The National Coordinator For Health Information And Technology

Health information management, also known as HIM, has been acknowledged as an allied health profession since 1928. HIM is a profession dedicated to the effective management of patient information and healthcare data needed to deliver quality treatment and care to the public. The original objective was to elevate the standards of clinical recordkeeping in hospitals, dispensaries, and other healthcare facilities (Sayles, 2014). Today HIM is known as the American Health Information Management Association or AHIMA. It still holds similar underlying purposes: to ensure the quality, confidentiality, and availability of health information across diverse organizations, settings, and disciplines (Sayles, 2014). HIM plays a critical role in the successful implementation of electronic health records and ensures that providers, healthcare organizations, and patients have access to the right health information when and where it is needed while maintaining the highest standards of data integrity, confidentiality, and security. It ensures compliance with legal mandates, but it has proven to be a challenge with the constant change in legislation and regulatory environment. Past surveys suggest that HIM plays some type of importance in accordance to HIPAA privacy and security compliance. In a 2006 AHIMA survey, members were asked about the progress of their organizations’ privacy and security compliance efforts. Margret Amatayakul & Mitch Work discuss those results in a 2007 journal article

Although the EHR is still in a transitional state, this major shift that electronic medical records are taking is bringing many concerns to the table. Two concerns at the top of the list are privacy and standardization issues. In 1996, U.S. Congress enacted a non-for-profit organization called Health Insurance Portability and Accountability Act (HIPAA). This law establishes national standards for privacy and security of health information. HIPAA deals with information standards, data integrity, confidentiality, accessing and handling your medical information. They also were designed to guarantee transferred information be protected from one facility to the next (Meridan, 2007). But even with the HIPAA privacy rules, they too have their shortcomings. HIPAA can’t fully safeguard the limitations of who’s accessible to your information. A short stay at your local

The purpose of this paper is to discuss the electronic health record mandate. Who started it and when? I will discuss the goals of the mandate. I will discussion will how the Affordable Care Act ties into the mandate of Electronic Health Record. It will describe my own facility’s EHR and what steps are been taken to implement it. I will describe the term “meaningful use,” and it will discuss possible threats to patient confidentiality and the what’s being done by my facility to prevent Health Information and Portability Accountability Act or HIPAA violations.

“Go Paperless and Get Paid” is how the Office of the National Coordinator for Health Information Technology (ONC) presents the incentives for electronic health records. The United States Department of Health and Human Services (U.S. Department of HHS) distributed more than $160 billion dollars to “improve and preserve health care, health information technology, community health, and prevention initiatives” (United States Department of Health and Human Services [HHS], 2014e). Likewise, the ONC offers “Health IT Adoption Programs” through the Health Information Technology for Economic and Clinical Health (HITECH) Act, seeking to advance the American health care delivery system and to improve patient care through an unique investment towards health information technology (HHS, 2014d). Additionally, the American Recovery and Reinvestment Act of 2009 allows the Centers for Medicare & Medicaid Services (CMS) to reward eligible hospitals and professionals with monetary incentives as they implement, adopt, or upgrade and demonstrate meaningful use of certified electronic health record (EHR) technology (HHS, 2014b). The Electronic Health Records Improvement Act (H.R. 1331) introduced by the United States House of Representative Diane Black is a bill to further improve the nation’s health care adoption of health information technology.

HIPAA increasingly dominates the nursing landscape. Safeguarding private patient information is not just important. It is becoming more technical with the introduction of Electronic Medical Records (EMR), training on the technology, safeguarding EMR and the complications of outsourcing of EMR management to contractors.

