EHRs in Health Care x x x Abstract In 2009, the Health Information Technology for Economic and Clinical Health Act (HITECH) was passed into law mandating interoperable Electronic Health Record (EHR) adoption throughout the United States health care system for all providers who serve Medicare or Medicaid patients. The HITECH Act sets “meaningful use” requirements, goals, and objectives, and gives specific timelines for which to achieve them.
As an incentive to expedite the process, the Centers for Medicare and Medicaid Services (CMS) has offered monetary rewards for those facilities and physicians who are taking steps to implement an EHR system by 2015.
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Meaningful use has three stages, each focusing on different areas of patient care. There are several advantages and disadvantages of implementing an EHR system, but the benefits greatly outweigh the risks. The HITECH Act is one of the most important pieces of health care legislation to date and has been called the “foundation for health care reform” (Blavin & Ormond, 2011). In 2004, the Bush administration introduced a plan to ensure that the medical profession completely converts to electronic health records (EHR).
This plan was passed into law by the Obama administration in 2009 under the Health Information Technology for Economic and Clinical Health Act (HITECH), which is a provision of the American Recovery and Reinvestment Act (ARRA) (Kwami, n. d. ). This Act is essentially a $27 billion stimulus package meant to accelerate health care information technology in the United States. It allows the Centers for Medicare and Medicaid Services (CMS) to offer financial incentives (up to $44,000 from Medicare and $63,750 from Medicaid per physician or up to $2 million per hospital) for implementing an
Electronic Health Record (EHR) system in their facility by 2015 (Murphy, 2012). Not only do they have to implement it, they must also meet the “meaningful use” requirements set forth by CMS for successful utilization of the EHR system. To receive the maximum incentive payment, physicians/facilities must begin participation by April 1, 2013. Starting in 2015, physicians and facilities who have not met those requirements will be penalized. What is Meaningful Use? Meaningful use is an umbrella term for the rules and regulations that hospitals and physicians must meet to qualify for the federal incentive funding under ARRA.
There are three stages of meaningful use; each has different goals and objectives. For example, stage one focuses on data capture and sharing, and is grouped into five patient-driven areas related to patient health outcomes: 1. ) Improve quality, safety, and efficiency, 2. ) Engage patients and families, 3. ) Improve care coordination, 4. ) Improve public and population health, and 5. ) Ensure privacy and security for personal health information (“Meaningful Use 101,” n. d. ). Step two focuses on the advanced clinical processes involved in patient care and stage three will focus on improving actual patient outcomes.
Requirements for meaningful use include the ability to e-prescribe, electronically exchange patient health information, and report on clinical data. The eventual goal is a national health information network. Facilities and physicians must achieve stage three of meaningful use by 2015. Traditionally, physicians have been reimbursed based on how many services they provide (fee for service). Meaningful use shifts this paradigm to a more patient centered process and concentrates on performance-based initiatives like pay for performance (P4P) reimbursement.
CMS recently introduced three P4P programs mandated by ARRA designed to reward higher-performing hospitals and penalize poorer-performing hospitals through these reimbursement practices. Hospitals performing at or below the 50th percentile nationally on hospital quality and patient experience measures can expect to see a significant reduction in payment from CMS as early as 2012 (“Pay for Performance Payment,” n. d. ). The shift from volume-based to value-based reimbursement methodology puts more emphasis on patient care and achieving positive outcomes.
Another part of meaningful use requires that EHRs are interoperable with other facilities and physicians even if they are not the within the same organization. This means that every organization’s EHR system must to be able to “talk” to other organizations’ systems. If a patient travels to another state or another country and needs to go to the doctor for any reason, the physician there will be able to bring up the patient’s EHR and treat them based on the up-to-date medical information contained in their EHR. This is especially important in emergency situations where the patient may not be in the position to supply needed information.
Locally, interoperability is important because it helps physicians communicate with other facilities such as a referral. A patient’s family physician may refer them to a specialty doctor and with an EHR, both doctors can view and document findings in one record rather than having separate papers that need to be brought in by the patient and filed in their paper record. EHRs are also an asset within the same facility. When a patient gets a lab or x-rays done, the physician can immediately bring up the results rather than having to wait for the lab/x-ray technician to physically bring the results to them.
Interoperability makes coordination of care easier and more efficient. Advantages of Implementing an EHR In addition to the benefits of interoperability, there are several other advantages of implementing an EHR. The main goal of an EHR is to improve the quality and safety of patient care. EHRs can help provide better health care by improving all aspects of patient care like safety, effectiveness, patient-centeredness, communication, education, timeliness, and efficiency (“What Are the Advantages,” n. . ). Having a single record that includes all of a patient's health information and is up to date, complete, and accurate allow for better coordination of care, accessibility of information, convenience, simpler disease management, enhanced collaboration between providers by improved information sharing, a significant reduction in medical errors, up-to-date medication and allergy lists, and cost savings in the long run (“Benefits of EHRs,” n. d. ). EHRs also reduce waste and liminate duplicate screenings and tests, as well as help physicians make better, more comprehensive clinical decisions by integrating patient information from multiple sources into one EHR (“What Are the Advantages,” n. d. ). Another advantage of having your health record in electronic format is increased security and privacy. With a paper record, anyone can pull it off the shelf and browse through it, but with an electronic record there are differing levels of authorization allowing only certain people access to your chart. Also, your chart cannot get “lost”.
