Essay Instructions: Electronic Health Records
Electronic health records (EHRs) are at the center stage of the effort to improve health care quality and control costs. In addition to allowing medical practitioners to access and record clinical documentation at much faster rates, EHRs are also positively influencing care delivery and nurse-patient interaction. Yet despite the potential benefits of EHRs, their implementation can be a formidable task that has broad-reaching implications for an entire health care anization.
In this Discussion, you appraise strategies for obtaining the benefits and overcoming the challenges of implementing and using electronic health records.
• Review the Learning Resources focusing on the implementation of EHRs in an anization. Reflect on the various approaches used.
• If applicable, consider your own experiences with implementing EHRs. What were some positive aspects of the implementation? What suggestions would you make to improve the process?
• Reflect on the reactions of others during the implementation process. Were concerns handled effectively?
• If you have not had any experiences with an EHR implementation, talk to someone who has and get his or her feedback on the experience.
• Search the Walden Library for examples of effective and poor implementation of EHRs.
Post on or before Day 3 an overview of at least three challenges in the implementation of electronic health records and provide an example of each challenge. Develop strategies for addressing each challenge based on what has been demonstrated to be successful. Cite your resources.
KEY WORDS: chronic diseases; meaningful use; health care policy; health information technology.?J Gen Intern Med 25(3):174??"6?DOI: 10.1007/s11-x
© Society of General Internal Medicine 2010
T he U.S. is making a historic investment in federal support for health information technology, which will likely ap- proach $50 billion.1 Most of this investment will go out in the form of incentives to providers who adopt electronic health records (EHRs) both outside the hospital and inside it. The rationale for this policy change is the belief that EHR use will
reduce the costs of care, and improve quality and safety. While there is widespread belief this will occur, the evidence with respect to the impact of EHRs on costs and quality has been mixed.2 Much of the trial data come from “home-grown” electronic records. Models show that in these settings costs can be reduced substantially with EHRs across a range of assumptions,3 but real-world results are less certain especially with vendor-developed records. Regarding quality, while there is clear evidence that in specific circumstances EHRs do improve performance for some domains such as preventive care and use of medications when decision support is deliv- ered,4 the evidence is much more mixed for other domains, and many commercial applications include relatively little if any decision support. Cross-sectional studies that have asked whether or not EHR use has been associated with improved quality performance in the ambulatory setting have mostly found that it does not??"in one study, Linder found no systematic association between EHR use and better quality performance.5 In another, Zhou asked whether length of EHR use was associated with better performance on quality mea- sures, and again found that it was not.6 A more hopeful result came from Friedberg et al. who found that frequently used multifunctional EHRs were associated with better performance on 5 of 13 HEDIS measures in Massachusetts.7 The key themes are that for care to improve, the electronic record
needs to be reasonably robust, and it has to be used well.?If the costs of care are to be addressed, it will be absolutely essential to address the care of patients with chronic diseases, who account for approximately three quarters of all healthcare expenditures.8,9 However, it has been a challenge to use EHRs to improve care for this group. Most work has focused on the impact of clinical decision support and registries to improve
Published online February 2, 2010
care for these groups, and while there have been some modest successes for example for diabetes and coronary disease,10 the results have been decidedly mixed overall.4 In patients with chronic conditions, care coordination is especially pivotal, because it can reduce readmissions, and ensure that needed follow-up occurs.
The main care redesign approach??"which is potentially transformative and is justifiably getting a lot of attention??"is the patient-centered medical home. Although this concept was developed many years ago,11 it has not been widely implemen- ted, largely because of the way we pay for care in this country. To improve quality, all practices need good care coordination, regardless of whether or not they are medical homes.
In this issue of JGIM, O’Malley et al. present arguably the most comprehensive assessment to date of the ability of the current iteration of vendor-developed EHRs to assist providers with care coordination.12 To do their assessment, the research- ers used qualitative techniques, and performed 60 interviews in a national sample of practices using 17 different commercial EHRs.
