Introduction
In April 2004, the president of the United States issued an executive order that called for action to put EHRs in place for the most Americans in 10 years. Today, there is growing consensus that EHR-Ss, can meet clinical and business needs in healthcare by capturing, storing, and displaying clinical information when and where it is needed to improve treatment and to provide aggregated cross patient data analysis.These systems can manage healthcare data information in a way that is patient-centered and information-rich. Improved information access and availability can enable both the provider and the patient to better manage the patients health by using capabilities provided by enhanced clinical decision support and customized education materials.
Defining Electronic Health Record Systems
The IOM’s 1991 definition of computer-based patient record system is currently the basis for domestic and international definitions of an HER-S:
- 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.
Recently, the IOM modified this definition in its
report, Key Capabilities of an Electronic Health Record System (2003),
reiterating the new definition in a report on patient safety. An EHR-S includes
the following:
- Longitudinal collection of electronic health information for about persons, where health care is provided to an individual.
- Immediate electronic access to person- and population-level information by authorized, and only authorized users.
- Provision of knowledge and decision support that enhances the quality, safety, and efficiency of patient care
- Support of efficient processes for healthcare delivery.
Federal Initiatives
Within the federal government, different departments exert different influences toward the common goal of an EHR for most Americans. Agencies providing direct healthcare offer evidence that the use of EHR-Ss across a multifacility enterprise is a realistic goal with measurable, repeatable positive outcomes.
Department of Veterans Affairs
The Veterans Health Information Systems and Technology Architecture (VistA) supports day-to-day clinical and administrative operations at local
VA healthcare facilities. This new interface named the computerized patient record system (CPRS) 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
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. DoD’s
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 medications transactions and to check
for drug allergies and drug interactions.
Indian Health Service
The IHS has long been a pioneer in using computer technology to capture clinical and public health data. Its Resource and Patient Management System (RPMS) was developed in the1970s, and many facilities have access to decades of personal health information and epidemiologic data on local populations.Its primary clinical component, the patient care component (PCC), has been in place since the early 1980s.
Office of the National Coordinator for Health Information Technology
The executive order of April 2004, mentioned earlier created the ONCHIT to coordinate HIT efforts in the federal sector and to collaborate with private sector in driving HIT adoption across the healthcare system. In July 2004, HHS Secretary Tommy Thompson and Dr. Brailer released a framework for strategic action intended to guide collaborative effort to promote progress toward a consumer-centric and information rich- healthcare industry.
The National Committee on Vital and Health Statistics
Held a series of national hearings to develop a consensus vision of the National Health Information Infrastructure ( NHII). In resulting report, Information for Health was presented the concept of an infrastructure that emphasizes health-oriented interactions and information-sharing among individuals and institutions, rather than simply the physical, technical, and data systems that make those interactions possible.
Agency for Healthcare Research and Quality
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. 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
CMS has initiated several pilot projects to promote
health IT. CMS awarded a $100,000 grant to the American Academy of Family
Physicians (AAFP) for a pilot project to provide comprehensive, standardized EHR software to small and medium-sized ambulatory care practices.
Public-Private Partnerships
A number of collaborative efforts are 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. Others are established standards development organizations, some are based in professional association, where they arose in efforts to serve their memberships.
Connecting for Health
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 the leading healthcare provider and payer organizations, HIT vendors, and representatives of federal and state agencies.
Health
Initiative
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
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
The Health Information
and Management Systems (HIMSS), American Health Information Management
Association( AHIMA), and National Alliance for Health Information Technology (
NAHIT) have joined together to establish the Certification Commission for
Health Information Technology(CCHIT). The goal of this group is to reduce the
risk of HER investment.
Health
Level Seven
An international,
non-profit, volunteer standards organization, Health Level Seven (HL7, 2004) is
known for its large body of work in the production of technical specifications
for the transfer of healthcare data. The HL7 HER-S functional model contains a
list functions in (3) categories:
- Direct Care
The
direct care functions are familiar to clinicians, contained the user interface,
these functions are needed to support direct care delivery.
- Supportive Care
The
supportive care functions involve secondary use of the data captured via the
direct care functions, these functions support enhanced functions for direct
care and advanced information handling needs for the organization.
- Information Infrastructure
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