Electronic Health Records. A Resource Guide

Transcription

1 Electronic Health Records A Resource Guide

2 Electronic Health Records A Resource Guide David Herzstein Couch Beatriz Reyes This publication was funded by a cooperative agreement by the Office of Population Affairs, within the Office of the Assistant Secretary for Health in collaboration with the Division of STD Prevention within the Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention.

3 ACKNOWLEDGEMENTS Cardea is pleased to acknowledge these staff who assisted in the creation of this resource guide. Erin Edelbrock, Program Manager Kyle Matsumoto, MPA, Program Manager Wendy Nakatsukasa-Ono, MPH, Vice President Jana Nakhleh, Training Coordinator Sandy Rice, MEd, Vice President Karen Shiu, MPH, Training/Data Manager Graphic Design: Robert, Mitchell, Eric Wheeler For more than 40 years, Cardea has provided training, organizational capacity building, and research and evaluation services to improve organizations abilities to deliver accessible, high quality, culturally proficient, and compassionate services to their clients. Cardea serves as the STD-related Reproductive Health Training & Technical Assistance Center (STDRHTTAC) for U.S. Public Health Service Regions VI, IX and X. Cardea has developed this guide as part of a resource portfolio to support public health programs with third-party billing for sexually transmitted disease (STD) and other related services. Contact us for more information: Region VI: ntrevino@cardeaservices.org or Region IX: reyes@cardeaservices.org or Region X: erin@cardeaservices.org or Electronic Health Records: A Resource Guide June,

4 Electronic Health Records: A Resource Guide June,

5 INTRODUCTION The purpose of this guide is to offer resources for planning and implementing electronic health records (EHRs), as well as to provide links to current articles on national EHR trends. For organizations that already have an EHR system, there are links to information about Meaningful Use. This resource guide contains: Stages of planning and implementing an EHR system Glossary Resources for EHR planning, selection, implementation, and meaningful use, including materials from the Center for Medicare & Medicaid Services (CMS) and Health IT Selected EHR-related articles and success stories The terms electronic health record (EHR) and electronic medical record (EMR) are often used interchangeably in the field, but they are not synonymous; we will use EHR throughout this guide. This resource guide is not intended to be a comprehensive guide to selecting an EHR system. We encourage you to consult the listed resources for detailed, up-to-date guidance from CMS and Health IT. 5

6 STAGES OF PLANNING AND IMPLEMENTING EHRs Before selecting your EHR, take time to assess the current state of your practice and envision and document your goals for the future. This assessment provides a critical foundation as you take subsequent steps in planning and implementing an EHR. The stages of EHR planning and implementation is from Health Information Technology (Health IT.gov) For more details on each stage, visit: Assess Your Practice s Readiness for EHRs Plan Your Approach Select a Certified EHR Conduct Training & Implement the EHR System Achieve Meaningful Use Continue Quality Improvement 1. Assess Your Practice s Readiness for EHRs Assess your current practice and its goals, needs, and financial and technical readiness Envision the future state of the practice and document your needs and goals 2. Plan Your Approach Draw on the assessment data to outline your implementation plan. You will need: Strong leadership; Provider engagement; A team that has authority to make decisions; A plan for effective change management; and Long-term commitment of resources. 3. Select a Certified EHR Solicit vendor proposals Set up structured vendor demonstrations Select two vendors Contract with vendor (include system warranties and acceptance testing ) 4. Conduct Training and Implement EHRs Conduct trainings, mock go-live, and pilot testing 5. Achieve Meaningful Use Use the EHR system to help you improve patient care quality, safety, privacy and efficiency; engage patients and their families; improve the coordination of care; and improve public and population Health 6. Continue Quality Improvement Continuously evaluate and implement quality improvement strategies to optimize your practice Electronic Health Records: A Resource Guide June,

7 GLOSSARY 1 Certified EHR: An EHR system that has been approved by the ONC as meeting EHR standards and criteria. Electronic Health Record (EHR): A medical record created and maintained by facilities and/or provider organizations to share information across facilities and/or providers (via reporting ability, for example). In practice, the terms EMR and EHR are often used interchangeably, though they are not synonymous. Electronic Medical Record (EMR) or Electronic Patient Record (EPR): A digital version of a paper chart in the clinician s office. Created and maintained by a single medical organization, they are a source of information for EHRs. Eligible Professionals (EPs): Professionals such as physicians, certified nurse-midwives, (CNM), nurse practitioners (NP), and physician assistants (PA) practicing in a Federally Qualified Health Center (FQHC) or Rural Health Clinic (RHC). Health Information Exchanges (HIE): Sharing electronic health-related information with confidentiality, privacy, and security; the electronic movement of health-related information among organizations according to nationally recognized standards. Meaningful Use (MU): Standards defined by the Centers for Medicare & Medicaid Services (CMS) Incentive Programs that govern the use of EHRs and allow eligible providers and hospitals to earn incentive payments by meeting specific criteria. Office of the National Coordinator for Health Information Technology (ONC): Part of the U.S. Department of Health and Human Services (HHS). ONC is the principal federal entity charged with coordination of nationwide efforts to implement and use the most advanced health information technology (HIT) and the electronic exchange of health information. The ONC HIT Certification Program: A process managed by ONC to ensure that EHR technologies meet adopted standards and certification criteria to help providers and hospitals achieve MU objectives and measures established by CMS. Starting in FY/CY14, providers and hospitals must use EHR technology that is certified to the 2014 Edition EHR Certification Criteria to support the achievement of MU. However, for example: a provider who needs to achieve MU Stage 1 does not necessarily need EHR technology certified to do secure messaging (an MU Stage 2 objective). Personal Health Record (PHR): A health record created by an organization or individual, maintained and controlled by the patient. Practice Management System (PMS): Software used to help manage day-to-day operations, financial and administrative functions, and appointment scheduling. Also used to track billing and demographic data. PMS records can be linked with a patient s health or dental record. 1 Definitions are from healthit.gov, hrsa.gov, and cms.gov 7

