Health Policymaking in the UsaHealth Policymaking in the UsaHSA 460Health Policymaking in the USKerry PaineProjectAn electronic medical record (EMR) is a medical record in digital format.In health informatics an EMR is considered by some to be one of several types of EHR (electronic health record)s, but in general usage EMR and EHR are synonymous.
The term has sometimes included other (HIT, or Health Information Technology) systems which keep track of medical information, such as the practice management system which supports the electronic medical record.
As of 2006, adoption of EMRs and other health information technology, such as computer physician order entry (CPOE), has been minimal in the United States. Less than 10% of American hospitals have implemented health information technology,[2] while a mere 16% of primary care physicians use EHRs.[3] The vast majority of healthcare transactions in the United States still take place on paper, a system that has remained unchanged since the 1950s. The healthcare industry spends only 2% of gross revenues on HIT, which is meager compared to other information intensive industries such as finance, which spend upwards of 10%.[4] The following issues are behind the slow rate of adoption:
InteroperabilityIn healthcare, interoperability is the ability of different information technology systems and software applications to communicate, to exchange data accurately, effectively, and consistently, and to use the information that has been exchanged. [5]
In the United States, the development of standards for EMR interoperability is at the forefront of the national health care agenda.[2] Without interoperable EMRs, practicing physicians, pharmacies and hospitals cannot share patient information, which is necessary for timely, patient-centered and portable care. There are currently multiple competing vendors of EHR systems, each selling a software suite that in many cases is not compatible with those of their competitors. Only counting the outpatient vendors, there are more than 25 major brands currently on the market. In 2004, President Bush created the Office of the National Coordinator for Health Information Technology (ONC), originally headed by David Brailer, in order to address interoperability issues and to establish a National Health Information Network (NHIN). Under the ONC, Regional Health Information Organizations (RHIOs) have been established in many states in order to promote the sharing of health information. Congress is currently working on legislation to increase funding to these and similar programs.
The Center for Information Technology Leadership described four different categories (“levels”) of data structuring at which health care data exchange can take place. [6] While it can be achieved at any level, each has different technical requirements and offers different potential for benefits realization.
The four levels are[7]:LevelData TypeExampleNon-electronic dataPaper, mail, and phone call.Machine transportable dataFax, email, and unindexed documents.Machine organizable data (structured messages, unstructured content)HL7 messages and indexed (labeled) documents, images, and objects.Machine interpretable data (structured messages, standardized content)Automated transfer from an external lab of coded results into a provider’s EHR. Data can be transmitted (or accessed without transmission) by HIT systems without need for further semantic interpretation or translation.
Older record incorporationTo attain the wide accessibility, efficiency, patient safety and cost savings promised by EMR, older paper medical records ideally should be incorporated into the patients record. The digital scanning process involved in conversion of these physical records to EMR is an expensive, time-consuming process, which must be done to exacting standards to ensure exact capture of the content. Because many of these records involve extensive handwritten content, some of which may have been generated by different healthcare professionals over the life span of the patient, some of the content is illegible following conversion. The material may exist in any number of formats, sizes, media types and qualities, which further complicates accurate conversion. In addition, the destruction of original healthcare records must be done in a way that ensures that they are completely and confidentially destroyed. Results of scanned records are not always usable; medical surveys found that
[PDF, 3MB]
3.1 Key findings of the study from the Clinical Use Cases project of the US Department of Health and Human Services (HHS) are as follows: A clinical use of electronic health records (EHRs) is now being used to facilitate diagnosis and treatment of specific medical conditions. A further 50% of EHRs (21 for men and 8 for women), by contrast, are in use for routine checkups and procedures, with use rates approaching the 95% confidence interval of current standard practice data (6). Despite high rates of eHRs (25%), this is the first time that this proportion has increased to 5%. The prevalence of EHRs as compared to standard practice records has declined for a number of other indications, including depression (3), anxiety (1), and insomnia (4). The greatest rate of the reported use of electronic health records for depressive disorders is associated with a 1% increase in the quality and efficacy of patient information over the 10-year period, which is at odds with the majority of the current EHR program in use. An increasing proportion of EHRs use for other indications such as diabetes, heart attack and stroke, as well as certain conditions (19%), are still at or above 5%-13%. In contrast, in general, patients and healthcare professionals are increasingly taking steps to improve their quality of patient information, which should improve the reported use rate of electronic health records. The reported use of electronic records for the purpose described was achieved in a number of clinical use cases, mostly among patients who were at the very beginning of a clinical use. Because of this, there is a need for information from all clinicians of these indications who can use the EHRs for the purpose defined by the EHR (4). The availability of EHRs is expected to increase in the future and be achieved through public adoption of