They identified six key themes: 1) that EHRs needed to help with in-office communications??"which they generally did adequately; 2) that they also needed to help with communi- cation between clinicians and settings which was much less satisfactory; 3) that clinicians found information overflow a challenge; 4) that current records don’t support care coordi- nation planning; 5) that care coordination processes need to evolve; and 6) not surprisingly, that fee-for-service pay- ment encourages billable event documentation, but not care coordination.
These issues have different solutions. The problem of between-clinician and between settings communication is being addressed by the development of clinical data exchanges between entities, and this is squarely within the sights of policy-makers.13 Even when such exchanges are developed, however, considerable challenges remain, for example how to make it easy for a provider to see immediately that a key piece of information like a cardiac catheterization from another site is present, or even more important that a result available from a discharge elsewhere needs early follow-up.
The problem of information overflow represents a fundamen- tal informatics problem, and will require some redesign of current clinical systems.14 It should be possible to “strain out” much of the extraneous information, while highlighting the few items that are truly need to be addressed soon.
However, the themes around the observation that current EHRs do not support care coordination well, and that the
Getting in Step: Electronic Health Records and their Role in Care Coordination
David W. Bates, MD, MSc1,2,3
1Division of General Internal Medicine and Center of Excellence for Patient Safety Research and Practice Brigham and Women’s Hospital, Boston, MA, USA; 2 Harvard Medical School, Boston, MA, USA; 3Department of Health Policy and Management Harvard School of Public Health, Boston, MA, USA.
JGIM Bates: Electronic Health Records and their Role in Care Coordination 175
overall process needs to be redesigned represent the central and most important part of the results, with the most profound implications. No EHR in this study could claim exemplary performance in this area, and there will be a tight linkage between performing good care coordination, imple- menting the patient-centered medical home, and actually delivering the results with respect to improvement that everyone wants to see. To move to team care, which is a central feature of the medical home, will require tools that enable the various members of the team to document progress for patients, agree on goals, and stay on the same page with respect to progress and who is responsible for specific items. Many have made the assumption that this documentation needs to be in the notes of the record, but this doesn’t have to be the case. Another approach would be to place much of this information in a new location in the record. Regardless, it will need to be linked with clinical decision support and registry functions that make it easier for care coordinators and providers alike to readily track patients.
But as O’Malley et al. found, these tools simply do not exist today in most EHRs, which means they will need to be developed. Even the underlying processes in practices in these areas are likely to evolve substantially in the coming years. This should be a key area of attention for SGIM members in the next several years, since it is especially important that this work well in primary care.
This work also illustrates the enormous value of qualitative research in evaluating healthcare information technology. In- creasingly, mixed-model approaches should be used in informat- ics, even when the main outcomes are quantitative, because they can help elucidate what did and did not work. When addressing an area like this one which has received little previous attention, qualitative approaches are especially useful.
These findings have a number of implications. Today’s commercially available EHRs do not come close to meeting provider needs with respect to care coordination, even though this is one of the most important domains for managing patients with chronic diseases. But practices themselves do not have well-developed processes for this area so this does not represent functionality the vendors can simply “add on.” This implies that it is too early from the policy perspective to require tools such as this for certification of records, except at a very basic level. Instead the key approach in the near term should be to support research to develop and refine the needed tools.
In addition, there are some issues that can be readily addressed by vendors in the near term. For example, vendors should be representing data in standard ways to enable data exchange among users of different systems, and developing interfaces and tools that help address the data overload issue. A simple example of this latter issue is a tool that takes all the test results for a provider, puts them in a queue, and prioritizes them according to how abnormal they are.15 Some vendor applications do include tools like this today, but most do not. The current policy agenda in these areas should result in improvement.
