Automating Medical Records in the 21st Century

The first ever paper medical record was the brainchild of none other than Hippocrates in the fifth century B.C.  Accordingly, a medical record must achieved two goals: one, the medical record must be precise and accurate to indicate the progression of the disease process; and two, the medical record must reflect the symptoms, the probable cause and the prognosis of the disease.

Timeline to Medical Records Automation Initiative

No, it was not President Obama’s idea to automate medical records, but it was actually then President George Bush in 2004 that brought the idea of electronic health records (EHRs) and electronic medical records (EMRs) to the fore.  George W. Bush announced in his State of the Union address the implementation of EHRs for every healthcare organization by 2014. The idea came into reality however, when President Obama signed into law the American Recovery and Reinvestment Act (ARRA) of February 19, 2009 which is commonly called “The Stimulus Bill” or “The Recovery Act,” allocating $787 billion to stimulate the economy, including $147 billion to rescue and reform the healthcare industry (Murphy, 2009). Of these funds, $19 billion was earmarked for the implementation of EHRs in every provider and hospital facilities by 2015.  Under the ARRA is the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 which provides help for providers and hospitals to procure and implement EHRs in their facilities.  Under the HITECH Act, the Office of the National Coordinator (ONC) and the Center for Medicare and Medicaid Services (CMS) will establish guidelines for which eligible professionals, eligible hospitals, and critical access hospitals (CAHs) can qualify for Medicare and Medicaid incentive payment program which is called “Meaningful Act” (HHS.gov, 2011).

 What is an EHR?

Electronic health records (EHRs) have been touted as one of the most recent health information technology (HIT) innovations that could improve the quality and efficiency of healthcare. EHRs along with other clinical information systems such the computerized physician order system (CPOE) and electronic medical record (EMR) have shown the most promise and capabilities for reducing costs and improving quality. They can collect, store, retrieve, and transfer clinical, health, and administrative data (Miller & Sims, 2004).  According to Armijo, McDonnell and Werner (2009), EHRs are mostly effective as an aid for memory, computing, decision support, and collaboration. To briefly discuss – it functions as a memory aid because it reduces reliance alone on memory for information. It also functions as computational aid since it reduces the need to group, compare and analyze information.  In terms of decision support aid, it integrates information from multiple sources to make evidence-based decisions. Patients can have their prescriptions ordered and insurance claims ready even before they leave their doctor’s office.  And finally, it serves as a collaboration aid because other parties such as healthcare providers and healthcare insurers can communicate information to other providers, insurers, or even patients. It means accessing patient’s health information when and where it is needed (Armijo, McDonnell and Werner, 2009).

Difference Between EMRs and EHRs

Electronic Medical Records (EMRs) and Electronic Health Records (EHRs) are used interchangeably by some people, thus studies for both systems and their applicability is interchangeable as well, but actually there is a distinct difference. The information on the EMRs stays inside and does not travel outside of the physician’s office (Garret & Seidman, 2011). In contrast, EHRs can do all the functions of an EMR and more because it can travel outside of the physician’s office and hence can be shared with other health care providers such as laboratories and physician offices. Moreover, the information moves from one stakeholder to another, from patient, to specialty groups, to hospitals, and between states. Thus, all of the healthcare givers that are involved in patient care could access the record online, even the patients themselves (Garret & Seidman, 2011).

What is the Meaningful Use Act (MU)?

Identifying the goals and standards of the MU is the beginning of a successful nationwide adoption process for EHRs. There are six initiatives under the MU criteria (Murphy, 2009):  1) Health care quality, safety and efficiency improvement; 2) Families and patients will be more engaged; 3) Coordination of care will greatly improve; 4) Public health improvement as well as improved population; 5) Privacy and security protection improvement; and 6) Healthcare costs reduction.

The MU Act also set the funding of EHRs through HITECH in which the federal government will allocate resources in supporting the adoption and use of EHRs. It will make available incentive payments totaling up to $27 billion over 10 years, or as much as $44,000 (through Medicare) and $63,750 (through Medicaid) per clinician.

Conclusion

The National Center for Healthcare Statistics (NCHS) reported in 2011 that the use of EHRs and EMRs among office-based physicians has increased by three folds, from 18% in 2001 to 57% in 2011. In the same report, the percentage of physicians applying for Medicare or Medicaid incentive payment has increased by 26% from 2010.

Cesar Aquino is a Cytotecchnologist with an MBA in Healthcare Management and currently a PhD Candidate in Healthcare Administration