electronic health records and meaningful use...electronic health records and meaningful use course...

Author: Denise R. Eccles, PhD, ED, RN

Advance Nursing Institute INC is approved as a provider for continuing education by Florida Board of Nursing.

Provider # 50-16977 Copyright © 2013 Advance Nursing Institute INC. 1

Electronic Health Records and Meaningful Use

Course Description

The purpose of this continuing education program is alert the audience on the Health Information

Technology for Economic and Clinical Health Act (HITECH) that was signed into law in

February 2009, and the law was finalized in November 2009. The HITECH Act promotes

adoption and meaningful use of health information to improve quality of care in a safe manner.

In addition the audience will also be educated on Safety Assurance Factors for EHR Resilience,

and Electronic health records (SAFER), and Meaning Use (EHR-MU).

Target Audience

Advanced Practice Registered Nurses, Registered Nurses and Licensed Practical Nurses

Course Objectives

1. Understand what is the HITECH Act

2. Define Meaningful Use

How to Receive Your CE Credits

Read your selected course

Completed the quiz at the end of

the course with a 70% or greater.

Complete the evaluation for your

selected course.

Print your Certificate

CE’s will automatically be reported

to the CE Broker




3. List the type of technology that a EHR should have for meaningful use

4. Understand Safety Assurance Factors for EHR Resilience

5. Identify meaningful use technology that is in compliance with the HITECH Act

6. Understand the Goal and the importance of implementing EHR

7. List the provision and the financial incentive for health care organization to implement

EHR

Introduction

Physicians and health care organizations are eligible for both Medicare and Medicaid incentives

for implementation and electronic health records (EHR) (GE Health Care, 2009). Health care

organizations implementing an EHR technology system has been proven to increase the quality

of patient care. The Health Information Technology for Economic and Clinical Health Act

(HITECH) will supplement and incentive for health care organizations who implement an EHR

system. These incentives are only eligible for those health care organization, and others

clinicians who implement a meaningful and qualified EHR.

Meaningful Use

According to GE Health Care (2009); HealthIT, (2014) a meaningful and qualified EHR is

defined as an electronic record that is a certified electronic health record (EHR) with the

technology to:

a. Inclusion of patient demographic and clinical health information, such as medical

history and problem lists




b. The capacity to provide clinical decision support

c. Support for physician order entry

d. The ability to capture and query information relevant to health care quality

e. Electronic health information exchange capabilities, including the ability to

integrate such information from other sources into the EHR (GE Health Care,

2009).

f. Improve quality, safety, efficiency, and reduce health disparities

g. Engage patients and family

h. Improve care coordination, and population and public health

i. Maintain privacy and security of patient health information

In addition meaningful use also includes that the technology compliance will result in HealthIT,

(2014):

a. Better clinical outcomes

b. Improved population health outcomes

c. Increased transparency and efficiency

d. Empowered individuals

e. More robust research data on health system

Additionally health care organization should include certain quality measures that will

demonstrate improvement in quality of care as a result of implementing EHR. These quality

measures should be key indicator that are reported or mined by administration monthly or

quarterly for quality improvement.




EHR Implementation Statement

Possessing the capability to share electronic health information within and among health

care organizations has been generally accepted as a way to improve the quality and delivery of

care and help control rising healthcare costs (Board on Healthcare Services and Institute of

Medicine, n.d.) The government is trying to initiate a national push that will allow doctors and

hospitals across the country to adopt electronic health records by 2014 (Health Policy Brief,

2010)

By 2014 health care organizations, physician offices, and other clinicians who treat

patients who are Medicare and Medicaid recipients will face governmental penalties if they fail

to implement an electronic health records (EHR) (Health Policy Brief, 2010). Blumenthal, and

Tavenner (2010) addressed in 2009, Congress and the Obama administration provided the health

care community with a transformational opportunity to break through the barriers to progress.

The Health Information Technology for Economic and Clinical Health Act (HITECH) approved

incentive payments through Medicare and Medicaid to clinicians and hospitals when they use

EHRs privately and securely to achieve positive improvements in care delivery.