The meaningful use definitions being developed should take the findings of this study into account, as should the Office of the National Coordinator. The current proposed meaningful use definitions around care coordination would require outpatient providers to participate in clinical data exchange and perform medication reconciliation at relevant encounters by 2011, and require providers to be able to
receive electronic prescription fill data by 2013, while in 2015 providers would be asked to demonstrate a 10% decrease in the 30-day readmission rate and improvement on NQF-endorsed measures of care coordination. These criteria say nothing about care coordination within practices where most of it will take place, and thus it is not at all clear that meeting the 2011 and 2013 criteria will be sufficient to put practices in the position to be successful in 2015. The 2015 criteria appear to be relatively distant goalposts, and lots will need to change in the practices themselves and the EHRs they use if the 2015 criteria are to be met. While it may be reasonable for the criteria to be ends not means, there is a great deal to be done to address the issues of how to better coordinate care within practices. The Office of the National Coordinator and the Agency for Healthcare Re- search and Quality should begin supporting research in these areas immediately.
Ultimately, for improving care coordination to rise to the top of the list, payment reform will be essential. In the short run, this appears likely to take the form of accountable care anizations and bundling, which would be helpful with respect to aligning incentives, although more fundamental payment reform will likely eventually be necessary.
The current work by O’Malley et al. represents some of the best to date on how EHRs support care coordination, which again is a crucial function. Moving ahead will require more research in this area, as today’s processes are immature and all of this will need to be interfaced with the medical home concept. Improving this could hardly be more important, as the patients who get the most benefit from care coordination account for a huge proportion of the costs in our healthcare system.
Acknowledgements: I thank Jennifer Love for her assistance with the preparation of this manuscript.
Corresponding Author: David W. Bates, MD, MSc; Division of General Internal Medicine and Center of Excellence for Patient Safety Research and Practice Brigham and Women’s Hospital, Brigham Circle, 1620 Tremont St., 3rd Floor, Boston, MA 02120- 1613, USA (e-mail: ).
1. American Recovery and Reinvestment Act of 2009; 2009.?2. Chaudhry B, Wang J, Wu S, et al. Systematic review: impact of health information technology on quality, efficiency, and costs of medical care.
Ann Intern Med. 2006;144(10):742??"52.?3. Wang SJ, Middleton B, Prosser LA, et al. A cost-benefit analysis of
electronic medical records in primary care. Am J Med. 2003;114(5):397??"
403.?4. Garg AX, Adhikari NK, McDonald H, et al. Effects of computerized
clinical decision support systems on practitioner performance and
patient outcomes: a systematic review. JAMA. 2005;293(10):1223??"38. 5. Linder JA, Ma J, Bates DW, Middleton B, Stafford RS. Electronic health record use and the quality of ambulatory care in the United
States. Arch Intern Med. 2007;167(13):1400??"5.?6. Zhou L, Soran CS, Jenter CA, et al. The relationship between electronic
health record use and quality of care over time. J Am Med Inform Assoc.
2009;16(4):457??"64.?7. Friedberg MW, Coltin KL, Safran DG, Dresser M, Zaslavsky AM,
Schneider EC. Associations between structural capabilities of primary care practices and performance on selected quality measures. Ann Intern Med. 2009;151(7):456??"63.
176 Bates: Electronic Health Records and their Role in Care Coordination JGIM
8. Bodenheimer T, Wagner EH, Grumbach K. Improving primary care for patients with chronic illness. JAMA. 2002;288(14):1775??"9.
9. Hoffman C, Rice D, Sung HY. Persons with chronic conditions. Their prevalence and costs. JAMA. 1996;276(18):1473??"9.
10. Sequist TD, Gandhi TK, Karson AS, et al. A randomized trial of electronic clinical reminders to improve quality of care for diabetes and coronary artery disease. J Am Med Inform Assoc. 2005;12(4): 431??"7.
11. Homer CJ, Klatka K, Romm D, et al. A review of the evidence for the medical home for children with special health care needs. Pediatrics. 2008;122(4):e922??"37.
