Case Study Patient Referral

Over the past few years, we have notice a significant change in the workflow of a healthcare organization. This change is caused by the technological advancements of Health Information Technology (HIT). One of the many technological advancements of HIT is the Electronic Health Record (EHR). Electronic health records are a patient’s paper chart in a digital format. It always contains real time information and can be easily accessible. With EHR put into act, it has the ability to electronically view and share a patient’s medical history, past and current medications, immunization dates, any diagnoses or allergies, as well as testing and lab reports. It is also used to document and store data, in addition with many more abilities. It is important to understand the purpose, application, challenges, and advantages of an electronic heath record. In order to get a greater understanding of its use, we will use a private family medicine practice as the foundation for implementing the EHR.

To achieve Stage 1 meaningful use of an EHR, providers must meet 15 core objectives and 5 objectives out of 10 from the menu set objectives. Providers must track the 3 required core Clinical Quality Measures (CQMs) on patients and identify at least 3 additional CQMs from the set of 38 CQMs on patients. Stage 2 requirements consist of continuations of stage 1 requirements, with heightened demands for the number of electronic transactions. Stage 2 impacts nursing, brings greater emphasis on disease management, clinical decision support, transition of care, documentation of care plans and patient access to health information (Guterl, 2012). Stage 3 is likely to follow the same format as its predecessors, with a divide between core (mandatory) and menu

In addition to the core elements, providers will have to choose any five of the ten additional tasks to implement in 2011-2012. Some examples of these might be clinical lab results, patient appointment reminders and drug-formulary checks. This gives the providers a chance to choose their own path toward full EHR implementation and meaningful use. Legislation ties payments to the achievement of advances in health care processes and outcomes. The regulations are specific as to when providers will have to use particular functions in order to be considered meaningful users. The meaningful use rule acknowledges the urgency of adopting the electronic health record and recognizes the challenges it will pose on all providers.

Electronic Health Records (EHR) are changing the way health care is delivered to patients, not just how patient medical information is stored. In the recent past, patient-doctor visits consisted of handwritten multiple medical forms to be completed, and most times duplicated. There were several areas of concern with past patient record keeping, omission of important care information, medical interventions and prescribed medication were missed in certain cases, erroneously prescribed or duplicated and records were lost or misplaced. EHR facilities and improves the quality of care by refining access to patient record by multiple health care providers and the patient; better decision support; reporting occurs in real time and is legible which

The Agency for Healthcare Research and Quality (AHRQ) had developed the “Use of Dense Display of Data and Information Design Principles in Primary Care Health Care Information Technology Systems (Virginia)” project, which identified the electronic health records utilization. Key recommendations is to improve the lack of standardized practices, development of process, and share information freely. These reports include core establishments in the EHR aspect in a hospital environment. The development of criteria through these practices, explore the operation of EHRs are crucial. Plus, some basic steps in utilizing IT systems would be to deliver safe, effective, and efficient care.

Health Information Exchange is the electronic movement of healthcare information amongst organizations according to the national standards. HIE as it is widely known, serves the purpose of providing a safe, timely, and efficient way of accessing or retrieving patient clinical data. Health Information Exchange allows for doctors, nurses, pharmacists, and other vital healthcare professionals to have appropriate access and securely share vital medical information regarding patient care. Health Information Exchange has been in efforts of developing for over 20 years in the United States. In 1990 the Community Health Management Information Systems (CHMIS) program was formed by the Hartford Foundation to foster a development of a centralized data repository in seven different geographically defined communities. Many of the communities struggled in securing a cost-effective technology with interoperable data sources and gaining political support. In the mid-1990s a similar initiative began known as the Community Health Information Networks (CHINs) with the intention of sharing data between providers in a more cost-effective manner. In 2004, the Agency for Healthcare Quality and Research Health Information Technology Portfolio was funded $166 million in grants and contracts to improve the quality and safety to support more patient-centered care. This was the beginning of the progress we have seen in HIE today. Health Information Exchange devolvement serves the purpose of improving

The preferred format for clinical health information is Health Level Seven (HL7) Clinical Document Architecture (CDA) for both Personal Health Record (PHR) and Electronic Medical Record (EMR). It is XML-based format identifies the encoding, configuration, and semantics of a clinical file. Blue Button+ Direct implementation ensure ease of transmission of medical records to a third party by the health care provider or patient. Direct uses SMTP, S/MIME, and X.509 licenses to maintain security, data reliability, privacy and verification of sender and receiver. Additionally, it meets the requirements for Meaningful Use (MU) Stage 2 of View, Download, and Transmit (VDT) that is required for certified EMR/EHR (Graham-Jones & Panchadsaram, 2013).

