Computerization of Health Records: A “Meaningful Use” Perspective

Computerization of health records vis-à-vis electronic health records (EHR) or electronic medical records (EMRs) is arguably the most important healthcare information technology (IT) trend these days. Although the healthcare information management arena has been relatively slow in catching up to technology, physicians and others in the healthcare industry are starting to see the impact that IT has had on other industries and are ready to utilize technology as a tool as well.

As paper begins to disappear, utilizing technological devices to provide secure, timely and logically organized access to clinical information will become more realistic and imperative. Of course, with President Obama’s economic stimulus package offering monetary incentives for adoption and use of EHRs through the Health Information Technology for Economic and Clinical Health (HITECH) Act, there is no doubt healthcare IT has received a much-needed boost.

On Feb 17, President Obama signed the 2009 American Recovery and Reinvestment Act (ARRA) into law that qualifies hospitals and physicians for $17 billion worth of incentive payments from Medicare and Medicaid over a five-year period. Under ARRA, specifically the HITECH Act, $40,000 to $60,000 may be available for each physician proving “meaningful use” of an EHR.

“It’s an investment that will take the long, overdue step of computerizing America’s medical records to reduce the duplication and waste that costs billions of healthcare dollars and medical errors that cost thousands of lives each year,” President Obama said at the stimulus bill signing on February 17.

While the exact definition of “meaningful use” is yet to be determined by Health and Human Services Secretary Kathleen Sebelius, the legislation outlined three requirements:

 · E-Prescription — The EHR must include e-prescribing.

· Electronic Exchange of Health Information — The EHR must provide electronic exchange of health information.

· Report Clinical Quality Measures — The EHR must allow submission of clinical quality measures.

In the words of David Blumenthal, M.D., the national coordinator for health IT, “This is the beginning of a conversation that will continue for some time,” adding “there is a long way to go” before a final definition of “meaningful use” is achieved. The task of defining “meaningful use” is assigned to the Meaningful Use Workgroup, which presented its initial recommendations to the HIT Policy

Committee on June 16. The key goals postulated in the initial recommendations vis-à-vis a three-page preamble to the report and a well-defined, simple-to-understand matrix are:

• to improve quality, safety and efficiency, and reduce health disparities
• to engage patients and their families
• to improve care coordination
• to improve population and public health
• to ensure privacy and security protections for personal health information

The Workgroup has clearly developed the foundation of an inspiring and comprehensive definition that sets the groundwork for a tangible and substantial vision of transforming healthcare delivery while highlighting that this is a progressive undertaking focused on results and not merely an exercise in software implementation.

The preamble states, “The ultimate vision is one in which all patients are fully engaged in their healthcare, providers have real-time access to all medical information and tools to help ensure the quality and safety of the care provided, while also affording improved access and elimination of healthcare disparities. This ‘North star’ must guide our key policy objectives, the advanced care processes needed to achieve them, and lastly, the specific use of information technology that will enable the desired outcomes, and our ability to monitor them.”

Of course, technology will play a tremendous role in the realization of this vision, which is highlighted by the Workgroup’s early call for adoption of EHRs and computerized physician order entry (CPOE), including time- and cost-saving features such as electronic transmission of permissible prescriptions and incorporation of lab test results into EHRs.

According to an Institute of Medicine report, an estimated 100,000 people die each year from medical errors in hospitals. To the extent that such errors are attributed to faulty software systems, companies should focus on providing EHR software solutions that promote using health IT to improve patient safety reporting and data analysis and to prevent such errors by providing built-in safety management protocols and risk assessment tools, including early warnings and alerts.

The functionality of the EHR product a company offers is a key element. At the same time, there are other factors that are equally significant towards the fulfillment of EHR adoption. At the end of the day — no matter how technologically and functionally advanced a product may be — service and support are critical in the overall adaptability, transition, implementation and continued success. Sound implementation strategies with emphasis on an “evolutionary” versus “revolutionary” approach — keeping in mind the diverse needs of users, whether small practices and clinics or large hospitals and organizations — will be the cornerstone of meaningful EHR adoption. Indeed, successful customer implementation experience proves that those users who started utilizing EHRs early on not only have had the luxury of implementation time on their side, but also have improved their workflows and quality of patient care in a progressively “meaningful” manner while benefiting from advances in technology along the way.

In addition, the role of information networks will be vital in improving communication among healthcare organizations. An information and communications infrastructure is critical as many avoidable errors and poor outcomes can be attributed to inaccessible data, lack of properly documented information and the inability of agencies to share critical information in a secure and timely manner. Therefore, coordination, integration and overall management of clinical information across localities, regions and providers of care is critical if any healthcare IT initiative is to succeed.

Computerization of health records is inevitable. The challenge lies not in its necessity — whether it should be done. Rather, it lies in the approach — how it should be done. Many have and will continue to raise myriad concerns, whether from a technology, privacy or security point of view. However, as stated by Dr. Blumenthal, “It is a journey we must take if we are to improve care through the use of EHRs.” Whether we are for it or against it or somewhere in the middle, it cannot be denied that the effort towards the realization of “meaningful use” is a positive step on the road to EHR adoption and computerization of health records. With initiatives such as those undertaken by the Office of the National Coordinator (ONC) under the auspices of ARRA, physicians and others in the healthcare industry are starting to see the positive impact that IT has had on other industries and are more encouraged to utilize technology as a tool themselves. As we progress towards the ultimate vision, utilizing technological advances to provide secure, timely and logically organized access to clinical information will become more realistic, imperative and ultimately “meaningful.”