Electronic health records

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Electronic health records (EHRs) are digital versions of patient medical files that can collect more comprehensive health histories from multiple providers than paper records. The federal government became a major proponent of EHRs when it enacted the HITECH Act in 2009, which established incentives and penalties for Medicare providers regarding EHR adoption. In 2013, 78 percent of physicians used some type of electronic health record (EHR) system, compared to only 18 percent in 2001.

The rules set by the Centers for Medicare and Medicaid Services for the HITECH Act included objectives for providers to achieve meaningful use of EHRs, with the ultimate goal of interoperability between systems for seamless sharing of patient information. However, interoperability has been a challenge for EMR systems, with only an estimated 20 percent to 30 percent of physicians using EHR systems to exchange information in 2015.

Background[edit]

Electronic health records (EHRs) are digital versions of patient medical files that can collect more comprehensive health histories from multiple providers than paper records. EHRs as a policy reform emerged in the early 1990s, when a 1991 report issued by the Institute of Medicine asserted that the adoption of EHRs was "needed to transform the health system to improve quality and enhance safety." The report called for the "widespread implementation" of EHRs within 10 years. However, adoption was slow, and in 2001 only 18 percent of physicians were using an EHR system.^[1][2][3]

In 2004, then-President George W. Bush "launched the federal drive to widely disseminate" EHRs by establishing the Office of the National Coordinator for Health Information Technology and tasking it with developing a national strategy to achieve the goal of an EHR for every citizen by 2014. Though there was little funding for the initiative, the prevalence of EHRs steadily increased over the remainder of Bush's term.^[4][5]

In 2009, the Obama administration made another big push for EHR adoption, and Congress passed the Health Information Technology for Economic and Clinical Health Act (HITECH Act) as part of the federal stimulus package that year, firmly setting the federal government's pro-EHR stance. The HITECH act included financial incentives for Medicare and Medicaid providers who make "meaningful use" of EHR systems and penalties for those who don't.^[4][5][6]

According to the National Center for Health Statistics, by 2013, 78 percent of physicians "used any type of electronic health record (EHR) system," compared to the 2001 figure of 18 percent. A little under half of all physicians used an EHR system that met federal "criteria for a basic system." Below is a map showing the range across the states of the percentage of physicians using a basic EHR system in 2013.^[1]

Meaningful use[edit]

The term meaningful use refers to physicians using electronic health records (EHRs) to improve the quality and efficiency of care, care coordination, and the patient experience. In other words, "the adoption of EHRs is not a goal in itself – it is the effective use of EHRs to achieve health and efficiency that matters." In its final rule for the HITECH Act, the Centers for Medicare and Medicaid Services established three stages of meaningful use with objectives that Medicare providers must meet to earn incentive payments; providers who ignore the objectives are penalized.^[7][8]

The three stages are as follows:^[9][10][11]

1. Data capture and sharing

Stage 1 focuses on basic EHR adoption and involves digitally recording patient information such as symptoms, current medications, allergies, and vital signs. Stage 1 objectives also require physicians to use EHRs to make decisions and "[p]rovide health information to patients."

2. Advance clinical practices

In Stage 2, providers should begin exchanging patient health information and using EHRs to improve care coordination. Stage 2 objectives also promote the creation of web-based portals where patients can interact with their personal health records.

3. Improved outcomes

While not yet finalized as of March 2016, Stage 3 objectives will likely focus on the use of EHRs to improve outcomes. CMS may also push for better interoperability in Stage 3.

Medicare providers who meet the meaningful use objectives are eligible for incentive payments at each stage. The incentives amount to 75 percent of normal payments made under Medicare Part B, up to an annual maximum amount. The penalties for providers not demonstrating meaningful use amount to a 1 percent reduction in Medicare payments in the first year, increasing by a percentage point each year to a maximum of a 5 percent reduction.^[11][12]

Interoperability[edit]

The term interoperability refers to the ability of different electronic health record (EHR) systems "to share information seamlessly." If EHR systems are interoperable, that means a physician treating a patient can access that patient's previous health record from another facility that uses a different EHR system and integrate that information into his or her own system. Interoperability is one of the ultimate goals of EHR adoption; policymakers and other stakeholders view interoperability as necessary for improving healthcare delivery and reducing costs.^[13][14][15]

Interoperability has been a big challenge in the push for EHR adoption. While 70 percent to 80 percent physicians are now using EHR systems, only an estimated 20 percent to 30 percent are using those systems to communicate with one another and exchange information, according to Julia Adler-Milstein, an assistant professor of health management and policy at the University of Michigan. Adler-Milstein identified one of the barriers to interoperability as the lack of incentives EHR vendors have to develop the necessary technology. Regardless of the usefulness or interoperability of an EHR system, vendors can expect steady demand from providers due to the Medicare financial incentives and penalties included in the HITECH Act.^[16][17]

Screenshots from an electronic health records system

In its November/December 2015 issue, the progressive magazine Mother Jones published an article investigating the state of EHR interoperability. While mostly focusing on one of the largest EHR vendors, Epic, the article also criticized the federal government for pushing providers to adopt EHRs too quickly, before the technology was ready to support interoperability. Because providers incurred large costs, both in money and time, to overhaul their IT systems and adopt EHRs, it will be more challenging to now go back and implement systems that are interoperable.^[18]

