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Electronic health record (EHR) technology is at the heart of the federal government's effort to make it easier for a wide variety of healthcare institutions to share medical data with other healthcare providers, with such groups as health information exchanges and regional health information organizations, and with patients themselves.
To that end, the Centers for Medicare & Medicaid Services implemented a financial incentive program to encourage healthcare providers to adopt certified EHR systems to improve patient care. The meaningful use program sets three stages of objectives for EHR adoption that eligible practitioners and hospitals must achieve to receive federal funds.
Beyond financial incentives, however, implementation of EHR technology is seen as a way to improve clinical workflows, data analysis and overall patient care.
What is an EHR?
An electronic health record is a digital version of an individual's medical data. It is collected and managed by multiple authorized healthcare 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 systems give 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.
What is the difference between an EMR and an EHR?
The terms electronic health record and electronic medical record (EMR) are often used interchangeably within the healthcare 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 and 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. Generally, an EMR contains information that is used for diagnosis and treatment. Many providers have an EMR system in place, but they are not necessarily interoperable with other providers' EMR systems. In other words, an EMR does not follow a patient and cannot be shared digitally with other healthcare providers.
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. Unlike an EMR, an EHR contains a broader view of a patient's medical history, including diagnoses and test results, and can follow a patient if he or she switches providers. 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.
How does EHR technology differ from PHR technology?
A personal health record is an electronic record that patients access with 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 PHR service is a component of EHR technology that gives patients a way to contribute information on symptoms or disease management to their records and communicate with their providers. A PHR contains the same information as an EHR but the patient manages it.
There are two subsets of PHRs: a standalone PHR and a tethered or connected PHR. With a standalone PHR, the patient fills in information from his or her own medical records. This information is stored on the patient's computer or online and can be shared with providers or caregivers. A tethered PHR is connected to a specific healthcare organization's EHR. The patient has access to information such as lab results or screening reminders through a secure portal.
Why is EHR technology important?
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 compel 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 systems that comply with HHS standards.
For regulatory purposes, the Office of the National Coordinator for Health Information Technology (ONC) 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 and went into effect in 2010.
For a 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 healthcare 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.
What are the benefits of an EHR system?
There are several benefits of EHR systems for providers and patients. EHRs offer faster access to patient records and a more complete and accurate picture of patient care. EHRs can also reduce the costs associated with paperwork and improve efficiency. They can also enable safer prescribing and reduce medical errors.
What is EHR interoperability?
EHR interoperability allows EHR systems to communicate and exchange data, and use the information that has been shared. However, because different EHR systems may capture data in different ways and for different uses, it can be difficult to share that information with another system. Standards and structure provide a common framework for data capture and exchange.
Do all paper records need to be converted to EHR?
There is no direct mandate at present for healthcare providers to convert paper records to electronic form. However, the federal government is requiring 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 and Medicaid Services within HHS released proposed meaningful use criteria on Dec. 30, 2009, with the final rule published July 28, 2010. Stage 1 of meaningful use set 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.
Should paper records converted to EHR be destroyed?
Medical records retention and destruction laws for both paper and electronic records vary from state to state, and the healthcare 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 systems. Records should not be destroyed without a thorough review of the applicable state and federal laws.
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