Electronic Health Records

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What are Electronic Health Records?

►An electronic health record (EHR) is a systematic collection of electronic health information about individual patients or populations in digital format that can be shared across health care settings.

►EHRs can:► Contain a patient’s medical history, diagnoses, medications, treatment

plans, immunization dates, allergies, radiology images, and laboratory and test results.

► Allow access to evidence-based clinical decision support tools that providers can use to make decisions about a patient’s care—and access comprehensive information about potential therapies.

► Automate and streamline provider workflow and communication across healthcare settings.

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Electronic Health Records – Who uses EHRs?

► EHRs are used by:► Primary care physicians and specialists ► Hospitals► Nurses and Technicians► According to HHS, 85% of eligible hospitals are participating in the EHR incentive program, and

75% have earned incentive payments. ► Additionally, 73%, or 388,000, of the nation’s eligible professionals have registered to participate in

the EHR incentive program, and 44% have earned the incentive payment.► Coordination of Care

► EHRs have the potential to integrate and organize patient health information and facilitate its instant distribution among all authorized providers involved in a patient's care.

► EHRs can improve prevention by providing doctors and patients better access to test results, identifying missing patient information, and offering evidence-based recommendations for preventive services.

► Example: EHR alerts can be used to notify providers when a patient has been in the hospital, allowing them to proactively follow up with the patient.

► Accurate and up-to-date information is especially important with patients who are seeing multiple specialists, making transitions between care settings or receiving treatment in emergency settings.

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Barriers to Adoption

► The price of EHR and provider uncertainty regarding the value they will derive from adoption in the form of return on investment has a significant influence on EHR adoption. In a project initiated by the Office of the National Coordinator for Health Information (ONC), surveyors found that hospital administrators and physicians who had adopted EHR noted that any gains in efficiency were offset by reduced productivity as the technology was implemented, as well as the need to increase information technology staff to maintain the system.

► The Healthcare Information and Management Systems Society (HIMSS), the industry’s largest trade group, has observed that the biggest barriers to adoption of EHR are the initial costs, the lost productivity during EHR implementation, and lack of efficiency and usability of EHRs currently available.

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Office of the National Coordinator of Health Information Technology (ONC)

►The Office of the National Coordinator (ONC) is the principal federal entity charged with coordination of nationwide efforts to implement health information technology and the electronic exchange of health information.

►ONC defines and certifies technical requirements for EHR technology that eligible hospitals and providers must possess to meet the “meaningful use” objectives in the EHR Incentive Program.

►ONC is led by the National Coordinator for Health IT► Dr. Farzad Mostashari is the most recent National Coordinator.

Mostashari is stepping down effective October 5th

► Jacob Reider, M.D. will be the be the new acting National Coordinator

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Meaningful Use

► Meaningful Use:► The set of standards defined by the Centers for Medicare & Medicaid Services (CMS) Incentive Programs that

governs the use of electronic health records and allows eligible providers and hospitals to earn incentive payments by meeting specific criteria.

► The Health Information Technology for Economic and Clinical Health (HITECH) Act (Title XIII under the American Recovery and Reinvestment Act of 2009) provides the Department of Health & Human Services (HHS) with the authority to award incentive payments to health care professionals and hospitals when they adopt and use certified EHR technology in a way that achieves specific health outcomes and objectives.

► These meaningful use objectives and measures will evolve in three stages over the next five years:► Stage 1 (2011-2012): Data capture and sharing► Stage 2 (2014): Advance clinical processes► Stage 3 (2016): Improved outcomes: the Office of the National Coordinator has outlined 6 broad ideas for

Meaningful Use Stage 3► Improving quality of care and safety► Engaging patients and families in their care► Improving population and public health► Affordable care► Reducing health disparities

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E-Prescribing

► E-Prescribing, one of the Core Measures for Meaningful Use, is a prescriber's ability to electronically send an accurate prescription directly to a pharmacy from the point-of-care.

► Meaningful Use Stage 1 Goal: More than 40% of all permissible prescriptions written are transmitted electronically using certified EHR technology

► Meaningful Use Stage 2 Goal: 50% of all permissible prescriptions transmitted electronically and compared to at least one drug formulary

► Key Uses:► Help to prevent, and in some cases eliminate, prescription errors including illegible hand-writing,

incorrect dosing, and missed drug/allergy reactions.► In some cases, serve as notification and record of patient treatment.► Systems must be capable of performing key functions such as:

► Medication selection – e.g. diagnosis based medication menus, drug interaction checking, safety-alerts, prescription renewal, dosage calculation

► Patient information – e.g. current patient medication list, access to patient historical data, patient identification

► System integration and interoperability – e.g. connection with databases, connection with pharmacy and pharmacy benefit manager systems

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Meaningful Use Timeline

Meaningful Use Stage 3 Priorities - 2016

Improving quality, safety, and efficiency, leading to

improved health outcomes

Decision support for national high-priority

conditions

Patient access to self-management tools

Access to comprehensive patient data through patient-centered HIE

Improving population health

Meaningful Use Stage 2 Priorities – 2014 Start Date Hospitals: 10/1/13 Start Date: Providers: 1/1/14More rigorous health

information exchange (HIE)

Increasing requirements for e-prescribing and

incorporating lab results

Electronic transmission of patient care summaries across multiple settings

More patient-controlled data

Meaningful Use Stage 1 Priorities – 2011-2012Electronically capturing health information in a

standardized form

Using that information to track key clinical

conditions

Communicating that information for care

coordination processes

Initiating the reporting if clinical quality measures and

public health information

Using information to engage patients and their

families in their care

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Meaningful Use – Latest Developments

► 17 Senators, led by Sens. John Thune (R-SD) and Lamar Alexander (R-TN) have recently requested that providers be given and extra year to meet the new requirements of for Meaningful Use Stage 2

► The request would only apply to those providers that are not yet ready to meet the new requirements in 2014

► The request was praised by the American Hospital Association and the American Medical Association

► During a Senate Finance Committee hearing in July 2013, heath care providers and health IT vendors recommended that Stage 2 be delayed by one year until October 1, 2015. Chairman Baucus has not expressed support for a delay.

► Other groups, including the Medical Group Management Association, also requested a delay earlier this year.