The Electronic Health Record (EHR)



HPM 702 The Electronic Health Record (EHR)Reflections on cost, access, and safetyMargaret D. Swift5/2/2011From 2002-2005 I worked at New York Presbyterian Hospital. During that time the Columbia University Medical Campus transitioned from a paper-based health record system to an electronic health record (EHR) system. The new system was faster, more convenient, reduced clinical errors, and streamlined our work. The transition appeared seamless to me, but current EHR efforts do not appear to be as easy. The American Recovery and Reinvestment Act (ARRA) of 2009 gave way to the Health Information Technology for Economic and Clinical Health (HITECH) Act; which promises to improve many aspects of health care services in the U.S. through the use and development of health informatics technology (HIT). Obama health care reform is ambitious, and concerns are mounting that current lack of funds, security, and provisions will not allow physicians or rural hospitals to meet the proposed 2014 deadline. This past February Dr. David Blumenthal announced he would be stepping down as the National Coordinator for Health Information Technology for the Health and Human Services’ (HHS) Office of National Coordination (ONC). Dr. Blumenthal was appointed by President Obama to spearhead a national effort to expand meaningful use HIT. Simply stated, meaningful use technologies should positively impacts health outcomes, and avoid using technology just for the sake of it. Health technology is believed to improve the access, quality, and cost of health care in the U.S.The EHR is being sold as the gold standard for hospital systems in order to provide more coordinated, safe, and effective medical care. The current administration is so confident in the EHR’s ability to improve quality they set forth a mandate for all health care facilities to adopt a system by 2014. In a memo announcing his resignation, Dr. Blumenthal noted that from 2008-2010 the proportion of Primary Care Physicians who have adopted a basic EHR increased from 19.6 to 29.6 percent CITATION Gal11 \l 1033 (Galewitz & Weaver, 2011). Since the mandate was announced, physicians have been slow to incorporate EHRs into their practices. If the slow growth rate continues 2014 deadlines will not be met. To eliminate potential EHR adoption barriers, ONC has set up Regional Extension Centers to provide support and guidance for physicians and rural communities “on the ground”. ONC has also partnered with community colleges across the U.S. to develop HIT training programs, and meet expanding IT demands. Other ONC programs, like SHARP and State HIE, support technology development and information sharing efforts. The ONC hopes these programs will support physicians, and make a difference in EHR adoption rates.Physicians most often cite a lack of financial incentives for not purchasing or integrating an EHR system CITATION Fel11 \l 1033 (Felming, Culler, McCorkle, Becker, & Ballard, 2011). To offset costs, the Center for Medicare and Medicaid Services (CMS) has issued meaningful use incentive programs. All incentives are provided on the physician’s ability to provide and demonstrate meaningful use. Medicare payments are targeted to physicians in fee-for-service environments and, with the exception of some Medicare Advantage restrictions, will provide payments regardless of Medicare patient load. Medicaid incentives provide 100 percent federal contribution for providers who meet the defined volume of Medicaid patients,. Payments can also be given for the initial cost of systems, upgrades, training, and other support services. Some states, including Kansas, are behind their HIT plan schedule. Plans must be submitted before Medicare and Medicaid payments can be made to physicians and hospitals CITATION Cau11 \l 1033 (Cauthon, 2011). This could greatly impact a physician’s willingness to use EHRs.An article in the New England Journal of Medicine acknowledges that HIT alone cannot transform our health system. The author suggests payment incentives be patient-centered, as opposed to performance based. Current incentives focus on billable events, rather than quality care tasks like coordination. The article goes on to suggest that, in a fee-for service environment, where time is limited, an EHR may further distract from patient care. CITATION OMa11 \l 1033 (O'Malley, 2011). There is also the matter of the EHR exchange systems. Seven states (Kansas (mentioned above), Maryland, Massachusetts, New York, Oklahoma, Oregon, and Wisconsin) were given a collective $241 million in “early innovator” grants. This money assists pilot programs indented to develop Internet-based systems that other states may be able to use in the future CITATION Lev11 \l 1033 (Levey, 2011). Exchange systems, in general, will create a competitive market where purchasing health care is as easy as shopping online for an airline-ticket. Early Innovator grant money hopes to increase access to health care coverage for the 24 million Americans without health care insurance. CITATION Lev11 \l 1033 (Levey, 2011)Skeptics question the impact of EHR technology on access, quality, and health care delivery. The Chart, a CNN health blog, cites a Stanford University study which found EHR delivered care is not as effective at increasing quality as promised. However, a later quote from Jeffrey C. Lerner states “new technology has a learning curve…Improving quality is a challenge, but avoiding use does not sound like an alternative.” CITATION San11 \l 1033 (Sanja & Cohen, 2011). Some physicians believe