HITECH and the History of EHRs (Baccalaureate) HBK1020

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New York Institute of Technology, Westbury *

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Medicine

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May 15, 2024

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docx

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Knowledge Activity: HITECH and the History of EHRs (Baccalaureate) Student instructions 1. If you have questions about this activity, please contact your instructor for assistance. 2. You will review the chart of Anna Danielski to complete this activity. Your instructor has provided you with a link to the HITECH and the History of EHRs (BS) activity. Click on 2: Launch EHR to review the patient chart and begin this activity. 3. Refer to the patient chart and any suggested resources to complete this activity. 4. Document your answers directly on this activity document as you complete the activity. When you are finished, you will save this activity document to your device and upload this activity document with your answers to your Learning Management System (LMS). The activity A Brief History of EHRs EHRs have their roots in the 1960s, when keyboards and video display terminals provided significant technological advances. Prior to the 1960s, medical records were kept on paper and manually filed. With this new technology, some innovative thinkers in the healthcare industry began the quest to improve healthcare delivery with this new technology. One of the notable early advancements was the creation of a clinical information system by Lockheed Corporation. Soon, academic medical centers and universities were creating their own systems. The federal government became involved with EHRs when the Department of Veteran Affairs implemented VistA in the 1970s. VistA was used in VA centers across the United States and in many other healthcare organizations worldwide. (Tripathi, 2012) A report released by the Institute of Medicine in 1991 recognized implementation of EHRs “ as one of seven key recommendations for improving patient records, and to propose a means of converting paper to electronic records.” (Marquez, 2017) Key Attributes of a Computer-Based Patient Record The 1991 first edition of The Computer-Based Patient Record: An Essential Technology for Healthcare, and its second edition from 1997, set the gold standard for features that should be available in electronic health records. (Institute of Medicine, 1991) . The 12 attributes outlined by the book, listed below, are still valid and necessary today. EHR Go Knowledge Activity: HITECH and the History of EHRs (Baccalaureate) HBK1020.2 1 Archetype Innovations LLC ©2021

 Problem list and current status of each  Systematic measurement and recording of patient's health status and functional level to promote more precise and routine assessment of the outcomes of patient care  Documents clinical rationale for diagnosis and management  Life time clinical record (longitudinal)  Addresses confidentiality  Accessible in a timely way at any and all times by authorized individuals  Allows selective retrieval and formatting of information by users  Linked to local and remote knowledge to support decision making  Decision analysis tools, clinical reminders, prognostic risk assessment, and other clinical aids  Supports structured data collection and stores information using a defined vocabulary. Supports direct data entry by practitioners  Helps individual practitioners and health care providers institutions manage and evaluate the quality and costs of care  Sufficiently flexible and expandable to support not only today's basic information needs but also the evolving needs of each clinical specialty and subspecialty (Institute of Medicine, 1997) EHRs made huge strides in the 2000s after these attributes were established. In 2004, the Office of the National Coordinator of Health Information Technology (ONC) was created, and, not long after, the Health Information Technology for Economic and Clinical Health Act (HITECH) was passed. (HeathIT.gov) The HITECH Act The Health Information Technology for Economic and Clinical Health (HITECH) Act was passed into law as part of the American Recovery and Reinvestment Act of 2009 (ARRA). The ARRA sought to promote and fund health information technology in the United States and incentivized the adoption and use of electronic health record systems by healthcare providers. The HITECH Act bestowed the U.S. Department of Health and Human Services (HHS) with the power to increase the use of EHRs and provide incentives to encourage hospitals and physicians to implement. Along with that power also came $19.2 billion in funding to meet that goal. (Gold & McLaughlin, 2016) More specifically, the goals of HITECH were to improve medical outcomes for individual and population health, increase the transparency and efficiency of the healthcare system, and improve the ability to study healthcare through connected systems and reporting. HITECH was EHR Go Knowledge Activity: HITECH and the History of EHRs (Baccalaureate) HBK1020.2 2 Archetype Innovations LLC ©2021

premised on the idea that health information technology would increase efficiency while decreasing healthcare costs by preventing medical errors, saving time for clinicians and patients, and reducing unnecessary or duplicate testing. (Tripathi, 2012). HHS was directed to use the HITECH provisions to advance the use and connectivity of EHRs and the interoperability, i.e. the ability to exchange and make use of information, of health information technology. HITECH provided health care providers with higher payments if they were able to demonstrate compliance with “meaningful use” criteria involving using an EHR. (Gold & McLaughlin, 2016) The HITECH Act’s Meaningful Use Standard The HITECH Act’s “meaningful use” standard for interoperable electronic health records is a key part of the law. HHS funded the Meaningful Use program, which incentivized healthcare providers to adopt EHRs. To qualify for federal funds from Medicare and Medicaid, providers not only had to adopt EHRs, but also conduct risk assessments to demonstrate compliance with the HIPAA Security and Privacy Rules. According to the Centers for Disease Control and Prevention (CDC), the meaningful use standard is made up of five pillars:  Improving quality, safety, efficiency and reducing health disparities  Engaging patients and families in their health  Improving care coordination  Improving population and public health  Ensuring adequate privacy and security protection for personal health information (Centers for Disease Control and Prevention) Stage 1 was finalized in 2010, while Stage 2 was set forth in 2012, followed by Stage 3 in 2015. With these different stages of meaningful use, the goal was to solve three problems: (1) to eliminate the logistical problems of the paper records by making clinical data immediately available to authorized users wherever they are – no more unavailable or undecipherable clinical records; (2) to reduce the work of clinical book keeping required to manage patients – no more missed diagnoses when laboratory evidence shouts its existence, no more forgetting about required preventive care; (3) to make the informational ‘gold’ in the medical record accessible to clinical, epidemiological, outcomes and management research.” (Tripathi, 2012) . The impact of HITECH EHR Go Knowledge Activity: HITECH and the History of EHRs (Baccalaureate) HBK1020.2 3 Archetype Innovations LLC ©2021

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