5. What are the Goals for
Electronic Records? Con’t.
Moreover, the security requirements of HIPAA are
essential minimum standards to ensure that electronic
records will be safeguarded, from the technical
standpoint. In fact, with adequate system design and
maintenance, electronic records will be more secure
and available than paper. Also, a lost or destroyed
paper record cannot be re-created, while backups
permit electronic records to be retrieved.
The HIPAA privacy requirements are essential to gain
professional and public trust in the electronic record.
Electronic records will be safer from casual access
than paper records, and evolving technology will
reduce the security burden on providers to
authenticate their identity for access.
8. How do Nursing Facilities fit
into the Electronic Record
Initiatives?
Nursing facilities will be significant beneficiaries of
electronic record development if the unique
characteristics and needs of the facilities are considered
in the development of record systems. The nature of
information needs in nursing facilities differs from those
in acute settings:
• Nursing facilities need extensive histories and
descriptive information with a relatively small amount of
treatment information and provider communication
• Acute setting –oriented systems are focused more on
diagnosis and treatment and fast, accurate
communication of orders and results.
9. How do Nursing Facilities fit
into the Electronic Record
Initiatives? Con’t.
Nursing facilities trying to implement acute hospital-
oriented systems have encountered limitations because
of the larger records and longer lengths of stays at the
nursing facility. While most standards work to date has
focused on the acute-care and ambulatory environments,
the interests of long-term care facilities are represented
on associated task forces.
Actually, the new data-management technologies being
applied by CMS, IT vendors, and standards organizations
have the potential flexibility to accommodate the needs
of all providers. Long-term care’s MDS 2.0 record was an
example of standardization using the technology
available at the time it was specified: fixed field
10. How do Nursing Facilities fit
into the Electronic Record
Initiatives? Con’t.
position records. For the upcoming MDS 3.0, CMS has
committed to using XML technology to make system
changes easier for providers to accomplish and
maintain, and vendors will do well to make the same
commitment. Also, future versions of the MDS will have
to meet the promulgated HIPAA data standards, a task
made easier by using XML technology.
Once electronic records are accepted in nursing
facilities, claims will be easier to compile and backup
documentation will be more readily accessible.
Wholesale copying of clinical records will be replaced
with an electronic transmission.
16. What Issues need to be
addressed? Con’t.
structures, and processing flow are closely guarded
proprietary property.
Professional acceptance of electronic systems has been
problematic for all but the most adventuresome or
technological sophisticated clinicians. Several large
systems for computerized physician order entry have
failed recently because physicians reject them as too
cumbersome to use. New approaches to system
interfaces must be explored. Methods to facilitate the
drafting of content, signing the content (authenticating),
and correcting errors will have to developed and
certified.
Public acceptance also must be considered. Patients
17. What Issues need to be
addressed? Con’t.
are unhappy if they perceive their clinician spending more
time at the keyboard than listening to them! Assurances of
the privacy of their information will continue to be
necessary, as well.
Before facilities can entrust their clinical information to
electronic systems, methodology must be developed to
certify the trustworthiness of such systems. Questions of
liability will have to be addressed – e.g., who is
responsible if a resident is harmed by a system failure?
Furthermore, the system standards being developed must
be implemented by vendors and then certified by an
outside agency. Currently, only the HIPAA Transaction
and Code Sets standard has a certification mechanism.
18. What Issues need to be
addressed? Con’t.
Cost will also be a factor. Current budgets in nursing
facilities devote less than 2% of operating costs to
information technology, while the hospital sector spends
about 5%, and other service industries much more.
Lawmakers have proposed various approaches to
increasing the use of technology and anticipating
significant reduction of medical errors and other
savings. However, the savings claimed will not
necessarily go to the facility making the investment –
insurance companies and fiscal agents experience the
most financial benefit from some systems. Nursing
facilities can expect to benefit from the use of electronic
records through increased efficiency, reduced claim
rejections, improved documentation, and more
20. What can Nursing Facilities do
now?
Nursing facilities will inevitably become a part of the
evolving national system of electronic records. President
Bush has appointed a health information technology
“czar” (David Brailer, MD, PhD) with the mission of
developing a strategic plan to upgrade use of healthcare
information technology and announced a deadline of ten
years for an all-electronic healthcare system; DHHS
confirmed this mission.
Meanwhile, facility managers and information specialists
can participate in local initiatives involving information
systems, such as collaborations among hospitals,
nursing facilities, and physician offices.
When shopping for replacement systems, consider,
25. The Strategy
Goal #1:
Inform Clinical Practices
Informing clinical practice is fundamental to improving care
and making health care delivery more efficient. This goal
centers largely around efforts to bring EHRs (electronic
health records) directly into clinical practice. This will reduce
medical errors and duplicate work, and enable clinicians to
focus their efforts more directly on improved patient care.
Three strategies for realizing this goal are:
Strategy 1: Incentive EHR adoption
The transition to safe, more consumer-friendly and regionally
integrated care delivery will require shared investments in
information tools and changes to current
29. The Strategy – Con’t
For PA/LTC facilities to benefit, their clinical systems will
have to become interoperable with physician-order
systems and hospital systems. The reduction in medical
errors will accrue when current orders are available for
residents transferred in and new physician orders are
available from physicians’ order-entry systems. Mutually
recognized standards for data representation and
communication are the keys to success.
The three strategies for realizing this goal are:
Strategy 1: Foster regional collaborations
Local oversight of health information exchange that reflects
the needs and goals of a population should be developed.
Local health information networks can begin to be
33. The Strategy – Con’t
Consumer-centric information helps individuals manage their
own wellness and assists with their personal health care
decisions. The ability to personalize care is a critical
component of using health care information in a meaningful
manner. The three strategies for realizing this goal are:
Strategy 1: Encourage use of Personal Health Records
(PHRs)
Consumers are increasingly seeking information about their
care as a means of getting better control over their health care
experience, and PHRs that provide customized facts and
guidance to them are needed.
PA/LTC settings would be great proving grounds for
PHRs since residents/clients tend to be recurrent and
eventually long term. Communications among the
35. The Strategy – Con’t
The use of Telehealth remote Communication Technologies
can provide access to health services for consumers and
clinicians in rural and underserved areas. Telehealth systems
that can support the delivery of health care services when the
participants are in different locations are needed.
PA/LTC would also be excellent proving grounds for
these technologies. Reducing the burden on residents
traveling to physician offices when remote access could
adequately serve them will reduce costs and improve
care. Emergency care will be better coordinated. And
staff will be less likely to err in not contacting physicians
on questionable issues.
Goal #4:
Improve Population Health
52. Heartbeat Clinical
Its Time Has Come! Cont.
The potential advantages of open source software in health
care are many. One of these is that it ensures correct and
timely implementation of standards. The creation of
technology standards that define how information is
structured, defined, and exchanged is critical because
successful health care information exchange depends on
them.
The mandate for Health Level 7 (HL7) in electronic medical
records has enabled different computer systems to work in a
compatible environment. Open source software is truly
compatible with HL7 for electronic medical record systems.
Open source software generally supports standards whenever
and wherever they are relevant.