8 RESOURCES FOR EHR PLANNING, SELECTION, AND IMPLEMENTATION Slide Shows/Recorded Webinars How Do I Adopt An EHR In My Organization? (June 2013) Family Planning National Training Center, Office of Population Affairs (OPA)/Department of Health and Human Services (DHHS). Recorded webinar series (3-part) with handouts: Selecting and Implementing EHRs (October 2013) North American Spine Society. ( All rights reserved): HealthIT.gov U.S. Department of Health & Human Services website that assists health care providers to better manage patient care through secure use and sharing of health information, including the use of EHRs. Resource Center EHR implementation resources: How to Implement EHRs: How to Select a Vendor: Certified Health IT Product List (listing of certified EHR systems): Product and Vendor Comparison KLAS: KLAS is a private, independent organization that maintains many free resources and extremely detailed ratings from provider members about specific products and vendors, as well as several options for a fee. All ratings are written and submitted by registered providers. For the use of providers only. AmericanEHR: Developed jointly by the American College of Physicians and a private tech firm, AmericanEHR partners with many medical professional organizations. It provides resources and detailed ratings (by providers). Registration is free and open to all but only providers may rate products. Black Book Rankings: Black Book Rankings is a private market research company that sells its reports. EHR reports cost about $1000 to $2000. Free, publicly visible results are limited but useful. For example, rankings of the single top products in several areas as of 2013 can be found at: Regional Extension Centers (RECs) RECs received funding under the Health Information Technology for Economic and Clinical Health Act to assist health care providers with selecting and implementating EHRs. RECs are located in every region of the country: Electronic Health Records: A Resource Guide June,

9 RESOURCES FOR MEANINGFUL USE CMS Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs Educational Resources: FAQs about EHR Incentive Programs: Stage 2 Meaningful Use Criteria: Meaningful Use Objectives Quick Reference Grids Explanation and Keys: Stage 1 Objectives and Measures Linked to 2014 Edition EHR Certification Criteria: Stage 2 Objectives and Measures Linked to 2014 Edition EHR Certification Criteria: 9

10 SELECTED PRESS NOTES AND SUCCESS STORIES March 18, 2013 Familiarity breeds doctor contempt with EHRs. A survey by AmericanEHR Partners of 4,279 clinicians, including primary care physicians, specialists and diagnostic professionals, found that user satisfaction declined from 39% in 2010 to 27% in The rate of those very dissatisfied increased from 11% to 21% during the same period. The findings were presented in March at the Healthcare Information and Management Systems Society annual conference in New Orleans. (First posted on amednews.com) July 16, 2013 Nine of ten insiders agree that the majority of EHR vendors currently implemented will fail to sustain operations by the time meaningful use stage 3 is fully implemented. Survey findinga from Black Book Rankings. August Many medical groups are not happy with the EHR systems they initially invested in and are looking for a better option. One survey by consultancy Software Advice, for instance, found that the number of medical groups purchasing new electronic health records to replace existing EHRs grew from 21% in 2010 to 31% in The vast majority switched because they were dissatisfied. In 2010, almost 59% were changing vendors for that reason, but that figure jumped to 74.2% in January 21, 2014 Three EMRs lead the pack in the midsize-practice space. Three vendors have set themselves apart from the EMR pack as many providers report that they are either replacing their EMRs or worse, feel stuck with their current EMRs. Epic, athenahealth and Greenway Medical have pulled away from the EMR masses in the physician practice space according to the latest KLAS report, Ambulatory EMR (11-75 Physicians). Can Any Vendor Set a High Standard? The report focuses on the key areas of usability, workflow and integration. As part of the report, KLAS interviewed providers using products from Allscripts, athenahealth, Cerner, eclinicalworks, e-mds, Epic, GE, Greenway Medical, McKesson, MEDITECH, NextGen and SRSsoft Success Stories: Providers are achieving meaningful use and earning their EHR incentive payments. Their stories may be an inspiration to others and an opportunity to share lessons learned. CalHIPSO - California Health Information Partnership & Services Organization. May 16, 2014 The Adoption and Use of Health Information Technology by Community Health Centers, U.S. physician offices and hospitals have accelerated their adoption and use of EHRs and other health information technology (HIT) in recent years. A comparison from two national surveys of Federally Qualified Health Centers (FQHCs) in 2009 and 2013 shows that HIT adoption has also grown substantially for these important providers of care in poor and underserved communities. Nearly all surveyed FQHCs (93%) now have an EHR system, a 133% increase from 2009, the year federal meaningful use incentives for HIT were first authorized. Three-quarters of health centers (76%) reported meeting the criteria to qualify for incentive payments. Remaining challenges for health centers include achieving greater interoperability of EHR systems and ensuring patient access to records. Mobile technology, such as text messaging, may help FQHCs further expand patient outreach and access to care. J. Ryan, M. M. Doty, M. K. Abrams, and P. Riley, The Adoption and Use of Health Information Technology by Community Health Centers, , The Commonwealth Fund. hlt_it_chcs_rb.pdf Electronic Health Records: A Resource Guide June,