Author: Denise R. Eccles, PhD, ED, RN
Advance Nursing Institute INC is approved as a provider for continuing education by Florida Board of Nursing.
Provider # 50-16977 Copyright © 2013 Advance Nursing Institute INC. 1
Electronic Health Records and Meaningful Use
Course Description
The purpose of this continuing education program is alert the audience on the Health Information
Technology for Economic and Clinical Health Act (HITECH) that was signed into law in
February 2009, and the law was finalized in November 2009. The HITECH Act promotes
adoption and meaningful use of health information to improve quality of care in a safe manner.
In addition the audience will also be educated on Safety Assurance Factors for EHR Resilience,
and Electronic health records (SAFER), and Meaning Use (EHR-MU).
Target Audience
Advanced Practice Registered Nurses, Registered Nurses and Licensed Practical Nurses
Course Objectives
1. Understand what is the HITECH Act
2. Define Meaningful Use
How to Receive Your CE Credits
Read your selected course
Completed the quiz at the end of
the course with a 70% or greater.
Complete the evaluation for your
selected course.
Print your Certificate
CE’s will automatically be reported
to the CE Broker
Author: Denise R. Eccles, PhD, ED, RN
Advance Nursing Institute INC is approved as a provider for continuing education by Florida Board of Nursing.
Provider # 50-16977 Copyright © 2013 Advance Nursing Institute INC. 2
3. List the type of technology that a EHR should have for meaningful use
4. Understand Safety Assurance Factors for EHR Resilience
5. Identify meaningful use technology that is in compliance with the HITECH Act
6. Understand the Goal and the importance of implementing EHR
7. List the provision and the financial incentive for health care organization to implement
EHR
Introduction
Physicians and health care organizations are eligible for both Medicare and Medicaid incentives
for implementation and electronic health records (EHR) (GE Health Care, 2009). Health care
organizations implementing an EHR technology system has been proven to increase the quality
of patient care. The Health Information Technology for Economic and Clinical Health Act
(HITECH) will supplement and incentive for health care organizations who implement an EHR
system. These incentives are only eligible for those health care organization, and others
clinicians who implement a meaningful and qualified EHR.
Meaningful Use
According to GE Health Care (2009); HealthIT, (2014) a meaningful and qualified EHR is
defined as an electronic record that is a certified electronic health record (EHR) with the
technology to:
a. Inclusion of patient demographic and clinical health information, such as medical
history and problem lists
Author: Denise R. Eccles, PhD, ED, RN
Advance Nursing Institute INC is approved as a provider for continuing education by Florida Board of Nursing.
Provider # 50-16977 Copyright © 2013 Advance Nursing Institute INC. 3
b. The capacity to provide clinical decision support
c. Support for physician order entry
d. The ability to capture and query information relevant to health care quality
e. Electronic health information exchange capabilities, including the ability to
integrate such information from other sources into the EHR (GE Health Care,
2009).
f. Improve quality, safety, efficiency, and reduce health disparities
g. Engage patients and family
h. Improve care coordination, and population and public health
i. Maintain privacy and security of patient health information
In addition meaningful use also includes that the technology compliance will result in HealthIT,
(2014):
a. Better clinical outcomes
b. Improved population health outcomes
c. Increased transparency and efficiency
d. Empowered individuals
e. More robust research data on health system
Additionally health care organization should include certain quality measures that will
demonstrate improvement in quality of care as a result of implementing EHR. These quality
measures should be key indicator that are reported or mined by administration monthly or
quarterly for quality improvement.
Author: Denise R. Eccles, PhD, ED, RN
Advance Nursing Institute INC is approved as a provider for continuing education by Florida Board of Nursing.
Provider # 50-16977 Copyright © 2013 Advance Nursing Institute INC. 4
EHR Implementation Statement
Possessing the capability to share electronic health information within and among health
care organizations has been generally accepted as a way to improve the quality and delivery of
care and help control rising healthcare costs (Board on Healthcare Services and Institute of
Medicine, n.d.) The government is trying to initiate a national push that will allow doctors and
hospitals across the country to adopt electronic health records by 2014 (Health Policy Brief,
2010)
By 2014 health care organizations, physician offices, and other clinicians who treat
patients who are Medicare and Medicaid recipients will face governmental penalties if they fail
to implement an electronic health records (EHR) (Health Policy Brief, 2010). Blumenthal, and
Tavenner (2010) addressed in 2009, Congress and the Obama administration provided the health
care community with a transformational opportunity to break through the barriers to progress.
The Health Information Technology for Economic and Clinical Health Act (HITECH) approved
incentive payments through Medicare and Medicaid to clinicians and hospitals when they use
EHRs privately and securely to achieve positive improvements in care delivery.
HITECH is federally funded governmental act. The HITECH act requires the government
to take a leadership role to develop standards by 2010. The standards will allow for nationwide
electronic exchange and use of health information to improve quality and coordination of patient
care (Majority Staff of the Committees on Energy and Commerce, 2009). HITECH act funds are
for those health care organization, and others clinicians who implement an electronic medical
records system. Health care organizations who fail to implement an EHR system by 2014 may
Author: Denise R. Eccles, PhD, ED, RN
Advance Nursing Institute INC is approved as a provider for continuing education by Florida Board of Nursing.
