Question

critique the three types of EHR’s to include the following:

Names of systems

Advantages and disadvantages

HITECH standards

How it protects patient privacy

How it improves efficiency

What settings they are best used in

Answer 1

An Electronic Health Record (EHR) is a digital version of a patient’s paper chart. EHRs are real-time, patient-centered records that make information available instantly and securely to authorized users. While an EHR does contain the medical and treatment histories of patients, an EHR system is built to go beyond standard clinical data collected in a provider’s office and can be inclusive of a broader view of a patient’s care. EHRs can:

• Contain a patient’s medical history, diagnoses, medications, treatment plans, immunization dates, allergies, radiology images, and laboratory and test results
• Allow access to evidence-based tools that providers can use to make decisions about a patient’s care
• Automate and streamline provider workflow

One of the key features of an EHR is that health information can be created and managed by authorized providers in a digital format capable of being shared with other providers across more than one health care organization. EHRs are built to share information with other health care providers and organizations – such as laboratories, specialists, medical imaging facilities, pharmacies, emergency facilities, and school and workplace clinics – so they contain information from all clinicians involved in a patient’s care.

Names of systems: eClinicalWorks, Allscripts, Epic Systems etc.

Advantages and disadvantages

There are numerous benefits of electronic medical records in hospitals and other healthcare facilities include:

Improved Quality of Care: Computerized notes are often easier to read than a physician's handwriting. This reduces the risk of errors and misinterpretations that can negatively impact the quality of patient care.
Convenience and Efficiency: Medical and office staff no longer have to waste time sorting through cumbersome paper records. Users can access electronic health records quickly and efficiently with just a few strokes on a keyboard.
Saving Space: Electronic health records eliminate the need to store documents in bulky file cabinets, which frees up more space in the office for medical supplies and equipment and other essentials.
Patient Access: Many EHR systems include a patient portal that allows patients to view their medical history and information whenever they wish.
Financial Incentives: Installing a certified EHR can help you fulfill the Meaningful Use requirements for Medicaid and Medicare, making you eligible for various incentives from the federal government.

There are also several disadvantages of electronic medical records, such as:

Potential Privacy and Security Issues: As with just about every computer network these days, EHR systems are vulnerable to hacking, which means sensitive patient data could fall into the wrong hands.
Inaccurate Information: Because of the instantaneous nature of electronic health records, they must be updated immediately after each patient visit — or whenever there is a change to the information. The failure to do so could mean other healthcare providers will rely on inaccurate data when determining appropriate treatment protocols.
Frightening Patients Needlessly: Because an electronic health record system enables patients to access their medical data, it can create a situation where they misinterpret a file entry. This can cause undue alarm, or even panic.
Malpractice Liability Concerns: There are several potential liability issues associated with EHR implementation. For example, medical data could get lost or destroyed during the transition from a paper-based to a computerized EHR system, which could lead to treatment errors. Since doctors have greater access to medical data via EHR, they can be held responsible if they do not access all the information at their disposal.

HITECH Standards

The Health Information Technology for Economic and Clinical Health Act (HITECH Act) is part of the American Recovery and Reinvestment Act of 2009 (ARRA). The HITECH Act was created to motivate the implementation of electronic health records (EHR) and supporting technology in the United States. EHRs have become an integral part of healthcare, but they often presented problems in installation and implementation when first introduced. The HITECH Act prompted healthcare organizations to implement EHR systems by offering an incentive program to eligible short-term acute care hospitals. If a provider has implemented an EHR system, HITECH compliance provides the patient the right to obtain their ePHI in an electronic format. The patient can also assign a third party to be the recipient of the ePHI. HITECH compliance provides that charge, equal to the labor cost, for an electronic request. For providers that have an EHR, it should be rather easy for them to accomplish this task. However, on further examination, EHR vendors did not make this easy on them in some cases and more work is required to produce such a file.

HITECH Act’s incentives are driven by the implementation of “Meaningful Use.” “Meaningful Use” gauges you implementation of an EHR and if the EHR you have chosen meets all the requirements the government has laid out. Not being able to show meaningful use may decrease or eliminate incentive payments. The HITECH Act maintains specific protocol that is to be followed when reporting data breaches. For example, if an entity encounters a data breach in which the information of 500 or more individuals is compromised, the HITECH Act requires that the entity provide specific details of the breach based upon said protocol. The HITECH Act also mandated Centers for Medicare and Medicaid Services (CMS) recipients to implement and use EHRs by 2015 in order to receive full reimbursements. Incentives were offered to providers who adopted EHRs prior to 2015 and penalties are imposed for those who do not beginning this year. The Office of the National Coordinator (ONC) created the three “meaningful use” stages to be followed by healthcare organizations adopting EHRs. Meaningful use determines the extent to which an entity is utilizing EHRs in comparison to previous patient documentation methods. There are many aspects of security for technology, which is the reason for HIPAA’s three-tier model of physical, technical, administrative. There are security techniques that fit each of these categories, but there is no panacea of technique to thwart spurious (or accidental) breaches.

