The EHR. primer ANSWERING QUESTIONS ABOUT THE BASICS OF EHR IN THE PUBLIC HEALTH SECTOR. INSIDE THIS ebook: WHAT IS CLOUD COMPUTING?

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1 The EHR primer ANSWERING QUESTIONS ABOUT THE BASICS OF EHR IN THE PUBLIC HEALTH SECTOR INSIDE THIS ebook: IS THERE REALLY A DIFFERENCE BETWEEN AN EHR AND AN EMR?....1 WHAT IS INTEROPERABILITY?...2 WHAT S SO MEANINGFUL ABOUT MEANINGFUL USE?...3 WHAT IS CLOUD COMPUTING? 4 CAN I PREPARE MY AGENCY FOR SECURE CLOUD COMPUTING?... 5 and David Rosebaugh, CEO, Champ Software

2 I f your agency has begun to take interest in electronic health records (EHRs), you may have already realized the overload of informa on available on the subject. When you begin researching EHRs you are immediately confronted with a new vocabulary including terms like EMR, meaningful use, ARRA, interoperability, and more, along with a plethora of technical concepts you are expected to understand without explana on. The process can be exhaus ng. This ebook was designed to alleviate some of that stress. This primer is meant to be a star ng point for those launching into the EHR arena for the first me. It outlines a very basic overview of the movement towards electronic records in the health sector, and explains a few of the key terms you will find yourself confronted with: Is there really a difference between an EHR and an EMR? What is interoperability? What s so meaningful about meaningful use? How does cloud compu ng work and is it secure? T he evolving Electronic Health Record (EHR) landscape is strewn with unfamiliar terminology and acronyms that can be daun ng for even the most experienced clinicians and administrators to understand. What is an EHR? How does the 2009 American Recovery and Reinvestment Act (ARRA) requirement that an EHR be established for all Americans by 2014 affect your prac ce and your documenta on? Let s take a moment together to understand just a few of the fundamental concepts and terms associated with the sweeping changes just ahead that will impact all healthcare Is there really a difference between an EHR and an EMR? providers, faculty, administrators, informa on technology (IT) professionals, and the popula ons we serve. What exactly is an EHR and how does it differ from an EMR (Electronic Medical Record)? Although the terms are o en used interchangeably, technically they are separate concepts. Simply put, an EMR is the electronic record of all healthrelated informa on on an individual that is "BY created, gathered, managed, and consulted by licensed clinicians and staff from a single organiza on who is involved in the individual s health care (Na onal Alliance for Health Informa on Technology). This informa on may consist of demographic data, progress notes, lab and radiology reports, etc. In contrast, an EHR is an aggregate record of health related informa on on an individual that is created, gathered, and shared cumula vely across more than one health organiza on. Permission to access an EHR is given by the client. EHRs are designed to provide na onwide access to designated informa on compiled from data created by various providers, even if they are from different health care systems and in different COMPUTERIZING geographical loca ons HEALTH RECORDS, WE CAN AVOID DANGER- OUS MEDICAL MIS- TAKES, REDUCE COSTS, AND IMPROVE CARE." PRESIDENT GEORGE W. BUSH* (Thede, 2008). In very basic terms, an EHR is an aggregated EMR with interoperability. In prac ce though, the term EHR is being used more and more as a generic term to describe a pa ent s individual record in a single agency, rather than an aggregate record shared across agencies. Whichever term you use in your own agency or ins tu on, the most important thing is to avoid confusion and ensure your staff and colleagues know what you mean. *Quote from State of the Union Address. 20 Jan Reference: n.p. ehrcentral Nov The Provider s Edge. Web. 20 Dec <