HITECH is federally funded governmental act. The HITECH act requires the government

to take a leadership role to develop standards by 2010. The standards will allow for nationwide

electronic exchange and use of health information to improve quality and coordination of patient

care (Majority Staff of the Committees on Energy and Commerce, 2009). HITECH act funds are

for those health care organization, and others clinicians who implement an electronic medical

records system. Health care organizations who fail to implement an EHR system by 2014 may




be faced governmental penalties. According to Pear (2010) starting in 2015, hospitals, and

doctors will be subject to financial penalties under Medicare if they are not using electronic

health records.

Safety Assurance Factors for EHR Resilience (SAFER)

According to HealthIT (2014) SAFER is used as self-assessment to identify the

organization’s level of implementation according to evidence-based recommended practices for

safe EHR implementation. SAFER consist of nine guides organized into three broad groups.

These guides enable healthcare organizations to address EHR safety in a variety of areas. The

nine organized groups into the three broad groups are as follows:

Foundational Guides

High Priority Practices

Organizational Responsibilities

HealthIT (2014)

Clinical Process Guides

Patient Identification

Computerized Provider Order

Entry with Decision Support

Test Results Reporting and Follow-Up

Clinician Communication

HealthIT (2014)

Infrastructure Guides

Contingency Planning

System Configuration

System Interfaces

HealthIT (2014)




Topic Explanation of the Topic Example

Health

Information

Privacy

(HIPAA)

The U.S. Department of Health and Human

Services (n.d.) indicates that the Health

Information Privacy Act (HIPPA) provides

federal protections for personal health

information held by covered entities and gives

patients an array of rights with respect to that

information. The Privacy Rule is balanced so

that it permits the disclosure of personal

health information needed for patient care and

other important purposes.

Without official consent given by

the patient. Health care

organizations will no longer be

able to disclose any medical

information regarding the care of

the patient.

Technology for

Economic and

Clinical Health

provisions of the

American

Recovery and

Reinvestment

Act of 2009

(HITECH)

“According to the Health Information

Technology for Economic and Clinical Health

Act of 2009, health information technology

helps save lives and lower costs. This bill

accomplishes four major goals that has

advanced the use of health information

technology (Health IT), such as electronic

health records by:

a. Requiring the government to take a

leadership role to develop standards

by 2010 that allow for the nationwide

electronic exchange and use of health

information to improve quality and

coordination of care.

b. Investing $20 billion in health

information technology infrastructure

and Medicare and Medicaid incentives

to encourage doctors and hospitals to

use HIT to electronically exchange

patients’ health information.

c. Saving the government $10 billion,

and generating additional savings

throughout the health sector, through

improvements in quality of care and

care coordination, and reductions in

medical errors and duplicative care.

d. Strengthening Federal privacy and

GE Health (2009) indicates that

meaningful use of EHR consist

of technology that contain the

capabilities of

j. Inclusion of patient

demographic and clinical

health information, such

as medical history and

problem lists

k. The capacity to provide

clinical decision support

l. Support for physician

order entry

m. The ability to capture and

query information

relevant to healthcare

quality

n. Electronic health

information exchange

capabilities, including the

ability to integrate such

information from other

sources into the EHR




security law to protect identifiable

health information from misuse as the

health care sector increases use of

Health IT (Health Information

Technology for Economic and

Clinical Health Act 2009).”

American

Recovery and

Reinvestment

Act

(ARRA)

Graham (2010), indicates that aim of the goal

of ARRA was to make patient health records

electronic so that medical errors could be

prevented and more lives be saved by

digitizing records and creating opportunities

for new jobs (p. 402).

According to the Institute of

Medicine, (1999) handwritten

paper medical records can be

associated with poor legibility,

which can contributes to the high

number of medication errors.

Government Regulatory Rules and Provisions of the HITECH Act

Having the capability to share electronic health information within and among healthcare

organizations has been generally accepted as a way to improve the quality and delivery of care.

Additionally helping control rising healthcare costs (Board on Healthcare Services and Institute

of Medicine, n.d.). The government is trying to initiate a national push to get doctors and

hospitals across the country to adopt electronic health records by 2014 (Health Policy Brief,

2010).

