Implementation of an electronic medical record (EMR) with computerized physician order entry (CPOE) can provide an important foundation for preventing harm and improving outcomes. Incentivized by the recent economic stimulus initiative, healthcare systems are implementing vendor-based EMR systems at an unprecedented rate. Accumulating evidence suggests that local implementation decisions, rather than the specific EMR product or technology selected, are the primary drivers of the quality improvement performance of these systems. However, limited attention has been paid to effective approaches to EMR implementation. In this case report, we outline the evidence-based approach we used to make EMR implementation decisions in a pragmatic structure intended for replication at other sites.
In this economic climate, healthcare providers may face extraordinary challenges securing financing for health IT projects, especially ones required to capitalize on the incentives in ARRA. Vendor financing may be the best option for many such providers. While such arrangements may often seem a win-win for both parties, providers should be aware of the many potential pitfalls inherent in vendorfinanced deals, including: 1.) additional pressure from vendors to accept their standard contractual terms and conditions because vendors have much more leverage if they are also the creditor in the transaction; 2.) failing to obtain necessary warranties and representations from vendors that their systems will comply with all relevant requirements under ARRA and will permit the provider to achieve meaningful use; and 3.) dealing with problems arising if the vendors' product fails to achieve certification, or the provider fails to achieve "meaningful use" in a timely manner.
Does the bipartisan commitment to EHRs, CPOE and other cost-reducing, quality-enhancing automation mean that digital transformation of healthcare will happen faster and better than it would have without ARRA/HITECH? Sadly, no. The law has at least as much potential to delay progress in health IT as to promote it. Leaders of provider organizations must approach HITECH with total awareness of its strengths and weaknesses. As a medical economist with 40 years of experience in the healthcare business, I cannot imagine an efficient and effective delivery system without digital transformation. Our highly dedicated personnel are often working beyond the limits of human capacity—that is, unproductively and unsafely—because they are reliant on paper records that cannot always give professionals the information they need to do the right things as inexpensively as possible. Good health IT is an absolute precondition for any of the economic or clinical improvements targeted by health reform. It’s (stIll) the economy, stupId
This article describes the conversion to electronic hospital notes at a large, multi-specialty group practice: Mayo Clinic in Rochester, Minnesota. Because of the size of the institution and the barriers to the adoption of electronic notes, the process was a gradual one that took several years. Making a convincing case for change to institutional leaders and maintaining their support was crucial to success. Equally vital was the careful investigation of user requirements and the development of software features that allowed providers to complete their notes quickly in the fast-paced hospital environment. Care providers discovered the value of having immediate access to legible hospital notes throughout the campus and from remote locations.
The Phoenix Indian Medical Center (PIMC) has successfully implemented the Resource and Patient Management System Electronic Health Record (RPMS-EHR) in its Ambulatory Care departments. One-hundred and twenty-six providers use the system for essentially all elements of documentation, ordering, and coding. Implementation of one function at a time, in one clinical area at a time, allowed for focused training and support. Strong departmental leadership and the development of 'super-users' were key elements. Detailed assessments of each clinic prior to implementation were vital, resulting in optimal workstation utilization and a greater understanding of each clinic's unique flow. Each phase saw an increasing reluctance to revert to old paper processes. The success of this implementation has placed pressure on the remainder of the hospital to implement the RPMS-EHR, and has given the informatics team an increased awareness of what resources are required to achieve this result.
Implementing a full-featured EHR at a community health center is a daunting undertaking. Stakeholder buy-in, contract negotiation, workflow redesign, equipment purchases, preloading charts and trainings are just some of the necessary tasks in managing an implementation. METCHIT, a health center controlled network, used a collaborative approach to implement electronic medical records. This article will cover the experience, benefits and lessons learned by a group of four FQHCs that took a cooperative, mentorship approach to implementation. Since 2005, the four community health centers, Charles B. Wang Community Health Center, Morris Heights Health Center, Settlement Health, and Comprehensive Community Development Corporation, have implemented EHRs at four organizations with multiple sites in diverse neighborhoods in New York City. The collaboration began and grew during this period, aided by a technology grant from HRSA.
The American Recovery and Reinvestment Act of 2009 (ARRA) has set forth legislation for the healthcare community to achieve adoption of electronic health records (EHR), as well as form data standards, health information exchanges (HIE) and compliance with more stringent security and privacy controls under the HITECH Act. While the Office of the National Coordinator for Health Information Technology (ONCHIT) works on the definition of both "meaningful use" and "certification" of information technology systems, providers in particular must move forward with their IT initiatives to achieve the basic requirements for Medicare and Medicaid incentives starting in 2011, and avoid penalties that will reduce reimbursement beginning in 2015. In addition, providers, payors, government and non-government stakeholders will all have to balance the implementation of EHRs, working with HIEs, at the same time that they must upgrade their systems to be in compliance with ICD-10 and HIPAA 5010 code sets. Compliance deadlines for EHRs and HIEs begin in 2011, while ICD-10 diagnosis and procedure code sets compliance is required by October 2013 and HIPAA 5010 transaction sets, with one exception, is required by January 1, 2012. In order to accomplish these strategic and mandatory initiatives successfully and simultaneously, healthcare organizations will require significant and thoughtful planning, prioritization and execution.
