Unit 2: The History of EHRs

Question 1

Requirements of Meaningful Use

Answer 1

Certification program for EHRs established by the government

incentive program for eligible professionals EPs, eligible hospitals, and critical access hospitals CAHs

EHRs must be used in a meaningful way (such as e-perscriptions), computerizer provider order entry CPOE)

Exchange of health information must be used to improve quality of health care

WHRs must b used to submit clinical quality measures CQMs and other measures identified by the ONC

Question 2

History of EHR adoption

Answer 2

60s-90s improving functionality
90’s entered private practices, mostly for billing
2000s more providers/vendors established, but no standardization
2010s government mandated standardization

Question 3

Benefits of EHR Adoption

Answer 3

Economic, Clinical, and Administrative

Easier access to current information, reminders and alerts, allows providers to spend more time with patients, faster test results, supports data analytics, reduces medical errors

Question 4

Barriers to EHR adoption

Answer 4

Not all providers are elligible
Interoperability issues (vendors not wanting to collab with competition)
Incomplete standards for implementation
Best practices still need to be refined and published
Intentional health information blocking

Financial and infrastructure barriers

Question 5

Reasons for shift to EHR

Answer 5

Increase in medical errors using paper forms, rising costs of health care, and need for more medical care coordination between providers

Question 6

Practice Management Systems (PMSs)

Answer 6

Computer programs focused on fiscal management for processing insurance claims and patient statements.

Eventually incentivized through medicare and medicaid to overcome financial implementation barriers for small to average sized private practices

Question 7

HITECH ACT of 2009

Answer 7

part of a stimulus package under the Obama administration AARA American Recovery and Reinvestment Act

develop national health infrasteructure, assisting in adopting EHRs,

Institutes must demonstrate Meaningful Use of a Certified EHR to be eligible for reimbursements through the program

Question 8

1991

Answer 8

IOM (institute of Medicine) called for eliminating paper records by 2001

Question 9

2004

Answer 9

ONC, Office of the National coordinator for Health Information Technology, position created by President Bush

Promotion of EHRs

Question 10

2008

Answer 10

Obama administration Sponsors EHR adoption as part of economic stimulus

Medicare improvements for patients and providers act MIPPA

Question 11

MIPPA

Answer 11

medicare reimbursement for providers, incentivized e-prescriptions
Automatic checking for drug and allergy interactions and eliminate errors due to poor handwriting

Question 12

HIPAA

Answer 12

Health insurance portability and accountability act

Question 13

Beacon Community Program

Answer 13

17 communities were given grants to document best practices and work towards establishing national EHR goals

Question 14

Regional Extension Centers

Answer 14

Provide training and assistance to primary care providers adopting EHRs

Question 15

ONC Office of the National Coordinator for Health Information Technology

Answer 15

Est 2004
Serves as a resource for the entire health system
Supports hit adoption
Promotes nationwide health information exchange

Overall goal is to improve healthcare in the united states

Tests and certifies EHR products

Question 16

Meaningful Use MU Program

Answer 16

defines minimum US government standards for EHRs

meant to improve collaboration between clinical and public healthcare

not initially popular with healthcare providers due to needing to prove meaningful use

emphasizes population health reporting, aggregate data on immunizations, and communicable disease for the sake of public rather than individual health

Question 17

CEHRT certified EHR Technology

Answer 17

a complete EHR that meets ONC certification requirements

improves quality, safety, and efficiency of health care
reduce health disparities among/between communities
engage patients and family
improve care coordination for population and public health
maintain privacy and security of patient health information

Question 18

Meaningful Use Stages

Answer 18

1: promote adoption of certified EHRs that allowed patients to access their own medical data
2. Encourage meaningful use of CEHRTs. More rules for compliance and reimbursement focused on coordinated care and patient engagement
3. Using CEHRTs to improve health outcomes through protected health information, e-prescriptions, computerized data entry, etc.

Question 19

Clinical Quality Measurements CQMs

Answer 19

Criteria and tools that measure or quantify healthcare processes, outcomes, patient perceptions:

Goals include effectiveness, safety, efficiency, patient-centrality, equability, and timeliness.

Question 20

HIE Health Information Exchange

Answer 20

electronic transmission of healthcare related data among medical facilities, organizations, and government agencies according to national standards.

Question 21

MIPS Merit-Based Incentive Payment System

Answer 21

part of MACRA, consolidates multiple quality programs into a single program to increase quality of care including Meaningful Use

4 performance categories
Quality, cost, Improvement Activities, and Promoting Interoperability PI

Question 22

Advancing Care Information

Answer 22

Replaced Meaningful Use, but has the same goals

Question 23

Unanticipated EHR problems

Answer 23

increased work for clinicians (time for data entry, especially at first)
unfavorable workflow changes
ongoing demands for system changes (constantly new software)
conflicts between paper and electronic systems
Changes in communication (less face to face between doctors and nurses)
Unanticipated user errors
Over dependence on technology
Inability to customize EHRs