Health care organizations are eligible for funding from HITECH. Health care

organization that show that they are meaningfully using health information technology, such as

through the reporting of quality measures are eligible for HITECH funding (Majority Staff of the

Committees on Energy and Commerce, 2009). The Act will also provide direct funding for

health information technology training, infrastructure, dissemination of best practices,

telemedicine, inclusion of health information technology in clinical education, and state grants to




promote health information technology. The incentive payment for eligible professionals or

hospitals who can demonstrate they attempted to adopt and implement EHR technology

payments range from $44,000 over 5 years for Medicare providers and $63,750 over 6 years for

Medicaid providers. Failure for a health care organization to implement an EHR by 2015 will

result in a negative adjustment to their fees starting at 1% and increasing to 3% reduction by

2017 and beyond. The HITECH imposes rigorous regulatory requirements under the security

and privacy rules of the Health Insurance Portability and Accountability Act (HIPPA) of 1996.

Furthermore, increases civil penalties for a violation of HIPAA, provides funding for hospitals

and physicians for the implementation of health information technology, and requires the

organization to notify patients of a security breaches (Peabody, 2011).

The Need to Implement EHR

Several factors that contributed to the implementation of EHR system for health care

organizations goals is to improve the quality of healthcare, decreased healthcare costs, and

minimize health care fraud. As the health care system have within the strategic plan to grow with

that growth the organization should have a central goal on improving the control, the monitoring,

the storing, and the coordinating the patients’ health information records. The central goal

should be geared at a challenge to improve the health care outcomes and securing the patient’s

medical records for the continuum of care.

An additional need to implement an EHR is frequent lost, inability to locate the paper

medical record in a timely manner, and the unavailability of the patient’s medical record.

Improper handling, storage, and transportation, of medical records were also a contributing

factor. According to the Joint commission, (2008), one must first identify the patient medical




information to determine the extent of patient care that will need to be provided by the health

care provider. Planning for the management of information does not require a formal written

information plan but does require evidence of a planned approach that identifies the hospital’s

previous information to supports the care of the patient (Joint commission, 2008). When

performing an assessment the health care organization must gather data on occurrences, these

occurrences must include the number of times the provider had to see a patient with the absence

of his or her paper medical records the above task cannot be performed. These are one of many

factors for the need of the health care organizations to implement an electronic health medical

records system.

The Financial Need

Health information technology of medical records has the potential to reduce health care

costs, improve efficiency, and enhance quality of care and patient safety (Blumenthal,

DesRoches, Donelan, and et al, 2008). One of the promising applications electronic medical

records is that it automates the paper-based patient chart and can improve clinical decisions.

EHR can facilitate improvements to workflow, for the nurse/physician-related hospital

experiences (Bolton, Gassert, and Cipriano 2008). An empirical study revealed a positive

relationship between EHR health information technology investment and hospital financial

performance (Menachemi et al. 2006; Thouin, Hoffman, and Ford 2008) and productivity

(Menon, Lee, and Eldenberg 2000). According to Majority Staff of the Committees on Energy

and Commerce (2009) the implementation of the HITECH act will save the government $10

billion, and generating additional savings throughout the health sector. Additional saving for the




implementation of the HITECH act will be solved through improvements in quality of care and

care coordination, and reductions in medical errors and duplicative care.

Conclusion

Over the past decade technology has improved the way heath care conducts business.

One of the greatest changes in health care is the use of the electronic medical records with

information technology progressively touching every part of healthcare (Fried, & Fottler, 2008,

p. 484). Health and Human Services Department (HHS) released a strategic plan outlining a

broad array of steps it plans to take to implement a national health information network and

electronic records for every American within the next decade (Winterkamp, n.d.). According to

the Institute of Medicine, (1999) handwritten paper medical records can be associated with poor

legibility, which can contributes to the high number of medication errors, and patients death.

Health care organizations that comply with the HITECH act definition of implementing a

meaningful EHR will be a beneficiary of the stimulus act. Electronic health record (EHR)

systems have the potential to improve patient quality of care. Health care organizations that

implement a multifaceted quality improvement tool to measure the timeliness, and accuracy of

patient care, will comply with HITECH definition meaningful use.




References

Baron, R., Fabens, E., Schiffman, M., & Wolf, E. (2005). Electronic health records: Just around

the corner? Or over the cliff? Annals of Internal Medicine, (143)2 222–226. Retrieved

from EBSCOhost database.