12. O’Malley AS, Grossman JM, Cohen GR, Kemper NM, Pham HH. Are electronic medical records helpful for care coordination? Experiences of physician practices. J Gen Intern Med. XXXXXX 2010.
13. Adler-Milstein J, Bates DW, Jha AK. U.S. Regional health information anizations: progress and challenges. Health Aff (Millwood). 2009;28 (2):483??"92.
14. Sittig DF, Wright A, Osheroff JA, et al. Grand challenges in clinical decision support. J Biomed Inform. 2008;41(2):387??"92.
15. Poon EG, Wang SJ, Gandhi TK, Bates DW, Kuperman GJ. Design and implementation of a comprehensive outpatient results manager. J Biomed Inform. 2003;36(1??"2):80??"91.
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The Journey to Meaningful Use of Electronic Health Records
The American Recovery and Reinvestment Act and its important Health Information Technology Act provision became law on February 17, 2009.
Commonly referred to as “The Stimulus Bill” or “The Recovery Act,” the landmark legislation allocated $787 billion to stimulate the economy, including $147 billion to rescue and reform the nation’s seriously ailing health care industry.
Of these funds, $19 billion in financial incentives were earmarked for the relatively short period of 5 years to drive reform through the use of advanced health infor- mation technology (HIT) and the adoption of electronic health records (EHRs).
The incentives were intended to help health care providers purchase and implement HIT and EHR sys- tems, and the HITECH Act also stipulated clear penal- ties would be imposed beyond 2015 for both hospitals and physician providers who failed to adopt use of EHRs in a meaningful way.
Nurses will be integral to achieving a vision that will require a nationwide effort to adopt and implement EHR systems in a meaningful way.
IN 2004, THOSE OF US IN nurs- ing informatics or who fol- low health information tech- nology (HIT) trends were thrilled when President Gee W. Bush said in his 2004 State of the Union address “...an Electronic Health Record for every American by the year 2014...by computerizing health records, we can avoid dangerous medical mistakes, reduce costs,
and improve care” (Bush, 2004). This was the first time a president formally recognized the value of HIT and set a deadline to do something about it! President Bush went on to establish the Office of the National
Coordinator for HIT (ONC), and Dr. David Brailer was appointed as the first coordinator by Tommy Thompson, then Secretary of the Department of Health and Human Services (HHS).
The support continued. In 2005, funding from HHS was earmarked to establish anizations for standards harmonization (HIT Standards Panel) and for certification of electronic health record (EHR) sys- tems (Certification Commission for HIT). In 2006, the Agency for Healthcare Research and Quality (AHRQ) launched its National Resource Center for HIT. Government attention persisted in 2007 with the funding of National Health Information Network pro- totypes. Momentum was building and there was much attention on HIT from the federal government.
Fast forward to 2009. President-Elect Barack Obama says he wants the federal government to invest in EHRs so all medical records are digitized within 5 years and vows to continue to push for the 2014 deadline established by Bush. “This will cut waste, eliminate red tape, and reduce the need to repeat expensive medical tests,” he said, adding that the switch also will save lives by reducing the num- ber of errors in medicine (Obama, 2009).
President Obama then does more than talk about HIT. He works with Congress to pass the American Recovery and Reinvestment Act (ARRA), providing unprecedented funding to promote health care reform through the use of HIT. Incentives totaling $19 billion are allocated for “meaningful use” of EHRs in hospi- tals and ambulatory settings beginning in 2011. This sets the stage for today’s focus on the use of HIT, and the proliferation of EHR implementation projects in our clinical settings. Let’s explore the legislative back- ground and details surrounding the federal incen- tives.
On March 23, 2010, President Obama signed into law the landmark Patient Protection and Affordable Care Act (PPACA), a federal statute that represents the most recent legislation in a sweeping health care reform agenda driven into law by the Democratic 111th Congress and the Obama Administration. The new law is dedicated to replacing a broken system with one that ensures all Americans have access to health care that is both affordable and driven by qual- ity standards. It includes broad provisions for improv- ing health care delivery that will take affect from the moment of enactment through 2018.
