One of the most exciting aspects of inter-professional healthcare informatics today is the Electronic Health Record, or EHR. The reference for this presentation, unless otherwise noted, is chapter three of the optional Hoyt text. The key points we'll cover are definition, benefits, core functions, and components. In 2008, the National Alliance for Health Informatics Technology, released this definition of the electronic health record. And electronic record of health related information on an individual, that conforms to nationally recognized interoperability standards. And they can be created, managed, and consulted by authorized clinicians and staff, across more than one healthcare organization. Note that this definition is inclusive from an inter-professional perspective, and suggests that data sharing is a fundamental goal. The benefits of EHR's are truly re, amazing. With fully functional EHR's all members of the team have ready access to the latest information, allowing for more coordinated, patient centered care. Before I give some examples. Consider which of these EHR benefits you have observed or experienced. Fully functional EHRs are life-saving. The information gathered by the primary care provider tells the emergency department clinician about the patient's life threatening allergy. So that care can be adjusted appropriately even if the patient is unconscious. From a public health emergency preparedness perspective, sharing access to clinical information is critical during disease outbreaks and disasters. Access to timely clinical data also improves care quality. And reduces patient harm. The lab results run last week are already in the record to tell the specialist what she needs to know without running duplicate tests. Transitions between care settings are information intensive, and require excellent inter-professional communication to ensure good patient outcomes. The clinician's notes from the patient's hospital stay can help inform the discharge instructions and follow-up care. And enable the patient to move from one care setting to another more smoothly. Patient portals are becoming available in many EHRs. A patient can log on to his own record. And see the trend of the lab results over the last year. Which can help motivate him to take his medications and keep up with the lifestyle changes that have improved the numbers. All of these real time EHR benefits create data streams that can be leveraged for research to improve care, generate new knowledge and address population needs. This fully functional EHR and its benefits are the ideal that we are all striving to attain. For each of these benefits, consider which of the multiple choice answers applies. Key point three: core functions. A bit of historical context might be helpful here. Until recently, the US lagged behind many other developed countries in the adoption of EHRs. In 2003, the Institute of Medicine envisioned this fully functional EHR and proposed eight core functions. That describe how robust information management will support healthcare. Much has happened since 2003 in this whirlwind field. Two American presidents, George W Bush and Barack Obama, have championed the adoption of EHRs in this country. In his inaugural address in 2004 President Bush pronounced the goal of universal EHR adoption for all by 2014. And established the Office of the National Coordinator to accomplish this goal. In 2009 President Obama reinforced these efforts through the HITECH Act. Allocating major resources for health information technology investments and incentive payments. Similar initiatives have taken place around the world as global EHR adoptions mirror trends in the U.S. The goals of EHR use specified in the HITECH Act were. To improve the quality, safety, and efficiency of care while reducing disparities. To engage patients and families in their care. To promote public and population health. To improve care coordination, and to promote the privacy and security of EHRs. The medicare and medicaid EHR incentive programs provide financial incentives for the meaningful use of certified EHR technology to improve patient care. To receive an EHR incentive payments, eligible hospitals, clinics, and healthcare providers primarily physician practices. Have to show that they are meaningfully using their EHR's, by meeting thresholds for a number of objectives. The EHR incentive program asks clinicians to use their capabilities of the EHRs to achieve benchmarks that can lead to improve patient care. Beginning in 2015, Medicare eligible professionals who do not successfully demonstrate meaningful use will be subject to a payment adjustment. The payment reduction starts at 1% and increases each year that a Medicare eligible professional does not demonstrate meaningful use. To a maximum of 5%. Needless to say, payment reductions are a huge concern for anyone in today's health industry. Key point 4: key components. One of the advantages of meaningful use certification is that it defined the components of EHRs. We've come a long way since the 2003 Institute of Medicine vision of eight core functions. With definitions of each of these core requirements and criteria for measuring them. Note the requirement of exchange of key clinical information among providers and patient authorized entities. Achieving meaningful use during Stage one requires meeting both core and menu objectives. All of the core objectives are required, hospitals may choose which objectives to meet from the menu set. Note the public health agencies and immunization registries are on the menu. And very important to informaticists, requirements for use of standards now exist. Information should be coded with ICD9CM or SNOMED CT. Such a huge investment of meaningful use incentives are sure to have improved the capacity for EHRUs in the United States primary care and hospital contexts. It is too soon to ask the question if the incentives achieved by the lofty goals set out by the HITECH Act. But we can appreciate and learn from the success stories that are beginning to emerge. Here are some health IT success stories, available online from the Agency for Healthcare Research and Quality. Please watch at least one of the videos and as you watch, make note of the role of the EHR in the example. Which high tech goals were achieved? Which are benefits do you obserse? How are the health IT will work with your health system profession and patient population? These examples offered an opportunity to look beyond the incentives at the big pictures. Related to meaningful use in the true sense of the word. In the true sense of the evolution of VEHR and the data that give voice to the real people whose health records and health interventions are represented in EHRs. Beyond incentives, it is safe to say that this huge investment into EHR capacity has opened new opportunities for some aspects of health care. Well some settings such as home care and public health have not realized the same benefits. Even so, we should all strive for meaningful use of our data. EHRs are evolving rapidly and innovation is amazing. However, technology can be expensive and the real return on investment is still unknown. Therefore we need to understand our goals and weigh the costs and benefits of our investments and keep striving to reach the real goals and benefits. We need to be informed EHR consumers. Finally, EHRs generate data that give voice to patients and those who care for them and data are very powerful. True meaningful use of interprofessional data will engage all health care professionals in meaningful interprefessional patient care. In this presentation we considered key points regarding the EHR including definition, benefits, core functions and components. Understanding these key points provides us with a foundation for informed decision making and EHR use. [SOUND].