A September 2015 report from the Government Accountability Office also reviewed the current state of various EHR systems and identified five barriers to interoperability:^[15]

The percentage of physicians using interoperable EHR systems could be lower than Adler-Milstein's estimate. According to the National Center for Healthcare Statistics, in 2014 about 13 percent of physicians said they used an EHR system that supported interoperability.^[1]

Support[edit]

Higher quality of care[edit]

Supporters of electronic health records (EHRs) say they improve the quality of care by cutting down errors and improving patient safety. They eliminate errors that are due to illegible handwriting on paper records. EHRs make it easier to access complete patient medical histories and coordinate care, advocates say, particularly for patients with chronic conditions and complex histories. EHRs can also more easily alert physicians to patient allergies or conflicting medications, thereby avoiding a potentially dangerous adverse reaction. In emergency situations, physicians could access patient records more quickly, enabling critical decisions to be made more rapidly.^{[3][14][20][21]}

A room filled with paper-based patient records

Supporters of EHRs assert that they may also improve community health overall, "by tracking trends, identifying health disparities, monitoring the use of preventive care and helping patients manage chronic medical conditions." For instance, EHRs may enable physicians to "to identify and notify patients who are due for preventive care" or send medication reminders to a select group of patients.^[14][21]

Greater physician efficiency[edit]

Advocates of EHR adoption argue that physicians will be more efficient when they are using electronic records. They say EHRs reduce paperwork and streamline tasks such as filling out forms and billing. Additionally, with patient charts stored in a centralized server, physicians save time searching for an individual's file. The federal website HealthIT.gov identified the following efficiencies related to EHRs:^[22]

Healthcare cost reduction[edit]

With greater efficiencies and higher quality of care, supporters of EHRs say they will lead to a reduction in healthcare costs. Easy access to patient records can help doctors identify expensive tests that have already been done, avoiding duplicate testing.^[14][22]

Additionally, with more streamlined operations, providers can employ fewer administrative staff. EHRs may also facilitate more accurate coding and billing, preventing overcharges and reducing administrative tasks.^[14][22][23]

Criticism[edit]

Data breaches[edit]

Critics of EHRs say storing health data electronically makes it more vulnerable to hacking and medical identify theft. According to the InfoSec Institute, a person's medical information is more valuable on the black market than his or her financial data. Health insurers and provider systems have suffered an increasing number of data breaches in recent years. Unlike with stolen financial data, in which victims can cancel their credit card and have their money refunded, there's no clear recourse for victims of medical identity theft. Additionally, medical identity theft can introduce potentially dangerous errors into a person's medical record that "can lead to serious consequences, such as a patient getting the wrong blood type for a blood transfusion."^[14][24]

Doctor dissatisfaction[edit]

Doctors have voiced a number of complaints against EHRs. A 2014 survey from the publication Medical Economics found that "nearly 70% of physicians say electronic health record (EHR) systems have not been worth it" and "67% of physicians dislike the functionality of their EHR systems." These critics say EHRs have slowed down their workflow and reduced their efficiency. They say the EHR system interfaces are based on old and outdated technology, making the systems "clunky" and difficult to use:^[25][26][27]

As a result, some doctors say they see fewer patients in a day and feel that they are providing worse care because their computer screen gets in the way of emotionally connecting with patients. One doctor, "Dr. Scott A. Monteith, a psychiatrist and health I.T. consultant in Michigan," said electronic records disrupt the thinking process that goes into diagnosing.^[27][28]

Increase in health costs[edit]

Some critics argue that inefficiencies caused by electronic health records (EHRs) will increase healthcare costs, rather than reduce them as supporters say. Doctor's who have declined in productivity have started hiring medical scribes to enter data into EHRs while the doctor cares for the patient. This and other added labor associated with EHRs could increase costs as practices must pay salaries for more employees. Physicians may also charge more per patient if they see fewer of them in a day due to the added time it takes to enter data into the EHR system.^[25][26][29]

Additionally, EHR systems are expensive to implement. According to the Agency for Healthcare Research and Quality, the total cost to implement an EHR system "is about $162,000 with an additional $85,500 in maintenance expenses during the first year." The publication Medical Economics found a similar figure in its survey of physicians, who reported costs between $100,000 and $200,000.^[25][30]

Recent news[edit]

The link below is to the most recent stories in a Google news search for the terms electronic health records. These results are automatically generated from Google. Ballotpedia does not curate or endorse these articles.

See also[edit]

• 

  All-payer claims databases

• 

  Centers for Medicare and Medicaid Services

• 

  Healthcare policy in the United States

External links[edit]

• HealthIT.gov
• Centers for Medicare and Medicaid Services, "Electronic Health Records (EHR) Incentive Programs"
• National Center for Healthcare Statistics, "Use and Characteristics of Electronic Health Record Systems Among Office-based Physician Practices: United States, 2001–2013"
• American Academy of Family Physicians, "Introduction to Electronic Health Records (EHRs)"
• Healthcare IT News, "Frustrations linger around electronic health records and user-centered design"

Footnotes[edit]