3 What is interoperability? enters the EHR arena. Meaningful use of informa on technology is mandated by ARRA this requirement is not sa sfied by across organiza onal boundaries purchasing new hardware or to create an EHR. Interoperability relies on shared standards, which so ware or adop ng use of a standardized terminology alone. provide common Planning and "INTEROPERABILITY MUST guidelines, rules, and partnerships BE ADDRESSED NOW, OR formats for systems to among clinicians, ELSE WIDESPREAD talk with each other. ADOPTION OF STAND- administrators, And the best way to ALONE EHRS WILL BE A make sure that your FAIT ACCOMPLIS." staff and vendors are necessary to ensure that use of DAVID BRAILER, MD, PHD, NTL. the EHR increases I nteroperability is the ability of health informa on systems to work together within and EHR has these shared standards is to use a standardized terminology, such as the Omaha System (for more informa on on standardized terminologies, please see our ebook, Evalua ng Standardized Terminology in EHR ). Remember that your input is vital as your individual agency COORDINATOR FOR HEALTH INFORMATION TECHNOLOGY* safety, quality, and efficiency of care. Just as important, nurses, faculty, social workers, nutri onists, and other care providers must take an ac ve role in working within their own healthcare system and with so ware vendors to ensure that their professional documenta on is included in their agency s electronic records, so that in turn, this cri cal informa on will be available in your client s broader EHR any me, anywhere. What s so meaningful about meaningful use? By David Rosebaugh, CEO, Champ Software H ealth care in the United States is a popular topic in the news these days. While the general public focuses on the changes coming with Obamacare, heath care providers are exploring a federal incen ve program called Meaningful Use that was part of the HITECH (Health Informa on Technology for Economic and Clinical Health) Act of early *Remarks at HIMSS 2005 Annual Conference. 17 Feb Reference: n.p. ehrcentral Nov The Provider s Edge. Web. 20 Dec <

4 What s so meaningful about meaningful use? (CONT.) T hese changes are designed to improve our health care system, which consumes a larger propor on of the US GDP (Gross Domes c Product) every year. In the case of HITECH, the expecta on is that increasing the level of automa on in the health care industry will improve outcomes and reduce costs. Toward this end, the federal government is offering significant incen ve payments for several years, up to approximately $44,000 a year or $64,000 a year (with varia ons for Medicaid vs. Medicare). To qualify for an incen ve payment, a health care provider, either a professional or a hospital, must acquire cer fied so ware and use it in a meaningful fashion to exchange data with other providers. In the first stage of meaningful use, providers must sa sfy several core objec ves, plus more from a list of 10 op onal measures. Public health agencies that employ certain professionals, such as a physician or nurse prac oner, may be able to qualify for the incen ve program. Many public health agencies employ such professionals, but many do not. The early indica ons are that these subsidy payments are producing the intended effect many physician prac ces are pu ng electronic medical systems into place, and hospitals are upgrading their systems to be sure that repor ng is possible on all required measures. For public health agencies, three of the requirements are of special interest, those having to do with immuniza ons, lab data, and electronic disease surveillance. Whether a public health agency qualifies for incen ve payments or not, it will want to exchange data in these three areas. Certainly it has a choice about how to do that. If the agency employs eligible professionals, it is likely to lean towards acquiring cer fied so ware, which is so ware that has passed structured tests conducted by a so ware tes ng agency that has been approved by the federal Office of the Na onal Coordinator. The cost of such so ware may be higher, inasmuch as the Centers for Medicare and Medicaid Services (CMS) has es mated that the cost of ge ng cer fied can be as much as $1.2 million, aside from the costs of developing the cer fied so ware. Some so ware vendors may choose to be cer fied on selec ve measures, and some vendors may choose not to be cer fied, even though they offer some of the features required under Meaningful Use. In the end, the Meaningful Use program is an important incen ve towards an electronic health/medical record. Whether a public health agency qualifies for federal incen ves or not, the public health world is moving towards an electronic health record.