the data captured will increase our understanding of the true impact chronic disease has on minority groups, a population traditionally lacking epidemiological data. Others believe that EHR technology will increase the digital divide and health disparities among low-income groups. Doctors serving low-income populations say Medicare incentives won’t cover the cost of EHR system integration, and not all cultures embrace technology. For example, many African-Americans don’t trust our medical system, and while overall adoption has been low, low-income patients are even less likely to trust or use electronic health systems. CITATION Sch11 \l 1033 (Schwartz, 2011). Aside from financial barriers, usability and security concerns also slow EHR integration. The Direct Project is a government program that brings together over 60 IT organizations to further coordinate patient care across our health care system. Companies like GE, Google, IBM, Intel, Microsoft, NextGen, Siements and Surescripts are working together to develop a secure Open-Source system model that, as Arien Malec the coordinator of the Direct Project once said, “builds on proven technology that people are accustomed to”. The model will be an internet based e-mail system with public key encryption technology for health care. The Open-Source model hopes to help contractors provide more affordable and easy to use systems CITATION Loh11 \l 1033 (Lohr, 2011). Current EHR systems are facing the “Y2K” of health care. This refers to the need for electronic medical systems to switch from using ICD-9 codes to ICD-10 codes. Ray Dorchester, chief operating officer of HealthEdge Software Inc. says “People have been finding reasons not to do it, and it’s amazing how much angst and anxiety is being caused because of this one issue.” CITATION The11 \l 1033 (The Wall Street Journal, 2011)Fazard Mostashari, M.D., the ONC Deputy National Coordinator for Programs and Policy, says we are building on a vision rather than technology itself. He says ONC is following a set of principles to keep “their eye on the prize”, “their feet on the ground”, “foster innovation”, and “watch out for the little guy”. The goal is not IT itself, but meaningful use policy, and we must build upon what we already have. Dr. Mostashari believes that if we follow these principles, while remaining open, transparent, and democratic we can meet our goals. CITATION Mos11 \l 1033 (Mostashari, 2011)To ensure success, HITECH Act proponents and ONC administration should take advice from one Dr. Mostashari “to be constantly agile, monitoring and adapting, and aware of what’s going on in the real world” if it plans to fully integrates use of EHRs CITATION Mos11 \l 1033 (Mostashari, 2011). Technology has to be advanced enough to deliver, users have to be efficient and accurate, outcomes must be monitored, and the system must be flexible. If EHRs do not meet user quality standards they will not be accepted, and our efforts will have been a waste of time and money. Our healthcare system is complex and constantly evolving. If EHRs cannot adapt the quality of our health care will continue to fall behind that of other nations. Time can only tell, but I wonder if our commitment to diversity will end up being our greatest challenge. Works Cited BIBLIOGRAPHY David Blumenthal M.D., M., & Marilyn Tavenner, R. M. (2010). The "Meaningful Use" Regulation for Electronic Health Records. The New England Journal of Medicine , 363 (6), 501-504.Felming, N. S., Culler, S. D., McCorkle, R., Becker, E. R., & Ballard, D. J. (2011). The Financial and Nonfinancial Costs of Implementing Electronic Health Records In Primary Crae Practices. Health Affairs , 30 (3), 481-489.Galewitz, P., & Weaver, C. (2011, February 11). Blumenthal To Leave Obama's Health IT Office. Retrieved February 11, 2011, from Kaiser Health Newa : , M. M., & Thorpe Hyatt, J. J. (2010, Summer). The First Anniversary of the Health Information Technology for Economic Clinical Health (HITECH) Act: The Regulartoy Outlook for Implementation. Perspectives for Health Information Management , 1-14.Levey, N. N. (2011, February 17). 7 states get grants to develp online shopping systems for health insurance. Los Angeles Times .Lohr, S. (2011, February 2). U.S. Tries Open-Source Model for Health Sata Systems. Retrieved February 2, 2011, from : Miles, A. (2011, February 8). Vermont Gov. Proposes Single-Payer Health Plan. Retrieved February 8, 2011, from Kaiser Health News : of National Coordination. (2011). ONC Health IT Buzz Blog. Retrieved May 2, 2011, from 'Malley, A. S. (2011). Tapping the Unmet Potrntial of Health Information Technology. The New England Journal of Medicine , 1090-1091.ONC Press Office . (2011, February 2). New Release: ONC announces launch of "Direct Project" pilots. Retrieved May 2, 2011, from U.S. Department of Health and Human Services : , G. D., & Cohen, E. (2011, January 24). Electronic Health Records No Cure-All. Retrieved January 24, 2011, from The Chart: , E. (2011, January 11). Digital Divide Threatens Health Care. Retrieved January 2011, from Kaiser Health News .The Office of The National Coordinator for Health Information Technology. (2010, December 7). Get the Facts About The Nationwide Health Information Network, The Direct Project, and Connect Software. Washington, DC: The Department of Health and Human Services .The Wall Street Journal. (2011, February 22). IT Companies Stand to Gain From Health Care's 'Y2K' Problem. Retrieved February 22, 2011, from The Wall Street Journal: ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download