Instead of someone having to sign it out every time they need to use it and having to manually track it, an EHR allows multiple users to access it at different times, on different computers, and leaves an audit trail automatically. Disadvantages of Implementing an EHR There are also disadvantages of EHRs including overall cost, ongoing maintenance costs, changes in workflow, and temporary loss of productivity just to name a few (Menachemi ; Collum, 2011). One of the biggest concerns of implementing an EHR system is the initial cost.
Acquiring and implementing an EHR system can be quite expensive depending on the size of the facility. The projected total cost for a medium sized inpatient facility with a seven year EHR installation is approximately $19 million. In the outpatient setting, cost is approximately $14,000 per physician in the initial year of implementation for a six-physician practice, and $19,000 per physician with three or fewer physicians (Menachemi ; Collum, 2011). Smaller practices may find it hard to cope with the added expense of an EHR system; the viability of those practices may suffer as a result.
Another disadvantage of implementing an EHR system is the cost of transitioning from paper to electronic records. Additional staff will be required to scan in all of the paper documents into electronic format. This process can take months depending on how big the facility is so it could really have an impact on a facilities bottom line. There will also be a period of time where the staff is less productive than they would normally be as they learn how to use the electronic system. This period is called the “learning curve”.
To help remedy this, temporary staff will need to be hired to fill in the gap and keep the workflow up to date which also has a significant financial effect on an organization. The maintenance of an EHR system can be costly and technology is not always reliable. Hardware must be replaced and software must be upgraded on a regular basis. In addition, providers must have ongoing training for staff as well as IT support available, such as a 24/7 help line. Also, as with all things electronic, there is always the possibility of the system going down.
Hospitals and physicians must have a plan in place outlining what the proper procedure is for the “down time” until the system is up and running again. This generally means they will have to revert back to paper documentation while the system is down, so they also need to have a recovery plan in place detailing how they will go about getting the paper documentation from the “down time” transferred into the EHRs. Conclusion Although some might argue that an EHR system is too costly and too much work, it is a federal mandate that all physicians/facilities (who service Medicare or Medicaid patients) implement an EHR system.
And while the transition from paper to electronic is a costly and tedious process, the benefits of an EHR are numerous and greatly outweigh the cost of implementation. As President Obama said, “You shouldn’t have to tell every new doctor you see about your medical history or what prescriptions you’re taking. You shouldn’t have to repeat costly tests. All that information should be stored securely in a private medical record so that your information can be tracked from one doctor to another — even if you change jobs, even if you move, even if you have to see a number of different specialists.
That’s just common sense. ” (Making the Switch: Replacing, 2010). References Benefits of EHRs. (n. d. ). Retrieved February 13, 2013, from http://www. healthit. gov/providers-professionals/improved-care-coordination Blavin, F. , ; Ormond, B. (2011, May). HITECH, meaningful use, and public health: Funding opportunities for state immunization registries [White paper]. Retrieved from http://www. medicaidhitechta. org/Portals/0/Users/011/11/11/ImmunRegWhitePaper. pdf Kwami, K. K. (n. d. ). The EMR federal requirements of physicians. Retrieved February 13, 2013, from http://www. how. com/list_6961848_emr-federal-requirements-physicians. html Making the switch: Replacing your EHR for more money and more control [White paper]. (2010, September). Retrieved from http://www. healthcareitnews. com/sites/default/files/ resource-media/pdf/making_the_switch_replacing_your_ehr. pdf Meaningful use 101. (n. d. ). Retrieved February 13, 2013, from http://www. medicity. com/meaningful-use-101. html Menachemi, N. , ; Collum, T. H. (2011, May 11). Benefits and drawbacks of electronic health record systems. Retrieved from http://www. ncbi. nlm. nih. ov/pmc/articles/PMC3270933/ Murphy, K. (2012, May 9). American Recovery and Reinvestment Act (ARRA). Retrieved from http://ehrintelligence. com/glossary/american-recovery-and-reinvestment-act-arra/ Pay for performance payment systems that reward or penalize hospitals based on performance. (n. d. ). Retrieved February 13, 2013, from http://www. getwellnetwork. com/services/health-reform/pay-performance What are the advantages of electronic health records? (n. d. ). Retrieved February 13, 2013, from http://www. healthit
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