The electronic medical record (EMR) and subsequent electronic health record (EHR) boom can be traced back to two pieces of legislation: the Affordable Care Act (ACA) and the Health Information Technology for Economic and Clinical Health (HITECH) Act. These laws, which have mandated and incentivized the use of digital medical tools for the past 7 years, have created the competitive healthcare landscape we see today.
“But how did we get from EMR to EHR?” one might ask, as the terms are often misunderstood and used interchangeably.
The simple answer is the growing need for interoperability and security, in the emerging field of electronic healthcare. In a recent interview by Medical Dealer, James Metzger, PrognoCIS Vice President of Marketing and HIPAA Compliance Officer, gave his insight: “The different systems that are out there today were forced by the market to grow in order to achieve an economy of scale in order to help them meet these regulatory issues that weren’t part of the landscape before,” he said. James, who was on the Affordable Care Act task force of Blue Shield California when the statutes were released, notes “We’ve gone from the medical record, which the medical detail is pertaining to specifically everything related to the patient [EMR], to the health record, which is the additional metadata that surrounds the medical data [EHR].”
Let’s look at the growth of EHRs and why they are an important milestone in electronic healthcare.
Challenges in EHR Adoption, Creating an Interoperable Landscape
EHR adoption has increased substantially in recent years, according to a May 2016 report from the Office of the National Coordinator for Health Information Technology (ONC). “The rate of data exchange increased significantly between 2014 and 2015, with 96 percent of non-federal acute care hospitals having a certified EHR system, and at least 80% of small, rural, and critical access hospitals having adopted a basic EHR”, the report notes.
The widespread adoption of EHRs is evidence of the industry noticing the benefits of electronic healthcare. The ability to participate in health information exchange (HIE) among patients and peers promotes interoperability and drives growth for everyone related. Health information exchange focuses on sharing health and financial data to improve patient experiences, which can be instrumental in creating a value-centric outcome-based healthcare system.
However, EHR adoption is far from perfect, as many in the industry can attest; there are major hurdles to overcome, such as the ability for different EHRs to communicate each other. The same ONC report says that though the number of hospitals possessing the capability to electronically send or receive data has significantly increased, a high proportion of hospitals’ exchange partners continue to lack the capabilities to receive data electronically. There was also a significant increase in the percent of hospitals having difficulty with patient matching, higher than other barriers reported by hospitals.
In order for providers to fully capitalize on the benefits of EHRs, there must be a level of, as James says, “shared responsibility” in the industry. Interoperability is only achievable if everyone is willing to participate.
Solving EHR Interoperability Problems with a Patient Identifier
The ability for seamless health information exchange is perhaps the main hurdle in EHR interoperability, but providers who adopt data exchange tools cannot fully utilize them if people are unwilling or unable to share data. “In order to have a business plan succeed in the medical marketplace, at what point do some companies decide to become market leaders by extending functionality?” James asks.
There has been a precedent for an interoperable gateway in the form of a National Patient Identifier (NPI), mandated in the Health Insurance Portability and Accountability Act (HIPAA) of 1999. PrognoCIS CEO Vinay Despande recently wrote about an NPI, describing one as something which “allows for the identifying and indexing of patients on a national scale, through one source. An NPI could allow all healthcare systems to align patient record data, allowing for accurate patient information to be presented across all providers concerned with a patient’s treatment.” Though the NPI was defunded following HIPAA (though the National Provider Identifier was not) over concerns of privacy, there has been increasing support for the implementation of one.
Organizations such as the EHR Association, a trade group of companies that develop and support the majority of operational electronic health records in hospitals and ambulatory care environments across the U.S., has long supported the development of a strategy to resolve this issue. In its requests to Congress from National Health IT Week 2014, the Association states: To improve patient safety and data interoperability, we also ask Congress to encourage the development of a consistent nationwide patient identity matching strategy.
Are EHRs the Future of Healthcare?
EHR adoption is not just about going paperless. “If you’re just digitizing forms, are you taking advantage of the quantum leaps in the workflow that a digital workflow can provide?” James asks. EHRs do many things for providers, such as streamlining tedious procedures into efficient automated electronic workflows, but they are not the end-all solution to solving interoperability challenges.
EHRs adoption is an important first step in harnessing data to manage health. With the mounds of data swirling around the industry, we must ask ourselves, “how can we transform data into actionable tasks?” Data analysis tools like population health management set the foundation for data-based health, but there are still real interoperability hurdles we must overcome.
Expect the use of data influencing health outcomes to be a critical component of healthcare in the future.