US healthcare is undergoing a transformation. The economic stimulus plan is intended to transform healthcare through health IT. The government has defined "meaningful use" of health IT. Healthcare is a team activity, and as such presents a challenge to the concept of meaningful use. While encoding clinical data into a computer is a positive step, it is not enough. A continuity-of-care record is needed to document and measure care; support clinical care; and coordinate care with public health agencies. This paper examines current research to assist decisionmakers moving forward. To realize the promise, integration across all clinical disciplines is critical. There are many challenges. These include: the threat of information overload, both at the transitions of care and between disciplines; the need to provide for data-sharing between clinical and public health agencies, an important component in both local community and national health issues; how to use health IT to improve the delivery of healthcare, especially with unintended outcomes of any change in healthcare and paper persistence; and addressing different views of "meaningful" for different uses and users of health IT. All of these challenges need to be considered for wise installation of health IT. In addition, attention must be paid to weaknesses in the current healthcare system to prevent codifying them in health IT.
While the development of health information technology, particularly electronic health records (EHR), is a triumph for the advancement of healthcare, non-interoperable clinical data systems lead to fragmented communication and incomplete records. If interoperable HIT systems could be achieved integrated HIT could be leveraged to lessen medical errors, improve patient care and optimize epidemiological research. To understand the barriers to interoperability or health information exchange (HIE), we reviewed the literature on HIT and barriers to HIE. Our search yielded 492 articles, 25 meeting our inclusion criteria. In general, we found that the predominant barriers to HIE are need for standards, security concerns, economic loss to competitors, and federated systems. Research on interoperability is limited because most HIE programs are still in formative stages. More research is needed to fully understand interoperability of HIT, how to overcome the barriers to interoperability, and how to design HIT to better facilitate HIE.
It is widely understood why medical devices need to be regulated by the FDA and other governing bodies. However medical software does not typically require the same level of regulation. Currently the FDA is investigating whether one type of medical software, Medical Device Data Systems (MDDS), should require FDA clearance because of the potential risk they impose when interconnected with medical devices. Hospitals are looking to implement MDDS because the technology allows nursing staff to spend more time on direct patient care and reduces charting errors. This article will explore the FDA's proposal and will review the possible risks and provide a rationale for why MDDS should be regulated by the FDA and why MDDS vendors should have the right level of quality and risk management procedures in place to ensure that they are developing and bringing to market the safest products possible.
Quality of healthcare is a high priority for several years but there was no standard until recently. The standards body, HL7 released draft standard for Quality Reporting Document Architecture (QRDA) with an aim to develop an electronic data standard for healthcare information systems to use in communicating patient level quality measurement data across disparate systems. This standard would enable Healthcare providers those use Electronic Health Record (EHR) systems to generate Quality Reporting documents to be consumed by payer agencies such as Centers Medicare and Medicaid Services (CMS) replacing proprietary file formats that existed in this space previously, This paper discusses various features of this new standard, which promotes interoperability and easy adoption, the three categories proposed by the QRDA standard and their application in different contexts, measure sets and measures and finally the relationship of this QRDA standard to the HQMF (eMeasure) standard proposed by National Quality Forum (NQF) in collaboration with HL7 to standardize the Quality Measures across the healthcare landscape. This paper also provides high-lights on early adoption of QRDA standard by Centers Medicare and Medicaid Services (CMS) for their Physician Quality Reporting Initiative (PQRI) program.
Covered entities need to conduct risk assessments that cover the requirements of HIPAA, HITECH and Meaningful use, and create a process for steady and consistent mitigation of known gaps and vulnerabilities based on risk. Reducing risk of vulnerabilities of unauthorized access to your ePHI can be done via safeguards and controls, plus audits and monitoring. When reducing risk is outside of a covered entities control, audits and monitoring are required in order to demonstrate due diligence. Know where your ePHI is stored, where it is at risk, and take steps now to reduce or eliminate the risk. Encrypt vulnerable locations. Encrypt sensitive data. By doing so, you will be protecting your organization by reducing risk of breach of ePHI. Finally, don't forget what is sometimes considered to be the hardest part--documenting your compliance activities in order to demonstrate evidence of due diligence in and avoid major $$$$ penalties for negligence under the HITECH Act of 2009.
Understanding international approaches to certification of electronic medical records (EMRs) in an effort to achieve widespread meaningful use is particularly timely. Canada's 34,000 primary care doctors cover a population of 33 million in 13 jurisdictions. A recent survey suggested only 14 percent of Canadian doctors are utilizing EMRs in a clinically meaningful way. In order to accelerate EMR adoption, most jurisdictions have initiated EMR programs. The objectives of these programs are to 1.) certify EMRs to ensure they meet needs for high quality care delivery; 2.) provide funding for EMR acquisition, implementation and support; 3.) supply services to assist with EMR purchase and implementation; and 4.) measure adoption and impact of EMR use. In this article we review the impact of certification on the advancement of EMR use in Canada and discuss both the benefits that these programs have provided and the challenges that they have posed.