5 What is cloud computing? A s you begin your explora on of available EHR so ware, sooner or later you will encounter heated discussions of the best way to store your client and administra ve data on your agency s local computers and server or in the cloud. You will find EHR so ware that is installed on your agency s individual computers or servers as well as so ware that is accessed through the Internet (web based) or the cloud. Which should you choose? First, what is the cloud? The cloud is a term that is used quite broadly. Simply put, the cloud refers using online applica ons which manage and store your data in highly secure remote servers spread throughout the country. What we are describing here, could more closely be termed private cloud compu ng, which means that the en ty storing your informa on knows exactly where the data will be stored. These servers are non public, and can only be accessed by authorized users. If you ve banked online, you ve already experienced this sort of cloud compu ng. Another name for cloud compu ng is So ware as a Service (SaaS). Whatever you call it, the advantages to cloud compu ng are compelling:. Storing your data in the cloud in loca ons across the country ensures that you will always have complete access to all of your records at all mes, regardless of any unexpected hardware tragedies that may occur locally. When you use your agency s own hard drives or servers for data back up, you put yourself at serious risk of data loss. Should your hardware be damaged by natural disaster (flooding or fire), or break down in some other way, such as computer malfunc on or virus, there may be no way to recover that data. 2. A so ware vendor who offers remote storage of your key client and administra ve files and reports translates to far less (or maybe no) onsitemaintenance me by your IT department. There is no need for your IT staff to apply so ware upgrades and new releases it s all handled by your so ware vendor. Releases and upgrades are free and go out to all user agencies at the same me, instantaneously. This means you save me and money. Vendors who sell so ware installed on local computers and/or servers can and o en do charge for later updates or new releases, wreaking havoc with your budget in later years. 3. Agencies, schools, and programs that have more than one loca on can access the same client record or stored document from any computer, anywhere. This means you can do point of care char ng in the home (with a wireless card) or on any computer with secure Internet access.

6 Can I prepare my agency for secure cloud computing? Y ou may wonder how safe your client informa on and reports will be if you store them in this sort of private cloud. The answer is: very safe. In fact, web based applica ons are o en much more robust and secure than local computers or servers, primarily because all data is encrypted. Access to client records can easily be managed through the use of passwords, designa on of specific levels of access, and privileges for individual employee, etc. The risks associated with cloud compu ng stem primarily from poor agency control and prac ces, rather than inherent risks in cloud compu ng itself. One of the most common risks agencies should guard themselves against is an inadequate access control policy. This means ensuring you clearly ar culate and enforce department and organiza on wide IT security policies and procedures. Another issue many agencies face is lack of educa on. Every single user really must be educated on the "do's and don'ts" of IT security, both overall and for specific applica ons. An uneducated user base is a key source of risk. Also, as with any en ty trying to protect data, an agency should be aware of insider threat. Most data breaches are the result of an employee who knowingly or unwi ngly shares data or enables someone else to view data. You can minimize this threat by choosing an applica on that limits user access to only those records, por ons of records, or reports that the user s job requires them to view. You may also worry about temporarily losing access to your EHR system when your Internet access goes down (whether you are in the field or at your desk). Using a trusted ISP (Internet Service Provider) is important. Be sure to ask poten al so ware vendors about their specific applica on security measures and back up procedures: What level of encryp on is used? Look for 256 bit SSL encryp on. How o en are full back ups taken on the public server data? What hos ng facility does the vendor use to host their public server? Do they meet SAS 70 requirements? What passwords are needed to access the applica on online? The majority of risk associated with cloud compu ng originates with the agency using the service. However, by taking the above measures to secure your agency from within, and understand exactly what data protec on and encryp on your so ware vendor offers, you will effec vely guard yourself from this risk. Many agencies are choosing to use cloud compu ng. With the right prepara on, you can assure yourself an easy and safe transi on, so you can truly enjoy all the benefits cloud compu ng has to offer. Reference: Merrill, Molly. Cloud computing myths vs. risks. Healthcare IT News. 08 Feb MedTech Media. HiMSS. Web. 13 Oct <