EMR/EHR Resources
EMR/EHR Resources
Promotion of Electronic Medical/Health Records (EMR/EHR) is a key component of Arizon'a new e-Prescribing (eRx) initiative, EAzRx. In promoting eRx, we realize there are two main options for physicians in achieving the benefits of this technology: dedicated/standalone eRx systems and eRx embedded within EMR systems. This is a real choice - each option has its advantages. Dedicated eRx has the advantage of cost and ease of implementation. EMR has the advantage of complete documentation at the point of care, including lab results, documents, and support for documentation and billing of the complete visit. Since we believe most physicians will ultimately become EMR users, we recommend that physicians fully consider the EMR option. For the benefit of the small-to-medium-size medical practices that dominate Arizona health care, we have focused the information below on EMR systems for those practices.
EMR Capabilities
EMR systems provide many services based on creating, storing and sharing a variety of patient-related information. Though their fundamental function is to capture clinical documentation as digital data rather than as ink on paper, they provide many other functions to create value from digital data, including:
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E-Prescribing: Creating new prescriptions (with clinical decision support), efficiently refilling existing prescriptions, checking formularies and eligibility, and viewing prescription history.
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Problem management: Making past and active diagnoses easily visible and connecting diagnoses with corresponding treatments
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Vitals, symptoms and findings: Providing efficient user interfaces for capturing the details of the patient's condition.
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Lab results management: Creating orders for internal and external labs, and automatically presenting incoming lab results for physician review.
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Document management: Scanning/filing of incoming documents and creation/transmission of outgoing documents.
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Reporting: Creating and presenting canned and custom reports about the patient population of the practice and the management of their health.
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Workflow management: Facilitating the flow of information and activities within the practice.
Benefits
EMR Systems provide a variety of benefits to the providers using them, but also to patients, payors, and society at large.
Benefits to Clinicians:
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Access to Information: Searchable data, no transcription delay, remote access, sharing information between clinicians and sites, clinical decision support, and easier patient follow up.
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Revenue Management: Improved coding, fewer lost charges, P4P eligibility, shorter revenue cycle and business continuity/disaster recovery.
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Workflow: No searching for charts, easier billing.
Benefits to payors, employers, consumers, and society include:
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Better quality care, improved continuity of care, improved patient safety, fewer medical errors, fewer redundancies, and more accessible data.
Standards and Certification
The 1996 Health Insurance Portability and Accountability Act (HIPAA) created a regulatory framework for sharing data across the healthcare industry. The HIPAA Privacy Rule gives broad permission for data sharing between healthcare entities and establishes penalties for misuse of patient data.
The same data standards apply to dedicated eRx systems as to eRx systems embedded in EMRs. A number of other data standards apply to EMRs, many of them prescribed by CCHIT.
The Certification Commission for Health Information Technology (CCHIT) has developed standards for functionality, interoperability, and security of EMR systems. The advantages of certification are described in the 2008 Physician's Guide to Certification for Ambulatory Electronic Health Records. The purpose of CCHIT certification is to establish a minimum level of capability for systems purporting to be EMR systems, reducing risks for purchasers. Lists of certified Electronic Medical Record (EMR) systems, also known as "Ambulatory Electronic Health Record Systems," and Inpatient Electronic Health Record Systems are available on their website. CCHIT has also developed a website to aid in evaluating, selecting and implementing EMR/EHR Systems at www.ehrdecisions.com
eRx Capabilities of EMR Systems
Because e-Prescribing is a major source of value for EMR systems, almost all widely marketed EMR systems provide some level of support for e-prescriptions.
SureScripts provides a catalog of the e-prescribing capabilities of dedicated and embedded eRx systems that have received SureScripts certification. The catalog lists over 70 EMR systems have received SureScripts certification. All of these systems provide the basic capabilities of e-prescribing and e-refills.
Three systems (Allscripts TouchWorks, NextGen, and eClinicalWorks) have achieved the SureScripts GoldRx certification for high levels of functionality, interoperability, and customer satisfaction. In addition to e-prescribing and e-refills, these systems also support formularies, eligibility, and prescription history.
EMR Selection and Implementation Process
Practices successfully adopting EMRs typically proceed through a five-step process. These steps include:
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Assessment: Assess its readiness for EMR adoption and define the goals to be achieved.
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Planning: Understand the workflow and infrastructure changes necessary to achieve value from electronic medical records
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Vendor Selection: the practice must choose an EMR product that satisfies the business and clinical needs of the practice, including functionality, user interface style, price, and vendor acceptability.
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Implementation: The most stressful stage, implementation must be carefully planned. All staff must understand the goals of the change, they must be prepared for the stresses of the change, and they must be adequately trained to make use of the new system.
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Process Improvement/Value Capture: Once the implementation is complete, the practice is positioned to implement additional changes in patient care and business practices that will maximize the value of EMR adoption
This multistep approach to EMR adoption is explained in great detail and supported by the resources described below.
Resources: Organizations and Web Sites
Leadership and funding from the Centers for Medicare and Medicaid Services (CMS) has resulted in large quantity of excellent introductory material about EMR systems and EMR selection and implementation. The mother lode of the CMS stimulated material can be found at this website (pronounced "med-quick"), the Medicare Quality Improvement Community. The MedQIC EHR Roadmap on this site is a guide to EHR selection and implementation.
During the CMS-funded Doctors Office Quality Information Technology (DOQ-IT) project, which ended in 2006, individual QIOs also created useful web pages and documents on the topic of EMRs. Excellent examples are:
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Arizona DOQ-IT, including the AZ DOQ-IT Toolkit and a recent review of EHR adoption in Arizona
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DOQ-IT University (free registration required), an interactive Web-based tool for learning about electronic health records.
Medical associations
Medical associations have also taken an interest in EMRs. Some good resources include:
The Health Information Management and Systems Society (HIMSS) is an excellent resource for a variety of health information technology and exchange subjects. It also has a section of its Web site devoted entirely to electronic health records.
This site is a web forum for discussion of topics related to EMRs.
California Health Care Foundation
A non-profit organization that addresses health IT issues, including electronic medical records on a national scale.
The U.S. federal government, including President Bush, has strongly endorsed the adoption of electronic medical records. The Department of Health and Human Services (HHS) addresses health IT one this site, providing links to the Office of the National Coordinator (ONC), the American Health Information Community (AHIC), and to topics including health IT certification, data standards, and privacy.
This site is published by a health IT consultant who has collected and indexed a vast array of articles about EMR systems and implementation.
The Medical Records Institute hosts an annual conference in May, called TEPR, as well as regional events, called EMR Roadshows, to educate physicians about electronic medical records.
