Difference between the Hybrid Medical Record and EHR Technology
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1. Explain the difference between the hybrid medical record and the EHR. hybrid record A record in which both electronic and paper media are used. electronic health record (EHR) A secure real-time, point-of-care, patient centric information resource for clinicians allowing access to patient information when and where needed and incorporating evidence-based decision support. (Davis 67-68)
2. List the features of an EHR. Explain how these features are advantageous for health care. An EHR results from computer-based data collection. Physicians and other clinicians capture data at the point of care, with the ability to retrieve the data later for reporting and use in research or administrative decision making. Health care workers document via various input ports on the various clinical units, using laptops, handheld computers, and bedside terminals, into templates. Very few, if any, paper reports are generated. The EHR allows all departments (e.g., nursing) to document care electronically using these templates. The electronic record should provide a CPOE. E-prescribing, which allows the electronic transmission of prescription information from physician’s office to the pharmacy—shown in Figure 3-2—is a pronounced feature in EHRs. Other important features included in the EHRs are to send reminders to patients for patient preference or preventive follow-up care, to print out the diagnosis summary and current medication list, to provide patients with timely electronic access to their health information, and to apply evidence-based medicine. (Davis 71)
3. Identify government sector intervention designed to hasten the implementation of the widespread use of EHR technology. Office of the National Coordinator for Health Information Technology (ONC) within the DHHS. In addition, it directed the ONC to produce a report on the development and implementation of a strategic plan to guide the nationwide implementation of an interoperable EHR in both public and private sectors. Nationwide Health Information Network (NHIN). The NHIN’s goal is to provide an interoperable health information exchange among providers, consumers, and others involved in supporting health and health care that is secure and is capable of sharing information nationwide over the Internet. Conceptually, the NHIN is not a centrally located database. It aims to set common computer language requirements and secure messaging to allow regional and state-based networks of HIEs, laboratories, pharmacies, physicians’ offices, and other entities involved in health care delivery to share information in a safe, efficient manner. (Davis 78)
4. Describe HIPAA protections governing the use of electronic health information. One major component of HIPAA is known as the Security Rule. This portion of the regulation addresses how organizations protect information from unauthorized access while maintaining the integrity of the record. Record integrity refers to the idea that regardless of the format, the record is complete, reliable, and consistent. The Security Rule focuses on a subset of information known as e-PHI (electronic protected health information). It refers to “all individually identifiable health information a covered entity creates, receives, maintains or transmits in an electronic form” (Health Insurance Portability and Accountability Act of 1996). Unlike a simple paper document that contains protected health information (PHI), e-PHI encompasses any piece of data that identifies the patient and is considered electronic. If an e-mail is sent, for example, and it includes the patient’s name or other identifying information, it is considered e-PHI. Organizations are required to conduct an overall security analysis reviewing potential risks to the security of the information, and to document measures put into place to minimize those risks (Health Insurance Portability and Accountability Act of 1996). (Davis 80)
5. Explain meaningful use and how it encourages providers to adopt EHR technologies. meaningful use A set of measures to gauge the level of health information technology used by a provider and required, in certain stages, in order to receive financial incentives from CMS. Through HITECH, which focuses on various aspects of HIT, the federal government allotted a total of $27 billion over 10 years through the Center for Medicare and Medicaid Services (CMS) to clinicians and hospitals when they use the EHRs that meet certain guidelines, called meaningful use (Centers for Medicare and Medicaid Services, 2012). When they meet these requirements, physicians who utilize qualified technologies would receive an incentive or payment from the CMS. Payments are significant, from $18,000 in 2011 up to $44,000 for Medicare-assigned providers during the span of the program. Physicians can choose to be reimbursed as Medicaid-participating providers and receive payments up to $65,000 on the basis of state-defined guidelines.