An Electronic Health Record is a computerized form of a patient’s medical chart. These records allow information to be readily available to authorized providers during a patient’s encounter with the healthcare system. These systems do not only contain medical histories, current medications and insurance information, they also track patients’ diagnoses, treatment plans, immunization dates, allergies, radiology images and lab tests/results (source). The fundamental aspect of EHRs is that they are able to share a patient’s information quickly across service lines and even between different healthcare organizations. Information is at the fingertips of lab techs, primary care physicians, pharmacies, clinics, etc. The

The U.S strives for an ethically health care system. There are many examples that prove that the law will fall behind ethics. One example that demonstrates an issue in healthcare that presents legal and ethical considerations is the use of electronic medical records (EMR). EMRs several as several challenges to patient’s privacy, EMR are set to provide data only to those health care provider that

In some cases, the unpreparedness of most physicians to use new technologies, may raise another problem. This would be difficult when attempting to meaningfully use the system properly. A great way to leverage EHR to improve quality is to achieve meaningful use. For example, “the emergence of electronic health records (EHRs) also is complicating organizational efforts to define and disclose information [3].” By implementing and putting EHRs into action, it will benefit providers not just financially but also by reducing medical errors, and increasing the availability of records and data. The 2016 Report to Congress on HIT Progress stated that “many health care providers still face challenges accessing and viewing individuals’ electronic health information for a variety of reasons, including confusion about privacy and security considerations, cumbersome enrollment processes, or complex contracts with technology vendors [6].” Furthermore, meaningful use also elevates in legal issues, such as privacy threats on patients and data breaches. These may happen because electronic documents and electronic use of medical information could get exposed as they get implemented in health care services. In this case, private information of

Bob Brown, PhD, director of Health Informatics at Michigan State University Kalamazoo Center for Medical Studies, reports that HIPAA requirements has not negatively impacted health research at MSU. However, its effect on research has been the need for researchers to obtain written permission from patients. The potential roadblock of HIPAA privacy rules have been mitigated by utilizing waivers signed by

Using EHR software can potentially put your organization at risk if you do not follow privacy protocols to an exacting degree. While paper records also make it easy to violate a patient’s privacy, the convenience and immediacy of electronic records make it easier to violate privacy at an unprecedented level.(The pros and cons of EMR, 2015).

Only authorized personnel has access to the clinical data captured in medical records which include health care providers, insurers, government agencies, claims processors, and patients. Since the Electronic Medical Record (EMR) archives, disseminates, and analyzes health related information, the patient’s protected data includes demographic, financial, or any clinical data that might potentially identify the patient. To comply with HIPAA regulations, the medical record software used by outpatient clinics should include safety settings such as access logs, audit trails, password protection, and message encryption to avoid any intruder.

“An electronic health record (EHR) is a digital version of a patient’s paper chart. EHRs are real-time, patient-centered records that make information available instantly and securely to authorized users.” (healthit.gov) The EHR mandate was created “to share information with other health care providers and organizations – such as laboratories, specialists, medical imaging facilities, pharmacies, emergency facilities, and school and workplace clinics – so they contain information from all clinicians involved in a patient’s care.” ("Providers & Professionals | HealthIT.gov", n.d., p. 1) The process has proved to be quite challenging for providers. As an

Since the creation of EHR, ethical dilemmas take a rise. Unauthorized disclosure is when a patient’s PHI is released to someone that is not authorized by the patient. Sometimes it can be an accident such as an email or phone call. Because of EHR, it is common to have breaches of privacy such as having a security breach or a decrypting a EHR program by stealing the laptop. Events as such violate ethical principles and show no integrity. Integrity assures that the data is accurate and has not been changed. Security breaches threaten patient privacy when confidential health information is made available to others without the individual's consent or authorization.

The Electronic Medical Records (EMR) is a secure source of information that give clinicians real-time access to a variety of patient health information, such as patient history, billing or insurance data, allergies, immunizations, medications, orders, laboratory tests, diagnostic results, and images. Such technology has enormous potential to enhance the efficiency and effectiveness of health care through decreased medical errors, increased preventative care and enhanced detection and treatment (Fiato, K. A., 2012).

As healthcare changes to incorporate the use of many different information technologies to make delivering care easier and more efficient for patients as well as the healthcare team, the implementations of electronic medical records and electronic health care records have been the choice for many healthcare systems. An electronic medical record (EMR) is a digital version of a paper chart that contains all of a patient’s medical history from one practice. An EMR is