Patient Safety / Quality

Advancing adoption of the electronic health record

They say health care is local and personal. I can attest to that. I moved from the private healthcare sector in Milwaukee, Wisconsin to the public national setting of Washington, D.C. to work in the Office of the National Coordinator (ONC) for Health Information Technology (HIT). It has been quite a journey.

Having experienced the value of HIT where I previously worked, I know how important HIT is to building a 21st-century healthcare system where care will be safer, better coordinated, and more patient-centered. I’ve learned how actions taken in the nation’s capital can affect my former Wisconsin colleagues and healthcare providers at the local level throughout the country.

At the ONC, we’re endeavoring to build an integrated system that will pay for the right care and the best care—not just more care. By implementing HIT—particularly electronic health records (EHRs)—we can ensure that patients and providers get secure access to health information when they need it. This, in turn, will help clinicians make good healthcare decisions based on best practices, and will help ensure patients get safe, well-coordinated, high-quality care.

Many healthcare organizations have already made the switch to EHRs, which are computerized versions of patients’ paper charts updated in real time. EHRs make patient information available instantly, whenever and wherever it’s needed, while keeping it private and secure.

But EHRs can do more than that. They can be accessed, managed, and consulted by authorized providers and staff across multiple healthcare organizations, consolidating information from the patient’s current and past visits at emergency facilities, school and workplace clinics, pharmacies, laboratories, and medical imaging facilities—all while protecting patients’ privacy.

At ONC, I work with hundreds of experts, both inside and outside the federal government, who are united in their efforts to advance adoption and meaningful use of EHRs and HIT, and to secure health information exchange among care venues and across time. Achieving this goal will let patients participate more actively in their health care and get better-coordinated care at lower costs.


Guidance from the ONC

As a nurse, I know what it’s like to be on the front lines of patient care, whether in a physician’s office, hospital, long-term care facility, rehabilitation clinic, or patient’s home. I know care transitions between venues can be particularly problematic because of the long history of information “silos” that can pose obstacles to sharing patient data.

ONC staff are working in unison on the standards, technology, and implementation guidance that will help push the exchange of health information further along. Each state has received significant federal funding to advance the nationwide infrastructure for health information exchange. We’re making good progress in ensuring use of the right tools to help improve care as more technology becomes available to providers.

EHR incentive programs

The first step in ensuring the right care is to increase HIT adoption and use. Farzad Mostashari, National Coordinator for HIT within the ONC, and the entire ONC staff have set an ambitious goal for 2012: Ensure that 100,000 healthcare providers from across the country receive payment under the Medicare and Medicaid EHR Incentive Programs by the end of this year.

Actually, we’ve already surpassed that goal: In June, ONC announced that more than 110,000 providers were getting incentive payments, thanks largely to work being done by ONC’s 62 regional extension centers (RECs). RECs offer provider practices of all sizes the technical assistance and support they need to make the transition to certified EHRs. Working with 132,000 primary care providers (more than 40% of all primary-care providers across the country), RECs have established their own milestones to help ONC reach more eligible professionals.

EHR Incentive Programs, which began in 2011 and are administered by the Centers for Medicare & Medicaid Services (CMS), make payments to eligible professionals, hospitals, and critical-access hospitals as they adopt, implement, upgrade, or demonstrate meaningful use of certified EHR technology. To prove meaningful use, providers must show they’re using certified EHR technology in ways that improve care, based on defined criteria.

So how are we doing? As of July 2012, Medicare and Medicaid incentive payments for the meaningful use of certified EHRs had passed $6.5 billion. More than 55% of eligible hospitals and 22% of eligible providers received Medicare and/or Medicaid incentive payments. Remarkable progress has been made, and 2012 is truly the “Year of Meaningful Use.”

Beacon Communities

Across the country, 17 Beacon Communities have already made inroads in developing secure, private, and accurate systems of EHR adoption and health information exchange. Beacon Communities are lighting the way for HIT adoption by testing innovative ideas, such as texting messages to diabetes patients in New Orleans about their treatments; sending notices to physicians’ offices when patients visit emergency departments in Cincinnati; and helping ensure patients understand information about their care when discharged from Pennsylvania hospitals.

The Beacon Community Cooperative Agreement Program helps demonstrate how HIT investments and meaningful use can advance the vision of patient-centered care and the three-part aim for better health, better health care, and lower cost. In the short time I’ve been at ONC, I’ve been impressed by the work being done locally in each Beacon Community through the efforts of the federally funded RECs and Beacon Communities.

Investing in Innovations program

Many other activities are underway to find the best way to coordinate care. Through a program called Investing in Innovations (i2), ONC uses prizes and challenges to stimulate and accelerate the development of solutions for targeted healthcare problems. (See Learning about the i2 program by clicking the PDf icon above.)

Expanded consumer health initiatives

ONC has extended its efforts to reach patients and their family caregivers through expanded consumer health initiatives. As more healthcare practices, clinics, and hospitals achieve meaningful use of EHRs, ONC’s consumer health team endeavors to put similar tools in patients’ hands. Using these tools allows patients to communicate with healthcare providers and ask questions about their health and treatment options. It also can help make their health information as accurate and complete as possible. Research shows that engaged patients receive better health care and can avoid potential medical errors.

These tools allow providers to plug electronic data from health records into a growing number of devices and applications that help better manage patients’ health and wellness—in many cases, outside the context of traditional health care. Such devices as digital scales and wireless pedometers can help track key health metrics. Smartphone applications provide information, tools, and reminders, while online communities help patients interpret information, obtain emotional support, and make choices that support their health goals.

Fulfilling the promise of HIT

The work of ONC and its partners across the country aims to help providers and patients realize the promise of HIT. ONC, RECs, and the Beacon Communities are collecting best practices and sharing that information with still-struggling facilities. ONC is helping to promote communication among them to make it easier to achieve meaningful use of EHRs, this year and into the future. The national transition to EHRs through the EHR Incentive Programs is laying the foundation for building a 21st-century healthcare system. Our patients depend on us for their care and we owe them the best care possible. HIT will help us all achieve that promise.

Judy Murphy is deputy national coordinator for Programs & Policy at the Office of the National Coordinator for Health information Technology, U.S. Department of Health & Human Services, in Washington, D.C.

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