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Electronic medical record transition faces obstacles

Robin Wulffson MD's picture
electronic medical records, Internet, implementation, privacy, security

Electronic medical records (EMRs) are making an increasing presence throughout the United States. A new report by the Bipartisan Policy Center notes that the promotion of the use of electronic medical records and other health IT enjoys bipartisan support and its being propelled by billions of dollars in government incentives.

However, according to the new survey, released in January 2012, implementation is encountering bumps in its transition into the information highway. The report presents the current status of EMR implementation in the U.S. Goals were initially established by George W. Bush and further promoted by the Obamas administration. The target is that by 2014, everyone in the United States should have an EMR.

The report notes that EMRs can help improve health outcomes, improve the healthcare experience, and save money; however, implementation of EMRs is encountering obstacles. One problem is a lack of health information exchange. Physicians and hospitals cannot readily exchange patient records and other pertinent medical data electronically. The report notes that streamlining the exchange off records and test results would lower costs by reducing duplication of services. Another problem is that patients are not yet widely using electronic tools to manage their care or coordinate with a healthcare provider. It notes that currently only 7-11% of Americans currently use some form of online personal health record. This is in part y due to concerns about privacy, security, and accuracy—issues that the government has not yet resolved.

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Ever since the introduction of EMRs, physicians, patients, and healthcare analysts have expressed concern regarding confidentiality and security of sensitive medical information. To address this issue, Consumers are also worried about privacy and security, the report recommends that “all entities that access, use and disclose consumers’ personal health information should be required to comply with privacy and security requirements that are at least as comprehensive as those applicable to entities covered under HIPAA,” the federal medical privacy rule.

To address implementation problems, the report offers the following recommendations:

  • Align Incentives: Federal, state and private sector purchasers and health plans should align incentives and payment with higher quality, more cost-effective healthcare, along with the health IT-enabled, coordinated, accountable, patient centered care delivery models that support such outcomes.
  • Accelerate Health Information Exchange Efforts: Because health information exchange plays a critical and central role in delivering coordinated, accountable, patient-centered care for achieving the triple aim, steps must be taken to promote access to health information for care teams and patients.
  • Accelerate and Support Engagement of Consumers Using Electronic Tools: Both the public and private sectors should expand consumer awareness of the benefits of electronic tools and the steps that consumers can take to protect their privacy in online communications. Beginning in 2012, the private sector, in collaboration with the public sector, should develop and implement training and educational programs to help providers use online and electronic tools to support consumer access to their health information, improve communication and coordination between patients and their care teams, and support self-care.
  • Expand Education and Implementation Assistance: The private sector, in collaboration with government, should rapidly develop and implement mechanisms for sharing best practices and strategies for addressing challenging issues associated with Meaningful Use – including those related to clinical quality measurement, clinical decision support, computerized physician order entry, and public health surveillance reporting.
  • Address Concerns about Privacy and Security: The administration should consistently issue comprehensive and clear guidance on compliance with federal privacy and security laws covering personal health information. Such guidance should address access, use and disclosure of health information for treatment and public and population health purposes, and be consistent in approach across multiple agencies. State governments should also provide this guidance with respect to state health privacy laws.
  • Further Align Federal Health Care and Health IT Programs: The Department of Health and Human Services (HHS), working closely with states and the private sector, should align policies, programs and requirements associated with the use of IT for multiple federal healthcare programs, including those related to delivery system transformation, payment, public health, healthcare coverage and access, administrative improvements, and program integrity. HHS should continue to review health IT programs to assure they align with the needs of delivery system and payment reforms.

The report was developed by a panel representing hospitals, physicians, health insurers, consumers, and Internet technology companies. The review was led by two former senators who held a relationship to the healthcare industry, Democrat Tom Daschle of South Dakota and Republican Bill Frist of Tennessee.

The Bipartisan Policy Center is not the only U.S. agency evaluating EMRs. Last November, the Institute of Medicine issued a report that recommended setting up an independent federal entity similar to the National Transportation Safety Board to investigate deaths, serious injuries or unsafe conditions associated with healthcare Internet technology.

Source: Bipartisan Policy Center