Electronic health record (EHR) technology is at the heart of the federal government’s effort to make it easier for a wide variety of health care institutions to share medical data with other health care providers, with such groups as health information exchanges and regional health information organizations, and with patients themselves.
To that end, the federal government has put financial incentive programs in place that encourage hospitals and health care providers to adopt EHR technology by the end of 2014. Beyond financial incentives, however, implementation of EHR technology is seen as a way to improve clinical workflows, data analysis and overall patient care.
An electronic health record is a digital version of an individual’s medical data. It is collected and managed by multiple authorized health care providers, and can be exchanged electronically among them. It consists of information gathered by organizations over a period of time – it’s often referred to as a longitudinal record -- rather than information from a single visit to a doctor or hospital. It includes demographic data, medical history and clinical information, such as laboratory, radiology and pharmacy data.
Additionally, EHR technology gives patients a way to access some portion of their electronic record through personal health record (PHR) services, which allow patients to view such information as lab results through a secure Web portal.
The terms electronic health record and electronic medical record (EMR) are often used interchangeably within the health care industry, but they actually mean different things in the regulatory arena.
EMR is a generic term long used by providers to refer to a computerized patient record. For many years, doctors and hospitals have been deploying their own, discrete EMR systems to improve their practices, basically replacing paper charts with computerized records.
The Agency for Healthcare and Research Quality within the U.S. Department of Health & Human Services (HHS) describes an EMR generally as a record that draws from a set of databases that hold patient health information within one institution, such as one hospital or one physician’s office. Many providers have an EMR system in place, but they are not necessarily interoperable with other providers’ EMR systems.
An EHR, as stated, refers to an aggregate of a patient’s EMR data that is generated over time by various institutions and can be shared among them. An institution can use EHR technology only if it has an EMR system that is capable of interoperating with other EMR systems.
This data-sharing component of EHR technology raises additional privacy and security issues beyond those created by EMR systems. Unlike EMRs, EHRs represent a government-backed initiative to link medical data nationwide and make it easier to collect, share and report on.
A personal health record (PHR) or a personal medical record (PMR) is an electronic record that patients can access using an application that allows them to manage their health information “in a private, secure and confidential environment,” according to HHS.
It should be noted that a PMR or PHR service is a component of EHR technology that gives patients a way to contribute information on symptoms or disease management to their record and communicate with their providers.
The Health Information Technology for Economic and Clinical Health Act, or HITECH Act, which is one section of the American Recovery and Reinvestment Act of 2009, established financial incentives and penalties to impel providers to become “meaningful” users of certified EHR technology. To qualify for incentive payments, which are administered via the Medicare and Medicaid programs, providers must use EHR technology that complies with standards issued by HHS.
For regulatory purposes, the Office of the National Coordinator for Health Information Technology (ONC) within HHS established definitions for “qualified EHR” and “certified EHR” technology in an interim final rule implementing the HITECH Act, which was published in the Federal Register Jan. 13 and went into effect Feb. 2.
For qualified EHR, HHS took a definition already created in the Public Health Services Act:
[A]n electronic record of health-related information on an individual that: (A) includes patient demographic and clinical health information, such as medical history and problem lists; and (B) has the capacity: (i) to provide clinical decision support; (ii) to support physician order entry; (iii) to capture and query information relevant to health care quality; and (iv) to exchange electronic health information with, and integrate such information from other sources.
Certified EHR, meanwhile, is qualified EHR technology that has met certification requirements established by the ONC.
There is no direct mandate at present for health care providers to convert paper records to electronic form. However, the federal government is impelling providers to become “meaningful” users of EHR technology if they want to receive financial incentives under the Medicare and Medicaid programs and avoid penalties under those programs later on. The incentives and penalties are established in the HITECH Act.
The criteria for being a meaningful user of EHR technology remain in flux, but currently they do not require providers to convert all old paper records to electronic form. The Centers for Medicare & Medicaid Services within HHS released proposed meaningful use criteria on Dec. 30, 2009, which are expected to be made final this spring. In Stage 1 of meaningful use, there are 25 proposed measures for physicians to meet, such as using EHR technology when submitting 80% of their clinical orders and transmitting 75% of permissible prescriptions electronically.
Providers must become meaningful users by 2015, or they will incur financial penalties, which will increase in subsequent years.
Medical records retention and destruction laws for both paper and electronic records vary from state to state, and the health care industry’s guidelines vary as well.. Some state laws may require providers to hold on to some paper records even after they have deployed EHR technology. Records should not be destroyed without a thorough review of the applicable state and federal laws.
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