For the Obama Administration, the hard-fought legislative success of PPACA turns the spotlight on
JUDY MURPHY, RN, FACMI, FHIMSS, is Vice President, Information Services, Aurora Health Care in Milwaukee, WI; a HIMSS Board Member; and a member of the federal HIT Standards Committee. Comments and suggestions can be sent to judy.
NOTE: Hear Judy speak on “The Economic$ for Meaningful Use of Health Information Technology” at the 4th Annual Nurse Faculty/Nurse Executive Summit, December 13-15, 2010, in Scottsdale, AZ. Visit www.nursingeconomics.net for Summit program and registration information.
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the growing recognition advanced HIT is and will be essential to support the massive amounts of electron- ic information exchange foundational to reform. In fact, the universal agreement that meaningful health care reform cannot be separated from the national, and arguably global, integration of HIT based on accepted, standardized, and interoperable methods of data exchange provided the linchpin for other criti- cally important legislation that created the glide path for PPACA.
This consensus resulted in the broad support and passage into law of the ARRA and its key Health Information Technology Act (HITECH) provision in the early weeks of Mr. Obama’s presidency in 2009. Backed with an allocation of over $19 billion, this leg- islation authorized the Centers for Medicare and Medicaid Services (CMS) to provide reimbursement incentives for hospitals and eligible providers that take steps to become “meaningful users” of certified EHR technology to improve care quality and better manage care costs.
At the core of the new reform initiatives, the incentivized adoption of EHRs will improve care quality and better manage care costs, meeting clinical and business needs by capturing, storing, and dis- playing clinical information when and where it is needed to improve individual patient care and to pro- vide aggregated, cross-patient data analysis.
EHRs will manage health care data and informa- tion in ways that are patient centered and information rich. Improved information access and availability will increasingly enable both the provider and the patient to better manage each patient’s health by using capabilities provided by enhanced clinical decision support and customized education materi- als.
ARRA and its HITECH Act Provision
ARRA and its important HITECH Act provision were passed into law on February 17, 2009. Commonly referred to as “The Stimulus Bill” or “The Recovery Act,” the landmark legislation allocated $787 billion to stimulate the economy, including $147 billion to rescue and reform the nation’s seriously ail- ing health care industry. Of these funds, $19 billion in financial incentives were earmarked for the relatively short period of 5 years to drive reform through the use of advanced HIT and the adoption of EHRs. The incentives were intended to help health care providers purchase and implement HIT and EHR sys- tems, and the HITECH Act also stipulated clear penal- ties would be imposed beyond 2015 for both hospitals and physician providers who failed to adopt use of EHRs in a meaningful way. Here are some of the key components of ARRA (Murphy, 2010) and HITECH (Blumenthal, 2010; HITFHC, 2009a).
Meaningful use. The majority of the HITECH funding will be used to reward hospitals and eligible
providers for “meaningful use” of certified EHRs by “meaningful users” with increased Medicare and Medicaid payments (HITFHC, 2009b; Murphy, 2009). Both programs have start dates of fiscal year 2011 (October 1, 2010) for hospitals and calendar year 2011 (January 1, 2011) for eligible providers. On December 31, 2009, the Centers for Medicare and Medicaid Services (CMS), with input from ONC and the HIT Policy and Standards Committees, published a Proposed Rule on Meaningful Use of EHRs and began a 60-day public comment period. After reviewing more than 2,000 comments, HHS issued the final rule on July 13, 2010. The final criteria for meeting “mean- ingful use” are divided into five initiatives:
1. Improve quality, safety, and efficiency, and reduce health disparities.
2. Engage patients and families.?3. Improve care coordination.?4. Improve population and public health.?5. Ensure adequate privacy and security protections
for personal health information.?Specific objectives were written to demonstrate
that EHR use has a “meaningful” impact on one of the five initiatives. Under the final rule, there are 14 “core” (required) objectives for hospitals and 15 for providers. Both hospitals and providers have 10 other objectives in a “menu set” from which they must choose and comply with five. If the objectives are met during the specified year and the hospital or provider submits the appropriate measurements, then the hos- pitals or providers will receive the incentive pay- ment. The hospital incentive amount is based on the Medicare and Medicaid patient volumes; the provider incentives are fixed per provider. The incentives are paid over 5 years, and the hospital or provider must submit measurement results annually during each of the years to continue to qualify. The objectives will mature every other year, with new criteria and stan- dards being published in 2011, 2013, and 2015.
