Electronic Health Record Systems: U.S. Federal Initiatives and Public/Private Partnerships

Introduction

ž  In April 2004, the president of the United States issued an executive order that called for action to put EHRs in place for most Americans in 10 years.

ž  Today, there is growing consensus that EHR-Ss, can meet clinical needs in healthcare by capturing, storing, and displaying clinical information when and where it is needed to improve treatment and to provide aggregate cross-patient data analysis.

Electronic Health Record Systems

- the set of components that form the mechanism by which patient records are created, used, stored, and retrieved. It includes people, data, rules and procedures, processing and storage devices.

- Longitudinal collection of electronic health information for and about persons, where healthcare is provided to an individual.

Federal Initiatives

  - Within the federal government, different departments exert different influences toward common goal of and EHR for most Americans. Agencies providing direct healthcare offer evidence that the use of EHRs across a multi-facility enterprise is a realistic goal with measurable, repeatable positive outcomes.

Department of Veterans Affairs

ž  The Veterans Health Information Systems and Technology Architecture support day to day clinical and administrative operations at local VA healthcare facilities.

ž   This new interface named the Computerized Patient Record System provided a single place for healthcare providers to review and update a patient’s health record and order medications, special procedures, x-rays, nursing orders, diets, and laboratory tests.

Department of Defense

ž  Providers have had a computerized physician order entry capability that enables them to order lab tests and radiology examinations and issue prescriptions electronically for over 10 years.

ž   DoD Pharmacy Data Transaction Service links military treatment facilities, mail order, and network pharmacies. This service enables providers at all military and civilian pharmacies to track daily medication transactions and to check for drug allergies and drug interactions.

Indian Health Service

ž  The IHS has long been a pioneer in using computer technology to capture clinical and public health data. Its Resource and Patient Management Systems was developed in the 1970s, and many facilities have access to decades of personal health information and epidemiologic data on local populations.

Office of the National Coordinator for Health Information Technology

ž  The executive order of April 2004, mentioned earlier, created the ONCHIT to coordinate HIT efforts in the federal sector and to collaborate with the private sector in driving HIT adoption across the healthcare system.

ž   In July 2004, Secretary Tommy Thompson and Dr. Brailer released a framework for strategic action intended to guide collaborative efforts to promote progress toward a consumer-centric and information-rich healthcare industry.

The National Committee on Vital and Health Statistics

ž  Held a series of national hearings to develop a consensus vision of National Health Information Infrastructure (NHII). In the resulting report, Information for Health, presented the concept of an infrastructure that emphasizes heath-oriented interactions and information-sharing among individuals and institutions, rather than simply physical, technical, and data systems that make those interaction possible.

Agency for Healthcare Research and Quality

ž  Unveiled a major HIT portfolio, with grants, contracts, and other activities to demonstrate the role of HIT in improving patient safety and the quality of care.

ž   AHRQ funded demonstration grants to establish and implement interoperable health information systems and data sharing to improve the quality, safety, efficiency, and effectiveness of healthcare for patients and populations on a specific state or regional level.

Centers for Medicare and Medicaid Services

ž  CMS has initiated several pilot projects to promote health IT.

ž   CMS awarded a $100, 000 grants to the American Academy of Family Physicians for a pilot project to provide comprehensive, standardized EHR software to small, and medium-sized ambulatory care practices.

Public-Private Partnership

ž  Focused on the use of EHR-Ss and HIT to improve care. Among these private sector organizations are those formed specifically to address issues of connectivity, HIT, and standards development.

Connecting for Health

ž  A large private collaborative with federal participants supported by the Markle and the Robert Wood Johnson Foundations, Connecting for Health is addressing the barriers to development of an interconnected health information infrastructure. It brings together several dozen of leading healthcare provider and payer organizations, HIT vendors, and representatives of federal and state agencies.

Health Initiative

ž  Is an independent, nonprofit affiliated organization established to foster improvement in the quality, safety, and efficiency of healthcare through information and IT. Its membership brings together hospitals and other providers, practicing clinicians, community organizations, payers, employers, community-based organizations, HIT suppliers, manufacturers, and academic organizations.

Institute of Medicine

ž  As an independent advisor to the nation with the goal of improving health, the IOM has championed the advantages of use of IT to improve healthcare since 1991 foundational work. The IOM continues to illuminate the importance for the use of IT in healthcare.

Certification Commission for Health Information Technology

ž  The Health Information and Management Systems (HIMMS), American Health Information Management Association (AHIMA), and National Alliance for Health Information Technology (NAHIT), have joined together to establish the (CCHIT).

ž   The goal of this group is to reduce risk of EHR investment.

Health Level Seven

ž  An international, non-for-profit, volunteer standards organization known for its large body of work in the production of technical specifications for the transfer of healthcare data.

ž The HL7-S functional model contains a list of functions in three categories:

 àDirect care function- needed to support direct care delivery.

àSupportive function- involve secondary use of the data captured via the direct care functions.

àInformation infrastructure- is the “backend” of the system; unfamiliar to many clinicians, this is considered essential by informaticists and technical staff.