EHR's Privacy and Security

The privacy of patients and the security of their information is the most imperative barrier to entry when considering the adoption of electronic health records in the healthcare industry. As defined by the Center of Medicare and Medicaid Services (CMS), “an electronic health record (EHR) is an electronic version of a patient’s medical history, that is maintained by the provider over time, and may include all of the key administrative clinical data relevant to that person’s care under a particular provider, including demographics, progress notes, problems, medications, vital signs, past medical history, immunizations, laboratory data and radiology reports.” While it is said that electronic health records are the next step in the evolution of healthcare, the cyber-security methodologies associated with the adoption of EHRs should also be thoroughly understood before moving forward. Due to the sensitive nature of the information stored within EHRs, several security safeguards have been introduced through the Health Insurance Portability and Accountability Act (HIPAA) and the Health Information Technology for Economic and Clinical Health (HITECH) Act.

Confidentiality and security of protected health information (PHI), which is included in a patient’s electronic health record, is addressed in the Health Insurance Portability and Accountability Act (HIPAA). The three pillars to securing protected health information outlined by HIPAA are administrative safeguards, physical safeguards, and technical safeguards. These three pillars are also known as the three security safeguard themes for healthcare.

Efficiency

An EHR can significantly improve practice efficiency, but the ways it does so can be surprisingly unique for each practice. Adoption of electronic health records (EHRs) is continuing apace as medical providers cope with a dizzying array of new regulations and demands from third party payers. Some healthcare providers have resisted implementing EHRs for fear of lower productivity, which they believe will lead to a reduced patient load and revenue.

When properly implemented and used by well-trained staff on workflows that have been defined and streamlined, however, EHRs should lead to greater efficiency. The right EHR solution allows practices to have ongoing visibility into efficiency, making it easier to identify stumbling blocks and adjust workflows accordingly.

1. Improved accuracy
“On paper [charts], we never had an accurate medication list; now it is accurate 90% of the time.”

2. Increased patient engagement
“Being able to create a care plan that patients can directly interface [with] on the patient health record side makes our job much easier as well.”

3. Structured data
“We now have more structured information in terms of medications and allergies and are able to transmit that to other providers.”

4. Better scheduling
“We are able to manage and schedule patients across two office locations, while before we had the EHR, we only had internet at one location, meaning we were unable to schedule patients from one office if the other office was closed.”

5. Easier viewing of patient history
“With the old paper charts, it was difficult to pull up ongoing medical problems, chronic medical problems, vaccination schedules, etc. With [the EHR], there is a separate section that can be pulled up instantly to track this.

6. Enriched patient history
“Complete patient history and charts were not readily available before EHR. Now they are at my fingertips.”

7. Improved management of appointments
“Scheduling and managing patient appointments are a lot smoother. Also the communication between the patient and the provider is also easier. The scheduling system allows patients to make their appointments without calling or making a visit to the office.”

8. Increased legibility of notes
“Way better to read typed notes than hand written.”

9. Quicker access
“[I am] able to access records quicker and see what we are missing or need.”

10. More accessible
“Easy access via internet everywhere.”

Behavioral healthcare (BHC) is one of the most varied healthcare settings, encompassing a wide range of services from outpatient substance abuse treatment to full-time, residential psychiatric care. Within these services, the type of care provided also differs. For instance, a single organization may offer group therapy, one-on-one counseling, crisis stabilization and community outreach. Compounding the diversity is the fact that each area has significant sensitivities in terms of both treatment approach and client privacy. EHRs have traditionally focused on capturing information about physical medical conditions, and the content for the BHC field has been limited. The expense of an EHR has presented additional roadblocks, as organizations are sometimes hesitant or unable to expend capital for technology. There are, however, challenges for healthcare organizations – providers, facilities and the greater industry – if EHRs are not implemented, especially as behavioral health information becomes a more critical piece of a patient’s longitudinal patient record. The reality is that selecting and onboarding an EHR that meets the diverse needs of the behavioral health segment can be complicated, but the challenges are not insurmountable. With the right system and a careful, well-considered implementation strategy, BHC organizations can reap the benefits of a tool that efficiently facilitates comprehensive client care and improved outcomes.