Quality measures. One of the “meaningful use” criteria for both hospitals and providers is the require- ment to report quality measures to either CMS (for Medicare) or to the state (for Medicaid). For providers, the final rule lists 44 measures, with a requirement to comply with six. For hospitals, the rule lists 15 measures, with a requirement to comply with them all.
Because HHS will not be ready to electronically accept quality measure reporting in 2011, the Proposed Rule specifies that hospitals and eligible providers will submit summary information on clini- cal quality measures to CMS through attestation in 2011. HHS expects to be ready to electronically accept quality measure reporting in 2012, so hospitals and providers will be expected to submit their results on the clinical quality measures electronically begin- ning in 2012.
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The quality measurement?is considered one of the most?important components of the?incentive program under?ARRA/HITECH, since the pur-?pose of the HIT incentives is?to promote reform in the?delivery, cost, and quality of?health care in the United?States. Dr. David Blumenthal,?current national coordinator?of HIT, emphasized this point when he said “HIT is the means, but not the end. Getting an EHR up and running in health care is not the main objective behind the incentives provided by the federal government under ARRA. Improving health is. Promoting health care reform is” (Blumenthal, 2009; Manos, 2009).
Research support. ARRA and HITECH increased funding by more than $1 billion for comparative effectiveness research through AHRQ and the National Institutes of Health (NIH). In addition, NIH designated over $200 million for a new initiative called the NIH Challenge Grants in Health and Science Research. NIH anticipates funding 200 or more grants, each up to $1 million, addressing specif- ic scientific and health research challenges in bio- medical and behavioral research.
In addition, the National Library of Medicine (NLM) offers applied informatics grants to health- related and scientific anizations that wish to opti- mize use of clinical and research information. These grants help anizations exploit the capabilities of HIT to bring usable, useful biomedical knowledge to end users by translating the findings of informatics and information science research into practice through novel or enhanced systems, incorporating them into real-life systems and service settings.
SHARP grants. Alongside the NIH and NLM focus on incentivizing research, ONC also made available $60 million to support the development of Strategic Health IT Advanced Research Projects (SHARP). The SHARP Program funds research focused on achieving breakthrough advances to address well-documented problems that have impeded adoption of HIT and accelerating progress toward achieving nationwide meaningful use of HIT in support of a high-perform- ing, continuously learning health care system.
Beacon communities. Also funded by HITECH, the Beacon Community Program includes $250 mil- lion in grants to build and strengthen the HIT infra- structure and HIT capabilities within 17 communi- ties. These communities will demonstrate the future where hospitals, clinicians, and patients are meaning- ful users of HIT, and together the community achieves measurable improvements in health care quality, safe- ty, efficiency, and population health. The funding was awarded to communities already at the cutting edge of EHR adoption and health information exchange to
push them to a new level of sustainable health care quality and efficiency. The communi- ties are expected to generate lessons learned on how other communities can achieve sim- ilar goals enabled by HIT.
Workforce training. Finally, ARRA funding has also been designated to educate the work- force required to modernize the promoting and expanding the
health care system by?adoption of HIT by 2014. Four grant programs support the training and development of the necessary skilled workforce:?• $32 million to establish nine university-based cer-
tificate and advanced degree HIT training pro- grams, including one sponsored by the University of Colorado-Denver School of Nursing.