Provider # 50-16977 Copyright © 2013 Advance Nursing Institute INC. 5
be faced governmental penalties. According to Pear (2010) starting in 2015, hospitals, and
doctors will be subject to financial penalties under Medicare if they are not using electronic
health records.
Safety Assurance Factors for EHR Resilience (SAFER)
According to HealthIT (2014) SAFER is used as self-assessment to identify the
organization’s level of implementation according to evidence-based recommended practices for
safe EHR implementation. SAFER consist of nine guides organized into three broad groups.
These guides enable healthcare organizations to address EHR safety in a variety of areas. The
nine organized groups into the three broad groups are as follows:
Foundational Guides
High Priority Practices
Organizational Responsibilities
HealthIT (2014)
Clinical Process Guides
Patient Identification
Computerized Provider Order
Entry with Decision Support
Test Results Reporting and Follow-Up
Clinician Communication
HealthIT (2014)
Infrastructure Guides
Contingency Planning
System Configuration
System Interfaces
HealthIT (2014)
Author: Denise R. Eccles, PhD, ED, RN
Advance Nursing Institute INC is approved as a provider for continuing education by Florida Board of Nursing.
Provider # 50-16977 Copyright © 2013 Advance Nursing Institute INC. 6
Topic Explanation of the Topic Example
Health
Information
Privacy
(HIPAA)
The U.S. Department of Health and Human
Services (n.d.) indicates that the Health
Information Privacy Act (HIPPA) provides
federal protections for personal health
information held by covered entities and gives
patients an array of rights with respect to that
information. The Privacy Rule is balanced so
that it permits the disclosure of personal
health information needed for patient care and
other important purposes.
Without official consent given by
the patient. Health care
organizations will no longer be
able to disclose any medical
information regarding the care of
the patient.
Technology for
Economic and
Clinical Health
provisions of the
American
Recovery and
Reinvestment
Act of 2009
(HITECH)
“According to the Health Information
Technology for Economic and Clinical Health
Act of 2009, health information technology
helps save lives and lower costs. This bill
accomplishes four major goals that has
advanced the use of health information
technology (Health IT), such as electronic
health records by:
a. Requiring the government to take a
leadership role to develop standards
by 2010 that allow for the nationwide
electronic exchange and use of health
information to improve quality and
coordination of care.
b. Investing $20 billion in health
information technology infrastructure
and Medicare and Medicaid incentives
to encourage doctors and hospitals to
use HIT to electronically exchange
patients’ health information.
c. Saving the government $10 billion,
and generating additional savings
throughout the health sector, through
improvements in quality of care and
care coordination, and reductions in
medical errors and duplicative care.
d. Strengthening Federal privacy and
GE Health (2009) indicates that
meaningful use of EHR consist
of technology that contain the
capabilities of
j. Inclusion of patient
demographic and clinical
health information, such
as medical history and
problem lists
k. The capacity to provide
clinical decision support
l. Support for physician
order entry
m. The ability to capture and
query information
relevant to healthcare
quality
n. Electronic health
information exchange
capabilities, including the
ability to integrate such
information from other
sources into the EHR
Author: Denise R. Eccles, PhD, ED, RN
Advance Nursing Institute INC is approved as a provider for continuing education by Florida Board of Nursing.
Provider # 50-16977 Copyright © 2013 Advance Nursing Institute INC. 7
security law to protect identifiable
health information from misuse as the
health care sector increases use of
Health IT (Health Information
Technology for Economic and
Clinical Health Act 2009).”
American
Recovery and
Reinvestment
Act
(ARRA)
Graham (2010), indicates that aim of the goal
of ARRA was to make patient health records
electronic so that medical errors could be
prevented and more lives be saved by
digitizing records and creating opportunities
for new jobs (p. 402).
According to the Institute of
Medicine, (1999) handwritten
paper medical records can be
associated with poor legibility,
which can contributes to the high
number of medication errors.
Government Regulatory Rules and Provisions of the HITECH Act
Having the capability to share electronic health information within and among healthcare
organizations has been generally accepted as a way to improve the quality and delivery of care.
Additionally helping control rising healthcare costs (Board on Healthcare Services and Institute
of Medicine, n.d.). The government is trying to initiate a national push to get doctors and
hospitals across the country to adopt electronic health records by 2014 (Health Policy Brief,
2010).
Health care organizations are eligible for funding from HITECH. Health care
organization that show that they are meaningfully using health information technology, such as
through the reporting of quality measures are eligible for HITECH funding (Majority Staff of the
Committees on Energy and Commerce, 2009). The Act will also provide direct funding for
health information technology training, infrastructure, dissemination of best practices,
telemedicine, inclusion of health information technology in clinical education, and state grants to
Author: Denise R. Eccles, PhD, ED, RN
Advance Nursing Institute INC is approved as a provider for continuing education by Florida Board of Nursing.
