercise in
software implementation. |
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| “The ultimate vision is one in which all patients are fully engaged in their
healthcare, providers have real-time access to all medical information
and tools to help ensure the quality and safety of the care provided while
also affording improved access and elimination of health care disparities.
This ‘north star’ must guide our key policy objectives, the advanced care
processes needed to achieve them, and lastly, the specific use of
information technology that will enable the desired outcomes, and our
ability to monitor them.” |
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| [Preamble | “Meaningful Use: A Definition” | Recommendations from the
Meaningful Use Workgroup to the Health IT Policy Committee | June 16, 2009] |
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| Of course, technology will play a tremendous role in the realization of this vision, which is highlighted by
the Workgroup’s early call for adoption of electronic health records (EHRs) and computerized physician
order entry (CPOE), including time and cost-saving features such as electronic transmission of
permissible prescriptions and incorporation of lab-test results into EHRs. According to an Institute of
Medicine report, each year an estimated 100,000 people die from medical errors in hospitals. To the
extent that such errors are attributed to faulty software systems, companies should focus on providing
EHR software solutions that promote using health information technology to improve patient safety
reporting and data analysis and to prevent such errors by providing built-in safety management protocols
and risk-assessment tools including early warnings and alerts. |
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| The functionality of the EHR product a company offers is a key element. At the same time, there are other
factors that are equally significant towards the fulfillment of EHR adoption. At the end of the day, no
matter how technologically and functionally advanced a product may be, service and support are critical
in overall adaptability, transition, implementation and continued success. Sound implementation
strategies with emphasis on an “evolutionary” versus “revolutionary” approach—keeping in mind the
diverse needs of users, whether small practices and clinics or large hospitals and organizations—will be
the cornerstone of meaningful EHR adoption. Indeed, successful customer implementation experience
proves that those users who started utilizing EHRs early on not only have had the luxury of
implementation time on their side, but also have improved their workflows and quality of patient care in a
progressively “meaningful” manner while benefiting from advances in technology along the way. |
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| In addition, the role of information networks will be vital in improving communication among health care
organizations. An information and communications infrastructure is critical as many avoidable errors and
poor outcomes can be attributed to inaccessible data, lack of properly documented information and
inability of agencies to share critical information in a secure and timely manner. Therefore, coordination,
integration and overall management of clinical information across localities/regions and providers of care
is critical if any health care information technology initiative is to succeed. |
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| Computerization of health records is inevitable. The challenge lies not in its necessity – whether it should
be done. Rather, it lies in the approach – how it should be done. Many have and will continue to raise myriad concerns, whether from a technology, privacy or security point of view. However, as stated by Dr.
Blumenthal, “it is a journey we must take if we are to improve care through the use of EHRs.” Whether
we are for it or against it or somewhere in the middle, it cannot be denied that the effort towards the
realization of “meaningful use” is a positive step on the road to EHR adoption and computerization of
health records. With initiatives such as those undertaken by the Office of National Coordinator (ONC)
under the auspices of ARRA, physicians and others in the health care industry are starting to see the
positive impact that information technology has had on other industries and are more encouraged to
utilize technology as a tool themselves. As we progress towards the ultimate vision, utilizing technological
advances to provide secure, timely and logically organized access to clinical information will become
more realistic, imperative and ultimately “meaningful”. |