• $360 million to create five regional community college consortia of more than 80 member com- munity colleges in all 50 states to help address the demand for skilled HIT specialists.
• $10 million to support HIT education curriculum development.
• $6 million to develop an HIT competency exami- nation program.
Nursing Informatics Empowering Meaningful Use
In this massive transformation from disconnect- ed, inefficient, paper-based islands of care delivery to a nationwide, interconnected, and interoperable sys- tem driven by EHRs and advancing HIT innovation, the importance of nurses and nursing informatics will be difficult to overstate. For decades, nurses have proactively contributed resources to the develop- ment, use, and evaluation of information systems. Today, they constitute the largest single group of health care professionals, including experts who serve on national committees and participate in inter- operability initiatives focused on policy, standards and terminology development, standards harmoniza- tion, and EHR adoption. In their front-line roles, nurs- es continue to have a profound impact on the quality and cost of health care and are emerging as leaders in the effective use of HIT to improve the safety, quality, and efficiency of health care services.
Informatics nurses are key contributors to a work- ing knowledge about how evidence-based practices designed in information systems can support and enhance clinical processes and decision making to improve patient safety and outcomes. In addition, as drivers in anizational planning and process re- engineering to improve the health care delivery sys- tem, informatics nurses are increasingly sought out by nurses and nurse managers for leadership as their profession works to bring IT applications into the mainstream health care environment.
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Informatics nurses are key contributors to a working knowledge about how
evidence-based practices designed in information systems can support and enhance clinical processes and decision making to improve patient safety and outcomes.
Therefore, it will be increasingly essential to the success of today’s health care reform movement that informatics nurses are involved in every aspect of selecting, designing, testing, implementing, and developing health information systems. Further, the growing adoption of EHRs must incorporate nursing’s unique body of knowledge with the nursing process at its core.
Many nursing and health care leaders agree that the future of nursing depends on a profession that will continue to innovate using HIT and informatics to play an instrumental role in patient safety, change management, and quality improvement, as evidenced by quality outcomes, enhanced workflow, and user acceptance. In an environment where the roles of all health care providers are diversifying, nurses will guide the profession from their positions as HIT proj- ect managers, consultants, educators, researchers, product developers, decision support and outcomes managers, chief clinical information officers, chief information officers, advocates, policy developers, entrepreneurs, and business owners. To achieve our nation’s health care reform goals, health care leaders must leverage the patient care technologies and infor- mation management competencies that informatics nurses provide to insure their investment in HIT and EHRs is implemented properly and effectively over coming years.
In fact, in its October 2009 recommendations to the Robert Wood Johnson Foundation on the future of nursing, the Alliance for Nursing Informatics (ANI) argued nurses will be integral to achieving a vision that will require a nationwide effort to adopt and implement EHR systems in a meaningful way. “This is an incredible opportunity to build upon our under- standing of effectiveness research, evidence-based practice, innovation and technology to optimize patient care and health outcomes. The future of nurs- ing will rely on this transformation, as well as on the important role of nurses in enabling this digital revo- lution” (ANI, 2009, p. 9).
For no professional group does the future hold more excitement and promise from so many perspec- tives than it does for nursing. $
Alliance for Nursing Informatics (ANI). (2009). Statement to the Robert Wood Johnson Foundation Initiative Future of Nursing: Acute care, focusing on the area of technology. Retrieved from http://www.himss./handouts/ANI ResponsetoRWJ_IOMonTheFutureofNursing.pdf?src=winew s20091014
Blumenthal, D. (2009). National HIPAA Summit in Washington, DC. Retrieved from http://www.healthcareitnews.com/news/ healthcare-it-means-not-end-says-blumenthal
Blumenthal, D. (2010). Launching HITECH. New England Journal of Medicine, 362(5), 382-385.
