Medical Informatics: The American Recovery and Reinvestment Act, HITECH, and The Health Information Technology Decade Chapter 2

Medical Informatics Medical informatics has many definitions. The common emphasis in all definitions is on the use of technology to organize information in health care.

Medical Informatics Medical Informatics focuses on using computers to organize information to:  Improve diagnostic images and image- guided and minimally invasive surgery  Develop simulations; develop low-cost diagnostic tests

Medical Informatics Medical Informatics also focuses on using computers to organize information to:  Treat physical handicaps  Provide consumers with information  Coordinate international medical reporting

Medical Informatics Medical Informatics also focuses on using computers to organize information to:  Develop and improve information systems  Develop decision-support systems

Medical Informatics Subspecialties include:  Bioinformatics  Dental informatics  Nursing informatics  Public health informatics

American Recovery and Reinvestment Act (ARRA) Included billions of dollars for the expansion of health information technology Offered monetary incentives through Medicare and Medicaid to doctors and hospitals to adopt EHRs

ONCHIT Office of the National Coordinator of Health Information Technology (ONCHIT) established in 2004

ONCHIT Its mission is to “provide leadership for the development and nationwide implementation of an interoperable health information technology infrastructure to improve the quality and efficiency of health care and the ability of consumers to manage their care and safety.” Funded by ARRA

ONCHIT ONCHIT has the task of overseeing the adoption and meaningful use of EHRs, setting standards, and judging the impact. The goal is the universal use of EHRs by 2014 along with the establishment of a national health information technology infrastructure.

Figure 2.1 Timeline for adoption of electronic health record (EHR). Source: © The Northwest Regional Telehealth Resource Center,

Use of EHR in % of doctor's offices 15% of hospitals

Health Information for Economic and Clinical Health Act (HITECH) HITECH seeks to improve American health care delivery and patient care through an unprecedented investment in health information technology.

Health Information for Economic and Clinical Health Act (HITECH) Provisions are designed to:  Work together to provide the necessary assistance and technical support to providers  Enable coordination and alignment within and among states

Health Information for Economic and Clinical Health Act (HITECH) Provisions are designed to:  Establish connectivity to the public health community in case of emergencies  Assure the workforce is properly trained and equipped to be meaningful users of EHRs

Health Information Technology (HIT) Two Years Later: The Impact of the Recovery Act, hhs.gov 2011  The funding levels below for improving and Preserving Health Care, Health IT, and Children and Community Services are actuarial estimates as of January 2011

Figure 2.2 Funding levels for health information technology (HIT). Source: Courtesy of U.S. Department of Health and Human Services,

Health Insurance Portability and Accountability (HIPAA) HIPAA was passed by the U.S. Congress and signed into law in 1996  Its goals are: To make health insurance portable from one job to another To secure the privacy of medical records HITECH extends the privacy rule and increases the penalties for violating it.

Patient Information Form Includes:  Personal data  Medical information  Insurance information

Paper Medical Record The traditional patient record was on paper stored in one doctor's office.  Problems Paper medical records may be illegible, which can lead to serious errors in diagnosis, treatment, and billing. There is only one copy of a paper medical record, leading to difficulty in sharing patient information.

Electronic Medical Record (EMR) Encouraged by HIPAA and the federal government, the electronic medical record (EMR) is very slowly replacing the paper record. The EMR is a record of a patient at one health care facility; it belongs to the facility.

Electronic Health Record (EHR) The information on a patient's EMR will form the basis of the electronic health record (EHR). The EHR is an electronic record of patient health information.  Generated by one or more encounters in any care delivery setting.  Includes information from all the health care providers and institutions that give care to the patient.

Electronic Health Record Ideally the EHR is not the property of any one institution or practitioner. Eventually, it must be interoperable nationally and internationally.

Figure 2.3 Electronic health record. Source: Courtesy of U.S. Department of Veterans Affairs,

Meaningful Use of EHRs Meaningful use of electronic health records is defined by ONCHIT. It refers to meeting a required fifteen criteria, and meeting 5 out of 10 other criteria.  Patient demographics, vital signs, up-to- date problem lists, active medication lists, and active medication allergy lists are among the required 15 criteria.

Meaningful Use of EHRs These certification criteria were developed by the Secretary of Health and Human Services. The meaningful use criteria may be adopted over a five-year period.

Figure 2.4a An office visit: MEDCIN electronic health record (EHR) meeting the criteria for meaningful use. Source: Courtesy of MEDCIN

Figure 2.4b An office visit: MEDCIN electronic health record (EHR) meeting the criteria for meaningful use. Source: Courtesy of MEDCIN

Figure 2.4c Office visit, symptom list. Source: Courtesy of MEDCIN

Figure 2.4d Form for recording vital signs. Source: Courtesy of MEDCIN

Figure 2.4e Diagnosis list. Source: Courtesy of MEDCIN

Figure 2.4f Printed encounter note. Source: Courtesy of MEDCIN

National Health Information Nework (NHIN) To be effective in improving care, EHRs have to be fully interoperable (have to be able to communicate with each other) nationally. Regional cooperation is being fostered through the establishment of regional health information organizations (RHIOs) in which data could be shared within a region.

National Health Information (NHIN) The national health information network (NHIN) is the infrastructure that would allow communication between RHIOs.

Computer Information Systems in Health Care Computerized information systems are used in some hospitals and other health care facilities  Help manage information  Organize relevant information

Computer Information Systems in Health Care To receive the full benefits of computer technology:  Each of these separate information systems needs to be linked under the hospital information system.

Figure 2.5 Picture archiving and communication system (PACS). Source: Courtesy of Carestream.

Hospital Information Systems Hospital information systems (HIS) should include:  Clinical information systems  Financial information systems  Laboratory information systems  Nursing information systems

Hospital Information Systems Hospital information systems (HIS) should include:  Pharmacy information systems  Picture archiving communication systems  Radiology information systems

Does Computerization Improve Patient Outcomes? Not enough providers are using the EHR to see the full benefit of computerization. An editorial in Health Affairs asserted that more testing is needed.

Does Computerization Improve Patient Outcomes? In 2011 the Institute of Medicine (IOM) announced that it would be conducting a one-year study to “ensur[e] that health information technology (HIT) will achieve its full potential for improving patient safety.”

The Introduction of Computer Systems Studies that do exist suggest that the most successful systems are created with the participation of those who will use them. Systems imposed from above are not as readily accepted.