Hospital reimbursement for meeting meaningful use criteria can be significant and can provide substantial financial incentives in the millions of dollars. In spite of the immense benefits of EHRs and the support of the federal government, there was little progress on their adoption except for a few large facilities and some smaller clinics. In order to break the barriers to the adoption of EHRs, President Barack Obama and his legislation provided a distinctive opportunity with the introduction of the American Recovery and Reinvestment Act (ARRA), also commonly referred to as the stimulus bill or the recovery act, signed into law on Feb 17, 2009. ARRA was created to jumpstart and address the challenges in much-needed areas of the U.S. economy, providing many stimulus opportunities in different areas, one of them being health IT. This portion of the stimulus package was given the subtitle, the Health Information Technology for Economic and Clinical Health Act (HITECH). This legislation further funded and set new mandates for the ONC, solidifying the office’s existence.
6. List two barriers to the implementation of the EHR.
Two of these barriers are lack of interoperability (the ability to exchange information) among computer systems and privacy issues. The Markle Foundation fosters collaboration in both private and public sectors through an initiative called Connecting to Health, which seeks to improve patient care by promoting standards for electronic medical information. In addition, the Markle Foundation has provided information and promoted meaningful use and the development of HIEs (Davis 77)
7. Explain the benefits of interoperable systems and the importance of a longitudinal record. interoperability (the ability to exchange information) among computer systems and privacy issues. One of the most important characteristics of an EHR while storing the clinical information is its ability to be interoperable: to share that information among other authorized users. If different information systems cannot communicate or interact with each other, then sharing is not possible. In order to achieve the objective to exchange clinical information, a secure, interoperable EHR is required that can share the information with other EHRs. longitudinal record The compilation of information from all providers over the span of a patient’s care, potentially from birth to death, which is facilitated by the electronic flow of information among providers.
During a patient’s lifetime, health care providers gather information in the form of demographic data, medical history, progress notes, vital signs, and clinical information such as laboratory, radiology, and pharmacy data. These data stored electronically in the form of an EHR are also referred as a longitudinal record, because they are collected over time and can provide a more complete picture of an individual’s medical history. Because a patient may acquire this information from multiple clinical sources over the course of her life, the interoperability of information among the many stakeholders in health care, from hospitals and physician’s offices to grocery store pharmacies, has been recognized as a key objective in utilizing the potential of an EHR (Figure 3-9). (Davis 86)
8. List three careers created by the widespread adoption of EHRs. •Project management: act as a leader to teams in the process of developing or implementing EHR systems •Design and development: test new systems, provide training on new systems •Marketing and sales: sell products and services related to the EHR, provide support to new clients (Davis 88)
9. Describe the future of the electronic health record.
The HITECH legislation under ARRA provides a huge government incentive for the meaningful use of EHRs. Many private and federal groups are working to make the EHR a reality. Many health care organizations are already using either hybrid or electronic health records. HIM employees who are using a hybrid record are already familiar with terms such as interfacing and document imaging. Health care organizations will standardize in order to enable interoperability, which is necessary for the creation and maintenance of longitudinal records, making health information more accessible to the users and thereby improving the quality of health care. The government has provided incentives to decrease the cost of EHR conversion. HIM departments making the transition to an EHR have to review and revise every function performed in the department. HIM professionals have to learn the information technology functions to manage the future HIM departments. As the interoperable EHR becomes a reality, there will be a growing need for professionals with HIM knowledge. In addition, the growth of data warehouses, clinical data repositories, and other large databases at the institutional, local, state, regional, and national levels requires professionals who are capable of understanding, retrieving, analyzing, and managing information. Job opportunities will be available for HIT personnel, project managers, privacy and security managers, vendor marketing and sales representatives, and database designers. (Davis 90)
10. List and describe the data elements of the physician’s order. physician’s order The physician’s directions regarding the patient’s care. Also refers to the data collection device on which these elements are captured. The form for a physician’s order has the very important function of communicating the patient’s care to all members of the health care team. All lab tests, for example, must start with the physician’s order. The form must satisfy every user’s needs, not just the physician’s. The form must be flexible enough to record the hundreds of different medications, therapies, and instructions that a physician might give and to communicate accurately the instructions needed by the recipient of the order, such as the radiology department. On a paper form, these data are recorded by the physician, who writes the orders in his or her own handwriting.