Electronic Records For All Patients Mandated By 2014


Kelly McLendon

Kelly McLendon

BREVARD COUNTY, FLORIDA – Regardless of the politics involved in President Obama’s Economic Stimulus Plan, recent legislation tied to this plan begins a long and complex expansion of foundation principles required for increased adoption and usage of electronic medical records by physicians and patients.

ARRA-wThis new legislation is called ‘The American Recovery and Reinvestment Act’ or ‘ARRA,’ and, while it is a massive piece of legislation reaching across multiple industries, the healthcare components are substantial.

Development and Adoption
Many who have worked in the medical record industry have been waiting for decades to have an increased governmental push towards adoption of electronic record systems. To date, development and adoption of these systems (of which there are many kinds of electronic medical records) has been an industry led initiative that has proceeded with fits and starts. The Act calls for electronic medical records for all patients by 2014.

Although there was development of computer software applications for use by physicians and nurses in the 1980s, widespread efforts by more companies did not commence until after the publication of the Institute of Medicine’s 1991 landmark report in which it was recommended that, for patient safety reasons, all physicians, nurses and patients should utilize electronic medical records.

During the nearly two decades since this report was published there have been dramatic improvements in technology, some electronic record adoption and increased laws protecting health information privacy (called ‘HIPAA’) – but by no means a stampede towards fully electronic medical records with the capability for information exchange between hospitals and physician offices.

It has become obvious that left to the non-mandated path of development it would take decades more to get all healthcare providers utilizing electronic medical records in ways that are beneficial to patient care and that increase the efficiencies garnered by computerized automation over paper based records.

For many years, advocates of more rapid adoption of electronic medical record systems pushed for regulations and funding to provide incentives for the design, development and implementation of automated healthcare records.

By strengthening privacy laws and providing critical funding to physicians and hospitals that will allow them to pay for the expensive new technology, the ARRA has removed some of the barriers to more extensive electronic record adoption

Medical Record Privacy

CURRENTLY THE MOST common types of health information exchanges are typically paper copies of paper medical records.

CURRENTLY THE MOST common types of health information exchanges are typically paper copies of paper medical records.

One of the greatest impediments to widespread adoption of electronic medical records by both physicians and patients has been fears of information breaches and other privacy concerns.

Several years ago, laws called The Health Insurance Portability and Accountability Act (HIPAA) were created to begin to tighten privacy, and are widely used by all healthcare providers to protect patients’ confidential healthcare information. The ARRA broadens privacy protections so that companies like Google and Microsoft can manage and make various forms of medical information more accessible using personal health records (PHR) via the web.

The Act also strengthens patients’ rights by including civil monetary penalties for people who breach medical information and increasing enforcement provisions.  Under provisions of ARRA, patients have the ability to request all incidences where their health information was released, copied or exchanged. These new protections go far to establish a much higher degree of medical record information privacy and security.

Health Information Exchange
To date, there has been very limited automated data exchange between hospitals and physicians outside local hospitals and their medical staffs. In today’s world the most common types of health information exchanges are typically paper copies of paper medical records.

These are inefficient at best and cause needless duplication of services.  For example, one physician simply may not know of a test that was completed on a patient earlier by another provider or that a diagnosis for a particular condition had been made.

The specific systems that will foster and ultimately allow increasingly automated data interchange of electronic medical record information are still very much in their infancy.  However, the foundations of privacy, better defined system requirements and monetary incentives built into ARRA are expected to drive increasing electronic medical record development and medical record data interchange between providers of care over the next few years.

MANY WHO HAVE worked in the medical record industry have been waiting for decades to have an increased governmental push towards adoption of electronic record systems.

MANY WHO HAVE worked in the medical record industry have been waiting for decades to have an increased governmental push towards adoption of electronic record systems.

Incentives For Adoption of Electronic Medical Records
ARRA creates funding mechanisms for incentives to be paid directly to hospitals and physician practices that adopt and have “meaningful use” of electronic medical records by 2014.

Conversely, penalties will begin to be applied in 2015 for providers of care that do not move to these electronic records. The premise is that, over time, electronic records will reduce the cost of medical care and increase the efficiencies of the administrative processes that surround medical information generation and usage.