In addition, the electronic healthcare record is “designed to facilitate the sharing of data across the continuum of care, across healthcare delivery organizations, across time and across geographical areas. The EHR typically contains information such as existing health conditions, physician visits, hospitalizations, test results, and prescribed drugs." (BMC Medicine) This means that not only has it made it easier for healthcare providers to access and document patient 's data, it has actually become a tool which is universally used.

Healthcare organizations (HCOs) are implementing patient portals and beginning to allow the patient access to pieces of their record online through web portals. This is a step toward actually implementing an electronic health record (EHR). According to Garets and Davis (2006), an EHR is actually a subset of an electronic medical record (EMR) and is actually an interactive piece that allows the patient to add and correct data in their personal EHR over time. Data is shared with the regional health information organization (RHIO) or the national health information network (NHIN) via summary documents like the continuity of care record (CCR) or continuity of care document (CCD). In order for the patient to have the ability to share this data

The answer to collecting patient health information and having it available throughout the network of facilities is ultimately the Electronic Health Record (EHR). Without the EHR, the MCO is still a combination of different facilities that try their best to achieve efficient communication ibn real time. The HITECH Act, a component of the American Recovery and Reinvestment Act of 2009, was signed into law to provide incentives to physician’s practices and other health care organizations for the implementation of EHR. The benefits of EHR include better health care by improving all aspects of patient care, including safety, effectiveness, patient-centeredness, communication, education, timeliness, efficiency, and

Next, stage 2 consist of seventeen core criteria and six specified core objectives of which three must be picked to be reported on by an eligible provider (Wright et al., 2013). Likewise, hospitals must meet sixteen core objectives and three of six menu objectives in order to demonstrate meaningful use under the stage 2 objectives. Additionally, this stage implemented two new core objectives that must be utilized by the provider which include, the use of protected electronic messaging to communicate pertinent health information to patients and, the tracking of medication through utilization of electronic medication administration by way of assistive technological devices. As a result of implementing the two new criteria, positive patient outcomes and safety will be achieved. This stage focuses on the clinicians exchange of medical information, and enhanced care management of patients. At this stage patients are given the ability to retrieve and fill out their medical information from home and submit it to the provider within an allotted time frame. Stage 2 is a program that is geared more toward nurses and their ability to achieve better patient outcomes with the use of evidence-based practice.

Following the initial literature search and subsequent refinement processes, three tools were identified to bear relevance to our setting. The Primary Care Assessment Tool (PCAT) was developed in Baltimore, America by Johns Hopkins University, and was created for implementation in qualitative studies. The PCAT is indicated for use in obtaining reports on first-contact accessibility, relational continuity, and coordination continuity. These terms feed insight into the self-reported ability of patients to obtain prompt care for sudden illness, their ability and likelihood of maintaining an ongoing relationship with the same healthcare staff, and mediation and coordination between their specialist and their physician, respectively.

The United States is entering a new generation of healthcare, requiring providers to use electronic health records to improve the new technology that have grow to a better use. The electronic health care replace all kind of information of medical records writing down on paper. Back in 2003 the (IOM) Institute of medicine create the use of EHR and stablish the eight core functions requirements to improve some issues. The quality care, feasibility, chronic disease management, and efficiency was needed to change for patients care.

The EHR and/or PHR and HL7 are needed tools that help to improve patient care and safety. EHRs and PHRs help healthcare providers in the exchanging and collecting of patient data. Both record types also exchange health data between various healthcare settings (ambulatory, long term, etc.), providers, patients, and other organizations. When records work in conjunction with HL7 standards the exchange of information is consistent and widespread. In the final rule of “meaningful use” stage 2 the use of HL7 in records helped to improve patient summaries, clinical messaging, electronic prescribing, and transportation details. HL7 allows all EHRs and PHRs the ability to communicate not on just a locally but on a global scale which will in turn provide

Simply stated, the way in which healthcare defines the meaningful use of Electronic Health Records (EHRs) is the improvement of safety, quality, and efficiency of care (Blumenthal & Tavenner, 2010). In order to achieve such broad goals, meaningful use has been divided into three stages over nearly a decade. Currently, the healthcare industry has reached the third and final stage of meaningful use, which aims to simplify the EHR programs and drive interoperability amongst the different EHRs (Athenahealth, 2018). Implementation of the infrastructure should be complete and healthcare providers are expected to begin linking their networks with other networks.