Provider # 50-16977 Copyright © 2013 Advance Nursing Institute INC. 8
promote health information technology. The incentive payment for eligible professionals or
hospitals who can demonstrate they attempted to adopt and implement EHR technology
payments range from $44,000 over 5 years for Medicare providers and $63,750 over 6 years for
Medicaid providers. Failure for a health care organization to implement an EHR by 2015 will
result in a negative adjustment to their fees starting at 1% and increasing to 3% reduction by
2017 and beyond. The HITECH imposes rigorous regulatory requirements under the security
and privacy rules of the Health Insurance Portability and Accountability Act (HIPPA) of 1996.
Furthermore, increases civil penalties for a violation of HIPAA, provides funding for hospitals
and physicians for the implementation of health information technology, and requires the
organization to notify patients of a security breaches (Peabody, 2011).
The Need to Implement EHR
Several factors that contributed to the implementation of EHR system for health care
organizations goals is to improve the quality of healthcare, decreased healthcare costs, and
minimize health care fraud. As the health care system have within the strategic plan to grow with
that growth the organization should have a central goal on improving the control, the monitoring,
the storing, and the coordinating the patients’ health information records. The central goal
should be geared at a challenge to improve the health care outcomes and securing the patient’s
medical records for the continuum of care.
An additional need to implement an EHR is frequent lost, inability to locate the paper
medical record in a timely manner, and the unavailability of the patient’s medical record.
Improper handling, storage, and transportation, of medical records were also a contributing
factor. According to the Joint commission, (2008), one must first identify the patient medical
Author: Denise R. Eccles, PhD, ED, RN
Advance Nursing Institute INC is approved as a provider for continuing education by Florida Board of Nursing.
Provider # 50-16977 Copyright © 2013 Advance Nursing Institute INC. 9
information to determine the extent of patient care that will need to be provided by the health
care provider. Planning for the management of information does not require a formal written
information plan but does require evidence of a planned approach that identifies the hospital’s
previous information to supports the care of the patient (Joint commission, 2008). When
performing an assessment the health care organization must gather data on occurrences, these
occurrences must include the number of times the provider had to see a patient with the absence
of his or her paper medical records the above task cannot be performed. These are one of many
factors for the need of the health care organizations to implement an electronic health medical
records system.
The Financial Need
Health information technology of medical records has the potential to reduce health care
costs, improve efficiency, and enhance quality of care and patient safety (Blumenthal,
DesRoches, Donelan, and et al, 2008). One of the promising applications electronic medical
records is that it automates the paper-based patient chart and can improve clinical decisions.
EHR can facilitate improvements to workflow, for the nurse/physician-related hospital
experiences (Bolton, Gassert, and Cipriano 2008). An empirical study revealed a positive
relationship between EHR health information technology investment and hospital financial
performance (Menachemi et al. 2006; Thouin, Hoffman, and Ford 2008) and productivity
(Menon, Lee, and Eldenberg 2000). According to Majority Staff of the Committees on Energy
and Commerce (2009) the implementation of the HITECH act will save the government $10
billion, and generating additional savings throughout the health sector. Additional saving for the
Author: Denise R. Eccles, PhD, ED, RN
Advance Nursing Institute INC is approved as a provider for continuing education by Florida Board of Nursing.
Provider # 50-16977 Copyright © 2013 Advance Nursing Institute INC. 10
implementation of the HITECH act will be solved through improvements in quality of care and
care coordination, and reductions in medical errors and duplicative care.
Conclusion
Over the past decade technology has improved the way heath care conducts business.
One of the greatest changes in health care is the use of the electronic medical records with
information technology progressively touching every part of healthcare (Fried, & Fottler, 2008,
p. 484). Health and Human Services Department (HHS) released a strategic plan outlining a
broad array of steps it plans to take to implement a national health information network and
electronic records for every American within the next decade (Winterkamp, n.d.). According to
the Institute of Medicine, (1999) handwritten paper medical records can be associated with poor
legibility, which can contributes to the high number of medication errors, and patients death.
Health care organizations that comply with the HITECH act definition of implementing a
meaningful EHR will be a beneficiary of the stimulus act. Electronic health record (EHR)
systems have the potential to improve patient quality of care. Health care organizations that
implement a multifaceted quality improvement tool to measure the timeliness, and accuracy of
patient care, will comply with HITECH definition meaningful use.
Author: Denise R. Eccles, PhD, ED, RN
Advance Nursing Institute INC is approved as a provider for continuing education by Florida Board of Nursing.
Provider # 50-16977 Copyright © 2013 Advance Nursing Institute INC. 11
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Author: Denise R. Eccles, PhD, ED, RN
Advance Nursing Institute INC is approved as a provider for continuing education by Florida Board of Nursing.
Provider # 50-16977 Copyright © 2013 Advance Nursing Institute INC. 12
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Author: Denise R. Eccles, PhD, ED, RN
Advance Nursing Institute INC is approved as a provider for continuing education by Florida Board of Nursing.
Provider # 50-16977 Copyright © 2013 Advance Nursing Institute INC. 13
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