EHR Paper
EHR
An Electronic Health Record, EHR is an electronic record of the details and contextual information of a patient’s health status. The record adopts a longitudinal format of information generation and storage based on successive encounters in healthcare delivery environments. It includes progress notes on the patient’s health status and conditions, the demographic information, medications administered, vital symptoms, past medical history, laboratory data, and administered immunizations (AMA Journal: Development of the EHR). The digital nature of the record promotes systematized collection and sharing of the patient’s health information on a network platform connecting different healthcare settings, enterprises, and institutions.
The document represents a convenient and efficient way of automating and streamlining the workflow of clinicians because it generates a comprehensive record of encounters that a patient has with different physicians at different times and places, enabling effective support of diverse care-related activities and efforts directly or indirectly. The EHR’s presentation on an interface represents a convenient method of sharing patients’ information to provide evidence-based decision support and support for reporting outcomes and efforts relating to quality assessment and management in healthcare services (AMA Journal: Development of the EHR). The purpose of an EHR concerns storing patients’ health data accurately and capturing their health states over time, hence eliminating physicians’ requirements to track previous paper records to acquire accurate ideas about patients’ medical histories.
HITECH and EHR
Health Information Technology for Economic and Clinical Health Act, HITECH, which the U.S. government enacted in 2009, is part of the American Recovery and Reinvestment Act. The Act’s purpose is to promote incorporation and meaningful application of technology in health care environments through an elaborate framework that considers security and privacy concerns while stimulating efficiency. The Act proposed allocation of funds to create and maintain a nationwide network of EHRs to support decision-making and efficiency-related assessments in healthcare. The Act proposed EHR technology as a fundamental tool in stimulating efficiency in the delivery of healthcare services among healthcare institutions across the country, based on effective support of policy-making, efficiency and quality evaluations of delivered care, and physicians’ access to stretched health histories of patients to influence better decision-making in healthcare. Part I of the Act’s first subtitle proposes introduction of an interoperable system of EHRs, identifying this aim as critical in context of the Act’s national goal. The stipulation certifies use of EHRs and its technology and network in meaningful ways as an effective strategy to improve healthcare across the country (AMA Journal: HITECH Act Overview).
Meaningful Use
Meaningful use encompasses the utilization of licensed EHR technology to achieve four essential objectives. These are improved coordination of care and public and population health, reduced disparities in health care services and better safety, efficiency, and quality, enhanced security and privacy of patients’ health data, and effective engagement with patients and their families (Sillow-Carroll, Edwards, & Rodin, 2012). The government hoped that compliance with these objectives would influence better clinical outcomes, more empowered individuals and community members, and higher levels of transparency and efficiency in healthcare services. Other targets included better results for population health and availability of more vigorous and productive research information on the health systems to evaluate delivered healthcare against quality and efficiency criteria. Meaningful use incorporates three phases, which the government designated to evolve over five years. The scheduled period for the first stage, involving data capture and sharing, was 2011-2012, while 2014 was the scheduled period for stage 2, involving advancement of clinical processes as the healthcare system adopted intensive use of the EHRs (AMA Journal: HITECH Act Overview). The government designated improvement of outcomes, in terms of quality and efficiency, to be the final stage, stage 3, whose enforcement is to take place in 2016.
In the first stage of meaningful use, the government expected all healthcare institutions to adopt the use of certified EHR technology and have the capacity to demonstrate the technology’s use to fulfill requirements, as the HITECH Act outlines. This phase comprised 25 combinations of targets and standards for eligible providers and 24 others for qualified healthcare facilities. Specifically, the stage required institutions to capture health information in a standardized format, utilize the information to track clinical conditions, communicate the details in ways that enable coordination in care, initiate reporting of information about public health and quality measures, and use the information to engage patients and families in contexts of care. The second stage required rigorous exchange of health information, higher incorporation of laboratory results and e-prescriptions, electronic communication of summaries of patients’ care across multiple environments, and accumulation of patient-controlled data. The planned third stage for 2016 shall incorporate focus on decision support for high-priority conditions nationwide, enabling patients’ access to self-management tools, improved population health, improved safety, efficiency, and quality in services to influence better health outcomes, and access to comprehensive patient data (AMA Journal: HITECH Act Overview). The government’s anticipation is that the three stages, in combination, shall sponsor overall efficiency, greater productivity, and improved patient-based care across the nation, thus influencing public and population health improvements towards the future.
Core EHR Functions
The Institute of Medicine identifies two of the core functions of EHRs as providing support for decisions in healthcare and facilitating electronic communications and connectivity in care services. The utility of EHRs in supporting decisions involves their usefulness in availing contextual and historical information on patients’ health status and conditions, such that the physician can decide the best therapeutic approach and drugs to solve the patient’s medical problem. Electronic communications and connectivity in the utility of EHRs involve convenient and easier access to shared histories and benefits relating to Continuity of Care Documents (HL7 Clinical documents useful in sharing summary information about patients within the broader health record context). By viewing a patient’s medical history and the list of prescribed medicines and their effects, the physician can make a more informed decision on the best care and medicine for the patient than if such information was unavailable (Sillow-Carroll, Edwards, & Rodin, 2012).
The history can also enable physicians to identify instances of interactions among drugsfrom the lists of medicines and their effects. This would allow them to acquire new knowledge about the effectiveness of drugs and avoid similar mistakes in future, and hence prescribe combinations of drugs that are most effective to address patients’ medical conditions. Easy and convenient availability of past histories and contextual information about patients’ medical conditions can also enable clinicians to acquireknowledge about patients’ conditions that the patients may forget or may not provide at each point of service. This would enable clinicians to have more accurate insights about the precise extent (stage of progression of the condition), previously administered medicines, and other clinicians’ assessments, influencing better understanding of each patient’s condition, better diagnosis, and more precise prescriptions, in both type and dosage terms. Availability of extended and more detailed information on factors such as allergies, problems, procedures, family history, functional status, and administered medications on CCDs and the shared histories of patients can yield clinicians’ deep understanding of their patients’ conditions and health states (Sillow-Carroll, Edwards, & Rodin, 2012). The clinicians can utilize this rich information to predict the kinds of medicine and therapeutic models that can yield the best outcomes for the patient.
References
“Development of the Electronic Health Record.” (2011, March). AMA Journal of Ethics 13 (3), 186-189. Retrieved from: http://journalofethics.ama-assn.org/2011/03/mhst1-1103.html
“The HITECH Act – an Overview.” (2011, March). AMA Journal of Ethics 13 (3), 172-175. Retrieved from: http://journalofethics.ama-assn.org/2011/03/hlaw1-1103.html
Sillow-Carroll, S., Edwards, J., & Rodin, D. (2012). Using Electronic Health Records to improve Quality and Efficiency: the Experiences of leading Hospitals. The Commonwealth Fund Document. Retrieved from: http://www.commonwealthfund.org/~/media/Files/Publications/Issue%20Brief/2012/Jul/1608_SilowCarroll_using_EHRs_improve_quality.pdf
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