Because electronic medical record systems cost tens of thousands of dollars for physician practices and millions for hospitals, the funding opportunities and usage mandates in the ARRA complete the circle to induce providers to invest in electronic record systems.

Increased Educational Opportunities
A key part of ARRA is the expansion of grants and other monies that will enhance college level programs that teach Health Information Management  (HIM-management of medical records) and Information Technology – Healthcare Informatics, which covers healthcare computer systems and the data contained within them.

The provisions and mandates in ARRA require a markedly increased pool of trained professionals to design, develop and manage the projected proliferation of automated record systems.  Grants and expanded HIM and Healthcare Informatics educational programs and curriculum are expected to shore up a work force which currently is understaffed relative to the requirements projected for the expansion of future electronic records.

There are currently programs in Medical Records (HIM) and Healthcare Informatics that are for two (A.S.) and four year (B.S.) degrees at institutions like the University of Central Florida, Daytona Beach Community College and St Petersburg College, but there are few Masters degree level and shorter certificate courses. The new Act broadens the opportunities in all of these areas.

Anyone considering a career in healthcare information should investigate these programs.  There are already some scholarships and grants available, and many believe the amount of this education assistance will be dramatically increased with ARRA funding.

Stay tuned for more information on ARRA and its impact in the local community and amongst our healthcare providers as they move towards increasingly automated electronic records for their office and in the hospitals.


DR. GEETHA PRIYANKA, a Melbourne, Florida  internist, and her husband, Naveen Venkatachalam, are ahead of the curve in terms of innovative electronic management of patients’ healthcare information.  CLICK HERE to read the story in Space Coast Medicine & Healthy Living Magazine.

  • D. Kellus Pruitt DDS

    Mandate or not, dentists are choosing to be left behind in the race for interoperable electronic dental records. Why? For one thing, they make no business sense. It is obvious that eDRs only help dental insurance companies. The difference in DDSs and MDs: Dentists bills are miniscule compared to hospital bills. That means we accept cash. Hospitals don’t.

    • http://www.hixperts.com Kelly Mclendon

      ARRA does provide incentive monies for Dentists that will help with the financial equation, but certainly may not mitigate all of the costs. I agree the needs are not as pressing for Dentists from a patient safety perspective, but dental information, especially surgeries are very useful for data exchange and building the entire picture of a patient’s history, allergies, etc. for all providers of care. BTW EHR adoption is voluntary. The administration would like to see adoption by 2015.

    • dr dmd

      Just stumbled upon this a bit late, I can see first hand how any data can be manipulated including signatures in the new versions of most popular dental programs

  • http://www.doctorspartner.com Don W. Lail, Jr.

    Believe it or not, it’s not just dentists who are openly choosing to not jump on board. Over the phone I have talked to a number of practices in Brevard and Broward counties that don’t see EMR in their future. And these are the practices that WILL be affected by the Federal mandates. I can’t imagine the uncertainty that these practices feel when viewing the future of the industry.

    • http://www.hixperts.com Kelly Mclendon

      Uncertainty is in fact well placed, it’s a very complex set of factors to evaluate. But one aspect should be clear, well executed EHR’s promote patient safety and that has to be one of the most important considerations.

  • Kate Gladstone

    How will mandated electronic recordkeeping function in another Katrina-like disaster disabling electric power sources and/or electronics?
    After power is restored — which may take hours, days, weeks, or (as after Katrina) months — medical records personnel will need to read thousands or even millions of pages in the writing of doctors who had to return to handwriting during the emergency.
    Just as emergency medicine means giving care under unexpected conditions, so emergency medicine must continue recordkeeping when electronics fail. To prepare for emergencies when the mandated electronics go down, MDs must learn to write legibly, fast, by hand in emergency situations: because recordkeeping cannot stop when power stops.

    Kate Gladstone
    Handwriting Repair/Handwriting That Works

  • dr dmd

    Absolute rubbish , electronic record keeping is a nightmare, the easiest way to fake or alter data , but then again this isnt about safety or privacy this is about complete government control of our lives and employment of half witted agents without whom this obama administration wouldnt exist

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