In July 2010, the U.S. Department of Health and Human Services issued their long-anticipated rules governing "meaningful use" of electronic medical record (EMR) systems. These updated rules (compared to the old rules) will make it easier for healthcare providers to tap into $27 billion in federal incentives. To qualify, physicians and hospitals must be able to prove "meaningful use" of EMR technology, but it wasn't clear until now exactly what that meant.

The old EMR criteria that were released in January 2010 specified 25 different items that providers would have been required to meet. That proposal was met with much criticism. It was said that these requirements were too stringent and that it would prevent most healthcare providers from being able to meet these criteria. To illustrate this point, a 2010 survey of chief information officers from various healthcare facilities revealed that the majority of these individuals doubted their organization would be able to meet the proposed criteria.¹

The new criteria has lowered the bar of eligibility for the stimulus monies, in that the finalized rules require that physicians and hospitals now only meet 15 base requirements, and choose five more from a menu of 10 options. By having physicians and their healthcare facilities meet these base requirements, they will in essence, be performing the basic functions that enable EMRs to support improved healthcare throughout the United States. For example, one of the base criteria allows for the entry of basic patient data such as vital signs, demographics, currently prescribed medications, history of allergies, smoking status, and an up-to-date problem list of current medical issues. Another base criterion will be to allow for better clinical decision making, all the while preventing critical errors. This will help to improve the safety, quality and efficiency of care. The additional menu of 10 items allows for data to be incorporated into the health record, which is essential for patient care. These include the ability for the electronic system to perform drug-formulary checks, provide clinical laboratory results and reminders to patients for follow-up or wellness care, identify and provide patient-specific health education resources and support the transition for patients between care settings.²

Here is a summary of criteria and additional criteria that healthcare professionals and facilities must meet to qualify for meaningful use. This summary should be used for reference only. It is not meant to be a comprehensive source of information for healthcare providers and their facilities as a means to comply with meaningful use in order to receive financial incentives from the Centers for Medicare and Medicaid Services. The full criteria can be found at http://www.cms.gov/ .

EMRs will allow electronic prescribing of medications, provide clinical reminders for the health screening and immunizations that patients need, and provide direct links to online resources for physicians to help solve medical problems. In addition to physicians, patients will also be able to see this confidential information on their own computer.

A highlight of EMR is to enviably allow physicians everywhere and anywhere to use the Internet to access the patient's medical information (with their permission). "Why," you ask is this so revolutionary? This unprecedented access will help physicians be privy to a patients' up-to-date medical history and an accurate medication list via electronic health records and electronic health information exchange. When patients need to see a doctor, have an emergency while traveling or are referred to another clinic or hospital, physicians will now have easy access to the clinic and hospital records, including all registration information and insurance. The plan is to have the electronic health record available to any clinic or hospital. For example, let's pretend that you are a New York native on vacation, taking a hike in the pristine Rocky Mountains. If you accidentally trip and fall 20 feet down a rocky cliff and suffer an open fracture of your leg, the local emergency room will know how to best treat you based on your electronic clinical record. There will be no mistake in giving you intravenous penicillin when your electronic medical record warns of an allergy to this type of medication. The list of efficiencies and health benefits goes on and on.

Rural hospitals, local community hospitals and group practices will have the same electronic health information available to them as teaching hospitals and big-city practices. Unimaginable in the past, a rural or local community hospital, through the use of EMRs, will now be able to transmit X-rays, and exchange critical information to other healthcare providers to enhance the quality of care. 

But what about a patients' privacy? What about the security of the electronic system? Do not worry. EMRs will give a patient the right to determine who has access to their record. Further, an audit trail is automatically generated each time a record is opened so at a patient's request, they can see who viewed their record and when this was done. Strict authorization rules will be in place for those with permission to view a record. Because this is not possible with our current paper records, the health record is now more secure and safeguarded than ever before. Electronic records will not travel over the regular Internet, but rather over a highly encrypted electronic highway. There will be no central repository of all the records in the state. The records will be electronically stored where they were generated. Multiple state-of-the-art mechanisms will be in place to maintain the privacy and security of the information. It is important to note that potential breaches of the system are of the greatest concern for both patients and clinicians, so this issue has received painstaking attention from those who are building the systems.

Patients' healthcare records and the way we have been exchanging health information has not changed since the days of surgery being performed by the barber/surgeon. All the pieces for EMR and health information exchange are being worked on and are happening right now. So it's good news that we've come into the new EMR electronic healthcare age. Patients will be safer and better cared for than ever before.

References
1. Pricewaterhouse Coopers' Health Research Institute.  (2010, June).  "Ready or not: On the road to the meaningful use of EHRs and health IT.  The Business Implications of Health Reform Series."  http://pwchealth.com/cgi-local/hregister.cgi?link=reg/Ready-or-not-On-the-road-to-meaningful-use-of-EHRs-and-health-IT.pdf

2. Centers for Medicare and Medicaid Services.  (2010, July).  "Comparison of Meaningful Use Objectives Between the Proposed Rule to the Final Rule (Released July 13, 2010), EHR Incentive Program."  http://www.cms.gov/EHRIncentivePrograms/Downloads/NPRM_vs_FR_Table_Comparison_Final.pdf

Steven Deitch is director, Medical Informatics, Inteck Inc.