Revolution In The Evolution Of The Electronic Health Record

The healthcare IT world is abuzz with excitement because the Electronic Health Record has finally gained recognition as a critical element in the restructuring of healthcare. For years Democrats and Republicans, clinicians and administrators have all talked about how automation would create the missing efficiency in the healthcare system. But, in reality, little was done about increasing the rate of EHR adoption.

Financial healthcare transactions received a boost in 1996 when HIPAA established rules for the use of electronic claims and other financial transactions. Since then electronic financial transaction volume in healthcare has climbed dramatically, benefitting all.

Electronic prescribing also received a nudge in 2003 from the Medicare Modernization Act, which established rules for the use of electronic prescribing and provided mandates and financial incentives. As a result ePrescribing has steadily gained traction, resulting in increased efficiency and lower medication errors.

Most recently, the economic downturn spurred the American Recovery and Reconstruction Act of 2009 which committed $19 billion to healthcare information technology. The Health Information Technology for Economic and Clinical Health Act, or the "HITECH" portion of ARRA, established standards, implementation specifications, and certification criteria for EHR technology. It also established programs under Medicare and Medicaid to provide financial incentives, including payments and penalties, to encourage the "meaningful use" of EHRs. (The full 556-page document defining meaningful use can be downloaded here).

Healthcare is one of the most information intensive industries, yet it has been one of the least automated. Today, many life and death decisions are made by physicians using barely readable documents transmitted by decades old FAX machines. Other developed countries, such as Denmark, are far ahead of the US in adoption of EHRs. The US needs automation to increase efficiency and reduce errors. The core functionality for healthcare clinical automation is the Electronic Health Record, also known as the Electronic Medical Record.

To understand EHR adoption in today’s US market, it is important to understand “Meaningful Use” the incentive scheme used by ARRA to motivate providers and hospitals to adopt and utilize EHRs. Proposed rules were issued on December 30th and final rules are expected by late spring

According to the proposed rules, hospitals will be measured by 23 indicators of meaningful use which will become increasingly stringent over time. A recent article in HealthCare IT News summarizes the 23 Stage 1 Meaningful Use criteria for eligible hospitals. These criteria include:

Communicating clinical orders electronically

Automatically checking for unintended drug interactions

Maintaining an up-to-date problem list of current and active diagnoses

Keeping an electronic list of each patient’s medications

Maintaining a list of the patient’s medication allergies

For doctor’s offices, there are 25 indicators of meaningful use. These include many of the same indicators as those used for hospitals. The full list is available here. Some examples are:

Recording and charting changes in vital signs

Recording smoking status

Incorporating clinical lab results as structured data

Generating lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, and outreach

Since the announcement of Meaningful Use, a great debate has arisen among EHR vendors and pundits. Many complain that Meaningful Use will delay adoption as hospitals and physicians wait to see which EHR vendors survive the certification process. Others say that Meaningful Use is stifling innovation as vendors focus their development efforts on fulfilling Meaningful Use requirements rather than inventing new features and functions.

However, one could argue that Meaningful Use does not promote technology for technology’s sake but instead requires providers and hospital to use EHRs to reduce medical errors and more effectively care for patients. This regulation could drive the transformation of American medicine in a positive direction, reducing medication errors and facilitating evidence-based medical practices.

Healthcare vendors may need to face the fact that EHR adoption and utilization in the US has been growing at a pitifully slow rate. Even if Meaningful Use creates a few initial hiccups, it is difficult to imagine that this innovative regulatory scheme, along with $19 billion dollars, won’t pick up the pace of EHR adoption as well as innovation.

MedHealthWorld
Ed Daniels
June 3, 2010