The Drive Toward Electronic Medical Records

Most people in the health care field have had more than a few conversations about electronic medical records. What, Why, How, When, Where and Who make for good lunchtime debate.

Home care providers are not yet in the throws of the movement, but should lend a keen eye toward what is taking shape in the acute care, as well as the ambulatory, side of our business. Records are being digitized at an amazing pace, and all health care stakeholders will be required to provide electronic data exchange at some point in the not too distant future.

What

The What is complicated! We are essentially talking about a nationwide network of computer hardware, software and telecommunications — all linked via standards and protocols that allow the input and receipt of secure health information. HIPAA privacy and security rules are driving EMR adoption. Developing audit-proof systems that show up-front compliance with HIPAA is important to holders of protected health information (PHI). A well-designed EMR system can help ensure HIPAA compliance. This does not mean any one entity, (i.e. the government) will develop this network itself. The government is seemingly acting as a catalyst for the industry itself to develop standards of interoperability that will tie the Web together and bridge today?s chasm that currently exists throughout the paradigm of care.

Why

Payers drive health care, and they realize that electronic data can be mined. It can provide decision-making tools at the point of care; it provides a secure and long-lasting record — one people can access anytime and anywhere given the proper authority. Advocates say EMRs will save more than $140 billion a year by saving lives and money. At the end of the day, electronic date improves quality and security and thereby, lowers the cost of care.

The boomers are getting older, so demand for services will rise. In most industries, that would be a good thing for providers. In health care, however, the buyers are third-party employers, that is, private insurance companies and the government. (The government pays over a third of in our nation?s $1.6 trillion health care spending.) These buying powers have almost complete control over price, i.e. reimbursement. The buying powers also have P&Ls to manage and hence, will seek out ways to serve the increased need without increasing spending. Of course, one way is to lower reimbursement. That's nothing new. Another way is to provide and/or require the use of technology that improves efficiency and quality and ultimately reduces cost.

How

There are many movements under way to spur technological adoption. Long-term care facilities are way ahead of the rest of the industry, except for the payors, in terms of their use of health care information technology (HCIT). The pace is quickening, however, with smaller providers. A large part of the government?s push for HCIT includes setting up regional health information organizations (RHIOs). RHIOs work at the local level as pilot tests for the major health care players in a given market to share electronic health information, including labs, prescriptions, claims, payments and more. Look for such initiatives in your local market.

Pay per performance is another major trend, shifting the burden of proof of quality to the provider. The underlying premise is that providers who can deliver better outcomes, meaning lower costs with no degradation in quality, should share in the bottom line improvement to payors. Providers who cannot meet the average in performance will not meet the average in reimbursement.

According to the Institute of Medicine there are eight core capabilities that EHRs should possess:

  1. Heath information and data: Having immediate access to key information — such as patients? diagnoses, allergies, lab test results and medications — would improve caregivers? ability to make sound clinical decisions in a timely manner.
  2. Result management: The ability for all providers participating in the care of a patient in multiple settings to quickly access new and past test results would increase patient safety and the effectiveness of care.
  3. Order management: The ability to enter and store orders for prescriptions, tests and other services in a computer-based system should enhance legibility, reduce duplication and improve the speed with which orders are executed.
  4. Decision support: Using reminders, prompts and alerts, computerized decision-support systems would help improve compliance with best clinical practices, ensure regular screenings and other preventive practices, identify possible drug interactions, and facilitate diagnoses and treatments.
  5. Electronic communications and connectivity: Efficient, secure and readily accessible communication among providers and patients would improve the continuity of care, increase the timeliness of diagnoses and treatments, and reduce the frequency of adverse events.
  6. Patient support: Tools that give patients access to their health records, provide interactive patient education, and help patients carry out home-monitoring and self-testing can improve control of chronic conditions, such as diabetes.
  7. Administrative processes: Computerized administrative tools, such as scheduling systems, would greatly improve hospitals? and clinics? efficiency and provide more timely service to patients.
  8. Reporting: Electronic data storage that employs uniform data standards will enable health care organizations to respond more quickly to federal, state, and private reporting requirements, including those that support patient safety and disease surveillance.

When

When is questionable. The U.S. government is a strong driver for EMR adoption. The Bush administration announced in April 2004 that it intends for all patients in the United State to have access to their own personal health record and for the nation to eliminate paper medical records within 10 years. The announcement was immediately compared to President Kennedy?s statement of going to the moon within the same period, and too many seemed much more ominous. So, Senate and House debate began on how and when. The movement has been bi-partisan, and few question if. The premise is to improve care and save lives when doctors, hospitals and patients are able to share information privately and securely, and have it available to them where and when care is needed. There are many hurdles unique to health care when assessing how to connect stakeholders. Those hurdles need to be addressed before significant change can take place. But the pace itself is now steady and will not likely slow.

The U.S. government pledged $100 million in 2004 toward this aim. The money appears to be primarily funneled through the Agency for Healthcare Research and Quality. Other federal agencies, such as the Bureau of Primary Care, the Centers for Medicare and Medicaid Research, and the Veterans Administration have indicated support for EMR or EMR-type initiatives. President Bush anticipates including $100 to $200 million in the January 2006 budget for new technology incentives in EMR adoption.

Where and Who

Where and Who are easy. The answer is everyone and everywhere. All health care stakeholders will be participants in the electronic exchange of data, including patients. We hear more about ?consumer-driven health care." We see the pilot projects going on with larger organizations and can draw a reasonable conclusions that this type of data exchange will ultimately spread throughout the health care industry.

This article originally appeared in the February 2006 issue of HME Business.

About the Authors

Daniel J. Cho is director of the Physical Water Treatment Center, a water treatment research laboratory in Pennsylvania. In recent years, the PWT Center has provided consulting services for water treatment companies both large and small and has also established new standards in non-chemical water treatment device testing and evaluation (mineral control, bio-control and corrosion control). Mr. Cho is active in promoting research in the fields of water treatment, indoor air quality, and energy efficient HVAC (heating, ventilation and air conditioning). He serves on the boards of directors of Vortex Aircon, Inc. and Filter Sciences Inc., both environmental technology companies.

Emily Morgan is a SLP and Clinical Specialist for RehabWorks, a contract therapy provider. She has been with RehabWorks for 11 years and also serves as a national auditor for the company, auditing medical records from nursing homes across the country. For more information visit http://www.rehabworks.com.

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