Electronic Health Record (EHR) at the Tipping Point
by Gwen Hughes RHIA, CHP, Director of e-HIM® Consulting Services, Care Communications, Inc.

Evidence continues to mount that the EHR has reached or is at Tipping Point.  Evidence includes the following:

• The Institute of Medicine publishes a report in  2000 that says 98,000 people die as a result of medical errors.  They call for a system in which it is  hard to make a mistake and easy to do the right thing.
• The Consolidated Health Informatics Initiative  (CHIA), part of the E-Government Act of 2002 requires the adoption of existing  health information interoperability, vocabulary and messaging standards.  Thus far, the government has adopted  19 of 24 standards. (www.whitehouse.gov/omb/egov/downloads/domain2.doc)
• The Medicare Prescription Drug Improvement and  Modernization Act of 2003 (MMA) authorizes the Secretary of HHA to make grants  to physicians to help them implement electronic prescription drug programs  starting 10/1/06
• President George W. Bush calls for computerizing  health records in State of the Union Addresses in 2004 and  2005.
• President George W. Bush calls for the majority of  Americans to have an interoperable electronic health record within ten years,  2005.
• The Office of the National Coordinator of Health  Information Technology is established and Dr. Brailer is named the National  Health Information Technology Coordinator in 2004.  He is charged with providing  leadership for building a national electronic health information  infrastructure in the US in 10 years and facilitating the vision for most  Americans to have a personal health record by 2014.
• The Commission on Systemic Interoperability  authorized by Congress in December 2003 as part of the Medicare Modernization  Act, explores consumer and public stake in a national electronic health  record.
• The Certification Commission for Health  Information Technology (CCHIT) is established August of 2004.  It’s purpose is to certify electronic  health record software such that purchasers know they’re getting something  that meets the functional requirements of an EHR, is reliable, interoperable  and secure.
• Implementation Support Organizations begin to  form, such as the Physicians EHR Coalition (PEHRC) to assist physicians to  acquire and use affordable standards-based EHR systems and other health  information technology that would improve quality, enhance patient safety and  increase efficiency.
• Tommy Thompson, former Secretary of HHS announces  four goals and twelve strategies to advance progress toward President Bush’s  vision in 2004.  The goals include  informing clinicians, interconnecting clinicians, personalizing care and  improving the population’s health.   
• Regional Health Information Organizations (RHIOs)  whose goal is to expedite data sharing improve patient outcomes, reduce costs  and coordinate administrative tasks stated forming throughout the country in  2005.  Approximately 25 states  have one or more RHIOs taking shape.
• The HIPAA Privacy and Security Rule established  minimum standards for privacy and security to support electronic data  exchange. (year?)
• The Veterans Administration makes medical record  software available to physicians in (YEAR?). (www.va.gov/vista, www.ifmc.org and VistA@ifmc.org)
• ASTM is developing a minimum data set for a  continuity of care record (CCR) to ensure continuity between care  settings.  The CCR is a  rudimentary way to connect and exchange certain pieces of data between  electronic health record information systems.
• The Agency for Healthcare Research and Quality  (AHRQ) is providing funding through a number of programs to support IT  application adoption, data sharing and interoperability. (www.ahrq.gov)
• The National Health Information Technology  Resource Center has been established and funded for five years to gather  information to help implement IT and support planning, implementation and  demonstration projects funded by AHRQ and other federal  programs
• The AMA establishes a CPT code effective July 1,  2004 that helps facilitate the coding and payment of physicians for evaluating  and managing patient encounters with an established patient via a secure  communication network.
• MedFusion and AAFP announced an agreement that  allows active AAFP members to create free web sites and communicate with  patients via a secure communication network (www.aafp.org or www.medfusion.net)
• The Markle and Wood Foundations published several  reports suggesting actions the government might take to help healthcare  organization overcome funding and legal obstacles to the electronic health  record
• Pay for Performance (P4) initiatives (one way of  funding the EHR) are piloted in at least five states
• Health Information Technology Leadership Panel  commissioned by Office of the Coordinator for Health Information Technology  publishes final report, March 2005. The Report identified three key  imperatives: 1) Widespread adoption of interoperable HIT should be a top  priority for the U.S. health care system; 2) The federal government should use  its leverage as the nation’s largest health care payer and provider to drive  adoption of HIT; and 3) Private sector purchasers and health care  organizations can and should collaborate alongside the federal government to  drive adoption of HIT.
• Patrick Kennedy and Timothy Murphy introduce the  21st Century Health Information Act, which would establish a  National Technical Assistance Center and provide up to twenty-- three year  grants for RHIOs, May 2005.
• HHS Secretary Mike Leavitt announces contracts totaling $18.6 million to develop prototypes for a  Nationwide Health Information Network  (NHIN) architecture.  "The Nationwide Health Information Network  contracts will bring together technology  developers with doctors and hospitals to create innovative state-of-the-art ideas for how health  information can be securely shared,"  Secretary Leavitt said.  "This effort will help design an  information network that will transform  our health care system resulting in higher  quality, lower costs, less hassle and better care for American  consumers."
  

Secretary of HHS, Mike Leavitt 500-Day Plan, announced in May of 2005, includes a vision that nearly all health records can be linked through an interoperable system that protects privacy as it connects patients, providers and payers—resulting in fewer medical mistakes, less hassle, lower costs and better health.  Recent evidence continues to indicate a focused effort to achieving each aspect of the plan.