Electronic Health Record (EHR) systems are used by healthcare providers to digitally record the medical and other relevant history of their patients. The purpose goes beyond replacing paper charts. The systems allow providers to record all aspects of care to build a broad view of their patients’ wellbeing, and track how patients are doing over time. EHR systems offer many benefits to the providers and their patients. During consultations, providers can see the full patient history. The EHR can display images, graphs and tables with results of health tests and trends in repeated tests.
Providers can use information on the screen to show patients what is going on. They can monitor and correlate health parameters, such as blood pressure, cholesterol, and drinking and smoking habits to patients' health. EHRs can identify patients who are due for checkups, preventative screening, vaccinations or follow-up visits and send them reminders.
Over time, as patient data is consistently collected in EHRs, novel therapies and technologies can be developed and tested more quickly and efficiently because the data will be digital and can be processed quickly by computers.
More information on the advantages of EHRs can be found on HealthIT.gov. Review the positive effects on the quality and convenience of patient care, increased patient participation, improved accuracy of diagnostics and health outcomes, enhanced care coordination, and increased efficiency and cost savings.
EHRs enable communication by allowing providers to share information electronically when they care for the same patients. The systems enhance completeness of patient data and facilitate better decision making. Likewise, EHRs can enable collaboration across healthcare organizations. However, when organizations use incompatible systems, this introduces a barrier in sharing information.
Interoperable EHRs resolve this problem by incorporating interfacing architecture and standards that allow diverse systems to communicate securely within an information network. Communications include physician orders, lab results, medication lists, diagnostic images, Admission Discharge Transfer (ADT) notifications, discharge summaries, treatment and therapy summaries, and Continuity of Care Documents (CCDs).
Interoperability, however, goes beyond EHR-to-EHR connections. The concept also covers interfaces with medical devices, healthcare monitors and other equipment that continuously produce data used in patient care. These interfaces eliminate the need to manually enter the data into the EHR, which is labor intensive and error prone.
Interoperability is defined by both the exchange of information, and the use of the information after the exchange
- Exchange mechanisms range from a secure email exchange, to the full-fledged functionality of an EHR interfaced directly with other EHRs through a Health Information Exchange (HIE).
- Use mechanisms vary too, from attaching received documents to patient records for viewing in the EHR, to pulling specific data elements of interest into the patients' records.
The ability to pull specific data elements from incoming documents and medical equipment into patient records enables EHRs to trend data over time, monitor unusual patterns, and flag healthcare professionals to take action. EHRs equipped with these advanced interoperability features provide the most comprehensive view on a patient's prognosis, and unlock the power of integrating care plans among the patient's care providers.
Transportation, encryption and content standards have been developed to improve interoperability. Transport is focused on exchanging data messages, encryption on protecting the messages, and content on formatting messages. Numerous proprietary and public standards exists, which are not all compatible. As the existence of multiple standards hampers providers from getting connected, there is a strong drive towards further standardization. For instance, HL-7 V3 and its latest variant HL-7 FHIR ("Fire") are the preferred content standards that define a uniform XML-based message format.
HealthIT.gov offers a set of online courses to learn more about interoperability. The courses highlight how interoperability is an enabler for transitions of care, patient and family engagement, lab exchange, and public health. The material also highlights the related requirements for Stage 1, 2 and 3 Meaningful Use.
In recognition of the advantages of Electronic Health Record (EHRs), the American Recovery and Reinvestment Act (ARRA) of 2009 provided incentives for providers to adopt an EHR into their practice of care. Specifically, ARRA incorporated the HITECH Act which promotes the adoption and Meaningful Use (MU) of EHRs.
The Centers for Medicare & Medicaid Services (CMS) created Meaningful Use standards, and implemented the Medicare and Medicaid EHR Incentive Payment programs to assist providers in the process. The Office of the National Coordinator for Health Information Technology (ONC) previously also provided subsidized Health IT implementation assistance via 62 Regional Extension Centers (REC) located across the United States.
To facilitate Meaningful Use compliance, CMS set certification standards for EHR systems. CMS certifies whether EHR systems and options meet these standards. While certification requires EHR-to-EHR interoperability, this does not guarantee compatibility of the interoperability standards used.
Technology that meets the certification criteria is listed as Certified EHR Technology (CEHRT) on the ONC CHPL website. To comply with Meaningful Use, providers need to select from the available CEHRT systems and options, with the flexibility that they can mix and match certified options from different vendors to create a customized solution that is suitable for their scope of practice.
Guidance, tools and templates to procure an EHR system can be found in MeHI's EHR Toolkit. The toolkit provides a structured process for how to evaluate and select a vendor, and important considerations when purchasing an EHR.