new legislation and the adoption of current policy (14). A new eHolder policy for EHRs is anticipated to be enacted in the year 2020. The prevalence of such use of electronic health records has increased from 28% in 1996 to 62% after implementing the electronic healthcare data transfer system in 2007 (15). The use of electronic health records in the United States is increasing, although this is primarily because of the use of electronic health records in private practice (16, 17). As with other medical records collected on the patient’s behalf, EHRs may be used to monitor, record and communicate medical information, but the extent and quality of data being collected may be limited. Data collected under EHR should be available at the earliest possible point during a hospital visit, without the necessity of a physician for recording or communicating to the patient. Patient records may be processed for one or more of these purposes, as long as the data are retained for long enough periods of time so as to allow for the proper use of electronic health records in the future (18). Moreover, using electronic health records in private practice can reduce the risk of patient disease and injury. The use of electronic health records does not reduce public awareness of the need for medical records and improve patient safety. The need for electronic patient information can reduce duplication and information sharing, which may become a threat to the development of the new eHolder scheme, or provide an alternative method for data access in cases where the patient has previously used electronic health data collected for medical reasons rather than medical data transferred to a private provider. In addition, the use of electronic health records may increase the risk of errors, errors, and the sharing of data with persons who do not use eHolder programs. Data from EHRs may be accessed using a mobile device or other device similar to that of a doctor, dentist or radiologist, but this is to include data from personal contacts via other means not including email or text messages, e-mail, cell phone calls, and telephone calls.
[/PDF]
3.2 Clinical use of electronic health records for diagnostic diagnoses and emergency medical care for morbidity and mortality may present challenges or limitations in use, particularly for those
[PDF, 3MB]
3.1 Key findings of the study from the Clinical Use Cases project of the US Department of Health and Human Services (HHS) are as follows: A clinical use of electronic health records (EHRs) is now being used to facilitate diagnosis and treatment of specific medical conditions. A further 50% of EHRs (21 for men and 8 for women), by contrast, are in use for routine checkups and procedures, with use rates approaching the 95% confidence interval of current standard practice data (6). Despite high rates of eHRs (25%), this is the first time that this proportion has increased to 5%. The prevalence of EHRs as compared to standard practice records has declined for a number of other indications, including depression (3), anxiety (1), and insomnia (4). The greatest rate of the reported use of electronic health records for depressive disorders is associated with a 1% increase in the quality and efficacy of patient information over the 10-year period, which is at odds with the majority of the current EHR program in use. An increasing proportion of EHRs use for other indications such as diabetes, heart attack and stroke, as well as certain conditions (19%), are still at or above 5%-13%. In contrast, in general, patients and healthcare professionals are increasingly taking steps to improve their quality of patient information, which should improve the reported use rate of electronic health records. The reported use of electronic records for the purpose described was achieved in a number of clinical use cases, mostly among patients who were at the very beginning of a clinical use. Because of this, there is a need for information from all clinicians of these indications who can use the EHRs for the purpose defined by the EHR (4). The availability of EHRs is expected to increase in the future and be achieved through public adoption of new legislation and the adoption of current policy (14). A new eHolder policy for EHRs is anticipated to be enacted in the year 2020. The prevalence of such use of electronic health records has increased from 28% in 1996 to 62% after implementing the electronic healthcare data transfer system in 2007 (15). The use of electronic health records in the United States is increasing, although this is primarily because of the use of electronic health records in private practice (16, 17). As with other medical records collected on the patient’s behalf, EHRs may be used to monitor, record and communicate medical information, but the extent and quality of data being collected may be limited. Data collected under EHR should be available at the earliest possible point during a hospital visit, without the necessity of a physician for recording or communicating to the patient. Patient records may be processed for one or more of these purposes, as long as the data are retained for long enough periods of time so as to allow for the proper use of electronic health records in the future (18). Moreover, using electronic health records in private practice can reduce the risk of patient disease and injury. The use of electronic health records does not reduce public awareness of the need for medical records and improve patient safety. The need for electronic patient information can reduce duplication and information sharing, which may become a threat to the development of the new eHolder scheme, or provide an alternative method for data access in cases where the patient has previously used electronic health data collected for medical reasons rather than medical data transferred to a private provider. In addition, the use of electronic health records may increase the risk of errors, errors, and the sharing of data with persons who do not use eHolder programs. Data from EHRs may be accessed using a mobile device or other device similar to that of a doctor, dentist or radiologist, but this is to include data from personal contacts via other means not including email or text messages, e-mail, cell phone calls, and telephone calls.
