You hear much in the news particularly in the medical community about electronic health records (EHR) and/or electronic medical records (EMR). An EHR is a technological method to input individual health records in a digital form where they are stored and accessed with a computer. The records may include single locations (clinics/hospitals) or a site that stores multiple records accessible by careproviders from virtually anywhere. A variety of types of healthcare-related information may be stored and accessed in this way.
What Type of Information Might be Included?
- Patient demographics
- Medical history, examination and clinical notes .
- Drug use and interactions, allergy and immunization history.
- Laboratory test results.
- Radiology images (X-rays, CTs, MRIs, etc.)
- Photographs, endoscopy, surgery, clinical
- Historical recommendations for specific medical conditions
- Appointments and other reminders.
- Billing records.
- Eligibility information on insurance protocols
- Advanced directives, living wills, and health powers of attorney
What is the Current Method of Producing and Managing Medical Records
First, think of all the variables involved with a record. The patient visits the doctor’s office, a record is developed there, demographics, history, treatment information, drugs recommended and their interaction, and the outcomes. The services are then billed and all of the billing from initiation to payment and writeoffs must be maintained. The patient may be referred to another care element, laboratory, x-ray, etc., and that entity then establishes its own record. It returns the results to the referrer which are now added to the referrer’s patient record. Now there are two distinct records created for the same patient.
When a patient is hospitalized, the same process is required. The hospital creates all of its treatment records, billing and payment information. The related treatment records are provided to the physician who managed the care of the patient.
When the patient is referred to a specialist, s/he then needs a copy of the patient record, and in turn, develops her/his own version, communicating the findings back to the referrer.
Medical facilities typically pay the highest costs per square foot for the space they occupy. Physical storage requirements for the potentially huge amount of hard copy data that is placed in file folders and filed in file cabinets is costly. When the hard copies are no longer required to be maintained, electronic methods are used to scan and store them.
With storage in so many different locations, transporting or communicating the information for review by a provider is time-consuming and may affect the quality of care. The way the information is communicated is the very core of the need for Health Information Portability and Accountability Act (HIPAA) regulation and the compliance requirements. HIPAA requirements were designed to protect health information.
With all of the disparate participants involved in managing the record, in the early 1990s, an estimate was made that one in seven (14%) hospitalizations occurred when medical records were not available. Additionally, one in five lab tests (20%) were repeated because results were not available at the point of care.
Implementation of electronic medical records are estimated to improve efficiency by 6% per year with the expectation that a fair amount of the cost of an EMR would be offset by the savings gained in not repeating unnecessary tests or require hospital admission. Not to mention at all the costs of litigation involved in the issues of quality of care.
Standardization is the goal for EMRs as well. Currently, handwritten paper records are associated with poor legibility (contributing to both medical coding and medical billing errors). EMR would help with the standardization process to include forms, terminology, abbreviations, data input and retrieval.
What are the Potential Benefits?
- Access to a full record reduces medical errors (which improves quality of care) since the problems and treatment history are ideally available immediately, rather than through other slower forms of communication (phone, fax, and snailmail)
- Increase physician and staff efficiency, and reduce costs
- Standardization of elements of health care documentation and interchange of such information
- Data collection for clinical and epidemiological analysis
Implementation to Date
Aside from the Veterans Administration Healthcare system, the vast majority of healthcare transactions in the United States still take place on paper, a system that has remained unchanged since the 1950s.
As of 2000, adoption of EHRs and other health information technology (HITs) (such as computer physician order entry (CPOE)) was minimal in the United States (outside of the VA system). Less than 10% of American hospitals had implemented HIT, and 16% of primary care physicians used them. In 2001-2004 only 18% of ambulatory care encounters utilized an EHR system. In 2005, 25% of office-based physicians reported using fully or partially electronic medical record systems (EMR), an almost one-third increase from the 18.2% reported in 2001. However, less than one-tenth of these physicians actually had a “complete EMR system” (with computerized orders for prescriptions, computerized orders for tests, reporting of test results, and physician notes).
The healthcare industry spends only 2% of gross revenues on HIT, which is meager compared to other information intensive industries such as finance, which spend upwards of 10%.
What is the Government’s Position?
With federal directives pushing for the HER, in September of 2008, Congressman Stark and eight co-sponsors introduced the Health-e Information Technology Act of 2008. According to Stark, chairman of the House Ways and Means Subcommittee on Health, the bill is designed to promote the adoption and meaningful use of health information technology.
The bill builds on measures already proposed in the PRO(TECH)T Act, H.R. 6357, introduced July 23 by John Dingell and under consideration by the House Energy and Commerce Committee.
The new bill includes measures that would provide clear deadlines and standards to spur development of HIT systems, incentives to drive healthcare IT adoption and strong rules to protect the privacy of personal health information.
According to Justin Barnes, chairman of the EHRA (formerly the Electronic Health Records Vendor Association), “There are some good points in the bill around HIT adoption incentives, and the privacy and consent language is much better than (the PRO-(TECH)T Act). But the negatives in this bill outweigh the positives right now.”
Mr. Barnes stated it would modify the HIPAA Act of 1996 and extend to business associates the same protections and penalties that apply to physicians, hospitals and other providers. “This is a dramatic change to HIPAA, and we need to take a closer look at the ramifications and burdens it could place on this industry.”
In addition, patients would be able to request an audit trail of medical record disclosures and civil monetary penalties would be increased for violations of federal privacy rules. “This is of great concern as well and we need to take a closer look at its ramifications and burdens placed on care providers.”
Federal Initiatives and Status
Visit the website of the Office of the National Coordinator for Health Information Technology (ONC). A good overview of the objectives and progress is available, plus a list of IT related articles. http://www.hhs.gov/healthit/chiinitiative.html
The benefits are clear. The problems are many, but EHRs are becoming more and more of a reality. As with any major change, the opportunities for newly described emerging jobs, positions and responsibilities will follow.