Bush, G.W. (2004). State of the Union Address. (2004, January 20). Retrieved from http://whitehouse.geebush./news/ 2004/012004-SOTU.asp
Health Information Technology for the Future of Health and Care (HITFHC). (2009a). HITECH programs. Retrieved from http://healthit.hhs.gov/portal/server.pt?open=512&objID=14 87&parentname=CommunityPage&parentid=1&mode=2&in_ hi_userid=10741&cached=true
Health Information Technology for the Future of Health and Care (HITFHC). (2009b). Meaningful use. Retrieved from http://healthit.hhs.gov/portal/server.pt?open=512&objID= 1325&mode=2
Obama, B. (2009). President-elect speaks on the need for urgent action on an American Recovery and Reinvestment Plan. Speech at Gee Mason University in Fairfax, Virginia, January 8, 2009. Retrieved from http://change.gov/news- room/entry/presidentelect_obama_speaks_on_the_need_for_ urgent_action_on_an_american_r
Manos, D. (2009). Healthcare IT is the means, but not the end, says Blumenthal. Healthcare IT News. Retrieved from http://www.healthcareitnews.com/news/healthcare-it- means-not-end-says-blumenthal
Murphy, J. (2010). This is our time: How ARRA changed the face of health IT. Journal of Healthcare Information Management, 24(1), 8-9.
Murphy, J. (2009). Meaningful use for nursing: Six themes regard- ing the definition for meaningful use. Journal of Healthcare Information Management, 23(4), 9-11.
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Excerpt From Essay:
Essay Instructions: In recent years, many health care organizations have been making the switch from paper-based medical records to paperless, computer-based medical records. Some argue that there are too many security and confidentiality issues that can be created when using a computerized system. However, advocates of the switch think one important difference is the ability for health care providers to take better care of patients.
The health care organization you are working for is considering switching from a paper-based system to electronic health records. Your boss has been on the fence about this for awhile, and you have actively tried to convince him to make the switch. Finally, he has approached you to hear why you think electronic health records (EHRs) would be better.
As an advocate for the switch to computer-based medical records. Your boss has asked you to address the following information:
How electronic health records help practices offer better options for the following:
What information will the EHRs include?
Although you are an advocate for EHRs, what drawbacks do they have?
Research and provide examples of a medical office that has implemented EHRs. How has it helped them? Has it created any negative aspects?
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Total Pages: 5 Words: 1688 References: 4 Citation Style: APA Document Type: Essay
Essay Instructions: ? In the second week of your internship, the CIO approaches you and asks you to research electronic health records (EHRs). She says, ?I must give a presentation at a staff meeting next week, and I?d like you to complete the research and create the slides and notes for me. The presentation must focus on EHRs, which our organization is considering implementing. Please be thorough with the speaker notes.?
The CIO adds that you must consider the effect of this technology on health care as well as the privacy and security implications of adopting the EHRs. Describe the HIPAA Privacy and Security Rules as well as the reasons those rules do or do not apply to this type of technology. These constraints are a major consideration for the staff when selecting new technology.
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Total Pages: 4 Words: 1460 Works Cited: 7 Citation Style: MLA Document Type: Research Paper
Essay Instructions: When electronic health records (EHRs) first entered the market, their primary focus was to collect and analyze patient information within health care settings. As technological capabilities grew, so did the interest in making these records available to patients. In addition, many health care professionals saw benefits in allowing the patient to enter his or her own health data into EHR platforms. Though many patients are already utilizing personal health records (PHRs) to manage and track their own health, some believe that an integrated system would provide a better, more comprehensive picture of a patient?s health history.
As a result, many EHR platforms are now equipped with a PHR tool. This PHR tool allows patients to enter health information as they would in a stand-alone PHR system. In addition, web-based portals within the EHR allow patients to access information entered by their physicians and health care providers.
Like many emerging trends and technologies, there is much discussion about the potential benefits and challenges of this type of integrated system. While many health care professionals are excited about the empowerment provided to patients, others express significant concerns about access, security, ethics, and other implications.
In this Discussion, you explore how integrating PHRs into EHR platforms could impact you and your patients.
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