[/PDF]
3.2 Clinical use of electronic health records for diagnostic diagnoses and emergency medical care for morbidity and mortality may present challenges or limitations in use, particularly for those
[PDF, 3MB]
3.1 Key findings of the study from the Clinical Use Cases project of the US Department of Health and Human Services (HHS) are as follows: A clinical use of electronic health records (EHRs) is now being used to facilitate diagnosis and treatment of specific medical conditions. A further 50% of EHRs (21 for men and 8 for women), by contrast, are in use for routine checkups and procedures, with use rates approaching the 95% confidence interval of current standard practice data (6). Despite high rates of eHRs (25%), this is the first time that this proportion has increased to 5%. The prevalence of EHRs as compared to standard practice records has declined for a number of other indications, including depression (3), anxiety (1), and insomnia (4). The greatest rate of the reported use of electronic health records for depressive disorders is associated with a 1% increase in the quality and efficacy of patient information over the 10-year period, which is at odds with the majority of the current EHR program in use. An increasing proportion of EHRs use for other indications such as diabetes, heart attack and stroke, as well as certain conditions (19%), are still at or above 5%-13%. In contrast, in general, patients and healthcare professionals are increasingly taking steps to improve their quality of patient information, which should improve the reported use rate of electronic health records. The reported use of electronic records for the purpose described was achieved in a number of clinical use cases, mostly among patients who were at the very beginning of a clinical use. Because of this, there is a need for information from all clinicians of these indications who can use the EHRs for the purpose defined by the EHR (4). The availability of EHRs is expected to increase in the future and be achieved through public adoption of new legislation and the adoption of current policy (14). A new eHolder policy for EHRs is anticipated to be enacted in the year 2020. The prevalence of such use of electronic health records has increased from 28% in 1996 to 62% after implementing the electronic healthcare data transfer system in 2007 (15). The use of electronic health records in the United States is increasing, although this is primarily because of the use of electronic health records in private practice (16, 17). As with other medical records collected on the patient’s behalf, EHRs may be used to monitor, record and communicate medical information, but the extent and quality of data being collected may be limited. Data collected under EHR should be available at the earliest possible point during a hospital visit, without the necessity of a physician for recording or communicating to the patient. Patient records may be processed for one or more of these purposes, as long as the data are retained for long enough periods of time so as to allow for the proper use of electronic health records in the future (18). Moreover, using electronic health records in private practice can reduce the risk of patient disease and injury. The use of electronic health records does not reduce public awareness of the need for medical records and improve patient safety. The need for electronic patient information can reduce duplication and information sharing, which may become a threat to the development of the new eHolder scheme, or provide an alternative method for data access in cases where the patient has previously used electronic health data collected for medical reasons rather than medical data transferred to a private provider. In addition, the use of electronic health records may increase the risk of errors, errors, and the sharing of data with persons who do not use eHolder programs. Data from EHRs may be accessed using a mobile device or other device similar to that of a doctor, dentist or radiologist, but this is to include data from personal contacts via other means not including email or text messages, e-mail, cell phone calls, and telephone calls.
[/PDF]
3.2 Clinical use of electronic health records for diagnostic diagnoses and emergency medical care for morbidity and mortality may present challenges or limitations in use, particularly for those