Electronic Medical Record Adalah – Despite millions of dollars and thousands of hours of doctors’ time, patients and their providers often find they have no way to access a patient’s complete medical history. That’s why it took so long.
Seema Verma, director for the Centers for Medicare and Medicaid Services (CMS), was returning to Washington, DC, after a weekend with her family when she received a panicked call from her daughter. His family was waiting for a connecting flight to Indianapolis, Indiana, when Verma collapsed and stopped breathing.
Electronic Medical Record Adalah
“If it wasn’t for the bystanders and first responders at the airport, my children would have found their father dead,” Verma told an audience at the Society for Information Systems and Management Conference. Health (HIMSS) in March 2018. Unfortunately, because his health care records were not immediately available, first responders and the medical team at the Hospital of the University of Pennsylvania knew nothing about his medical history. Verma tried desperately to get the information they needed, returning calls to her husband’s doctors in Indianapolis. The following week, doctors discovered the cause of his heart failure and treated him well. But even when her husband was finally released, getting the records of his weekly treatment to take to his doctors back home was a struggle.
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Verma used his remarkable personal story to introduce a new CMS initiative, called MyHealthEData. Its goal: make Medicare and Medicaid patients’ medical records accessible, both to doctors and patients, and avoid uncertainty, delay, unnecessary tests and procedures, and unnecessary risks useful that your husband faces. By giving patients more control over their medical data, he told conference attendees, MyHealthEData will help patients make better health decisions while also driving innovation and research progress to cure diseases. , which will reduce costs and improve health outcomes.
Almost everyone agrees that making electronic health records (EHRs) fully portable will mean better care at lower cost. But while the purpose of MyHealthEData is laudable, critics are quick to note that the announcement lacks much detail on how it will be implemented.
There is good reason for the skepticism. The healthcare world has been talking about EHR adoption for over two decades. “And we’re a long way from that goal,” says Julia Adler-Milstein, PhD, associate professor and director of the Center for Clinical Informatics and Improvement Research (CLIIR) at the University of California, San Francisco, and doctor said an international. . Know expert in health information. “All you have to do is look at how many medical offices still use fax to see how far we have to go.”
Why does it take so long? And what do you need to do to make real progress in living?
What Is An Ehr System And How Can You Build One?
The basis of making patient health records portable is interoperability—the ability of an EHR system to communicate with another and allow patients and providers to exchange health information with minimal time and effort. The goal of interoperability was first enshrined in policy in the Health Information Technology Act of 2009 for Business and Health Care (HITECH), which stated that one of the required capabilities for an approved EHR system is “interchangeability health information”. The 21st Century Cures Act, passed in 2016, requires that certified EHR systems be interoperability to include Certified Electronic Health Record Technology (CEHRT).
“That’s not happening,” says John Meigs, Jr., MD, chairman of the board of the American Academy of Family Physicians. “For the most part, many of the EHR software systems available don’t talk to each other and actually make it very difficult to exchange data between systems.”
Critics are quick to blame vendors who make and sell EHR systems, which have a competitive incentive to keep their systems private. But while vendors certainly share some of the blame, Adler-Milstein thinks there are more fundamental reasons why EHRs can’t take off. Perhaps the biggest, he said, is the sheer complexity of the healthcare industry. “People want to use the example of financial information. We can go to an ATM anywhere in the world and use a debit card to withdraw money from our account. Shouldn’t we be able to access our medical records as easily?” he noted. “But medical records are more complicated than financial records. There are significant issues of confidentiality … and very complex laws and regulations, with many stakeholders.”
“For the most part, many of the EHR software systems available don’t talk to each other and actually make it very difficult to exchange data between systems.” John Meigs, Jr., Chairman of the Board of MD, American Academy of Family Physicians
Paper Vs Electronic Medical Records
The technical hurdles are also considerable. Policymakers and vendors must agree on technical strategies and methods to implement standards at a time when new technologies and platforms are constantly changing.
Ultimately, achieving engagement is hindered by a lack of strong incentives to make it happen, Adler-Milstein said. “What we’re talking about is big business. You really need to have strong regulatory and business incentives in place to create market demand for interoperability, and we’re not seeing that.” Regulatory incentives are weak at best, and business incentives are non-existent.
In fact, there are often specific objections to interoperability, with vendors not wanting providers to easily switch to a competitor’s EHR platform.
Interoperability is only part of the challenge, however. Entering information into a health information system and retrieving it when needed should be easy and efficient. As many front line providers know, we are far from it.
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“Documentation guidelines require physicians to spend more time than writing unnecessary information and re-entering the same information over and over again,” Meigs said. “Many of the requirements are more than 20 years old. They are designed for billing, without caring for patients. They are a huge and unnecessary burden on doctors, and they make it very difficult for someone to check the EHR just find out quickly and efficiently what you really need to know about a patient.”
Adding to the burden is the fact that many EHR systems are generating large amounts of boilerplate text in patient records, creating what Don Rucker, MD, head of the Office of the National Coordinator for Information Technology Sanitaria, recently called “antimatter information”. or what has long been known as “note bloat.” Most EHR systems allow clinicians to easily cut and paste information—a feature that can offer convenience for data entry, but which can also end up filling a patient’s health record with a large amount of additional and often unnecessary content. . For patients without medical training trying to understand and manage their own health records—one of MyHealthEData’s stated goals—the challenge is even more daunting.
The launch of MyHealthEData is a welcome sign that government policymakers are not zeroing in on the move. And there are other encouraging signs that real changes are taking place. In July, CMS announced proposed changes to documentation requirements for outpatient and physician office visits, as well as proposed major payment changes. The paper changes are designed to ease some of the burden on doctors — and could make EHRs more useful. For example, doctors are not required to document a patient’s family, social and medical history every time they see a patient, which is the case. Instead, they will only be asked to document the parts of the story that have changed. (While paper changes are welcome, there is concern that the proposed payment changes will have a negative financial impact on physicians).
CMS also announced the launch of the Health Element Library (DEL), a new CMS database that supports the exchange of electronic health information. For example, it would allow the public to access specific types of data that CMS requires acute care facilities, such as nursing homes and rehabilitation clinics, to collect. Blue Key 2.0, which allows former Medicare patients to download and print their health records, will also help transfer as developers work with Medicare to create applications that will allow patient records to be shared. . At a White House briefing last week, Verma announced that more than 600 developers have signed up to the initiative.
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“Connecting these systems so that records can be exchanged seamlessly from one provider to another, wherever they are, is a huge task. But the benefits, in terms of patient care and improved safety are at a cost. small, they will be great.” Janis Orlowski, MD Chief Health Care Officer
But much more needs to be done, experts agree. Future providers understand that health information transfer is essential to optimal patient care and should be prioritized; at the clinical management level, however, interoperability and portability are not always a priority given the cost and complexity involved. “There’s a lot more incentive, at this point, to take that money and build a new heart plant, which can be profitable, than to invest in EHR interoperability,” Adler-Milstein said.
Moving forward, both regulation and business incentives should be well aligned to encourage interoperability, he stressed. And that alignment