Bowman, S. (2013). Impact of Electronic Health Record Systems on Information Integrity:

Quality and Safety Implications. Perspectives in Health Information Management, 10, 1.

Blumenthal, D., & DesRoches, C. (2008). Health information technology in the United States:

where we stand. Princeton, NJ: Robert Wood Johnson Foundation.

Blumenthal, D., & Tavenner, M. (2010). The meaning use. Regulations for electronic health

records. New England Journal of Medicine, 363, 501-504.

Bolton, L., Gassert, C., & Cipriano, P. (2008). Smart Technology, Enduring Solutions:

Technology Solutions Can Make Nursing Care Safer and More Efficient. Journal of

Health Information Management, 22 (4), 24–9.

Fried, B. J., & Fottler, M. D. (Eds.). (2008). Human resources in healthcare: Managing for

success (3rd ed.). Chicago: Health Administration Press.

GE Health Care. (2009). American Recovery and Reinvestment Act of 2009. HITECH Act for

Healthcare. Retrieved from www.gehealthcare.com/usen/hit/.../ARRA-GEHCIT-FAQ-

022709.pdf.

Graham, C. M. (2010). HIPAA and HITECH Compliance: An exploratory study of healthcare

facilities ability to protect patient health information. Northeast Business & Economics

Association, 402-406. Retrieved from http://BSCOHost Database.




HealthIT. (2014). Meaning Use. Retrieved from http://www.healthit.gov/providers-

professionals/meaningful-use-definition-objectives

HealthIT. (2014). SAFER Guides. Retrieved from http://www.healthit.gov/safer/safer-guides.

Health Policy Brief. (2010). Electronic Health Record Standards. Retrieved from

http://www.healthaffairs.org/healthpolicybriefs/brief.php?brief_id=26.

Institute of Medicine (1999). To err is human. Building a safer health system. The National

Academies Press. Retrieved from http://fermat.nap.edu/catalog/9728.html#toc.

Majority Staff of the Committees on Energy and Commerce. (2009). Ways and Means, and

Science and Technology. Health Information Technology for Economic and Clinical

Health Act or HITECH Act. Retrieved from

waysandmeans.house.gov/media/pdf/110/hit2.pdf.

Menachemi, N., J. Burkhardt, R. Shewchuk, D. Burke, and R. G. Brooks. 2006. “Hospital

Information Technology and Positive Financial Performance: A Different Approach to

Finding an ROI. Journal of Healthcare Management 51 (1), 40–58.

Menon, N., Lee, B., & Eldenburg, L. (2000). Productivity of Information Systems in the

Healthcare Industry. Information Systems Research 11(1), 83–92.

Peabody, N. (2011). Health Law Alert: Legal and Poltical developments affecting the health care

industry. The Health Information Technology for Economic and Clinical Health Act

(HITECH Act): implications for the adoption of health information technology, HIPAA,

and privacy and security issues. Retrieved from

http://www.nixonpeabody.com/publications_detail3.asp?ID=2621.

http://fermat.nap.edu/catalog/9728.html#toc




Pear, P. (2010). Standards Issued for electronic health records. The New York Times. Retrieved

from http://www.nytimes.com/2010/07/14/health/policy/14health.html.

Thouin, M. F., J. J. Hoffman, and E. W. Ford. 2008. “The Effect of Information Technology

Investment on Firm-Level Performance in the Health Care Industry. Health Care

Management 33 (1): 60–8.

U.S. Department of Health and Human Services. (n.d.) . Regulations. Retrieved from

http://www.hhs.gov/policies/index.html.

White Paper. (2007). Digital signatures and PDF combine for definitive electronic records and

transactions. Retrieved on January 18th, 2011 from www.adobe.com/government/pdfs/p

df_electronic_records_wp.pdf.

Winterkamp, K.(n.d.).Retrieved on January 21, 2011, from http://www.writepad.com/(s

0bb5qvuxubmuc45ag1gs255)/news.aspx?s=5&sub=12&l=False&nid=8.

http://www.writepad.com/(s

electronic health records and meaningful use...electronic health records and meaningful use course...

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