EHRs are known as ‘Electronic Health Records’ and EMRs are
known as ‘Electronic Medical Records’. EMRs are electronic documents that are
in a doctor’s office and they show the history of when the patient came for
medical treatment. They also help track patient data over certain periods of
time and are able to determine which patients need a checkup or any screenings
to prevent further illness in a particular area. EHRs are also able to do the
same thing as EMRs but have more benefits. The patient is able to look at his
or her personal health record and is able to see notes from the doctor on
follow-up care. The patient is more involved with his or her health with EHRs.
They contain information from all physicians who have seen that patient rather
than just one physician that was visited.
The ONC is known as the ‘Office of the National Coordinator
for Health Information Technology’. It was founded during the Bush era in 2004
in order to provide a national IT infrastructure (Rouse 2017). The ONC’s
purpose is to reduce costs and improve the patient’s healthcare quality, allow
for electronic health records to be confidential and secure, and be on the
lookout for early onsets of diseases in order to better coordinate hospital
visits with the patient. The ONC has set certification criteria for EHRs. These
criteria must be met in order to be used by healthcare providers. They are
approved by the Secretary of Health and Human Services (Practice Fusion 2015). The
EHR technology then becomes ‘Certified EHR Technology’, or CEHRT. It provides reassurance
among healthcare providers and patients that the EHR technology functions
properly (Practice Fusion 2015). Health data is very critical and needs to be
handled securely, so the technology it runs on must meet security and
The concept of Meaningful Use was introduced in 2009 by the
United States government. Its purpose is to promote the use of electronic
records (AthenaHealth 2017). Healthcare providers must show that they are “meaningfully
using” their EHRs in order to be qualified for incentive payments. This would
also show that there is a positive impact that EHRs have on patients. According
to HealthIT.gov, meaningful use should have these outcomes: better clinical
results, individuals who are empowered, more integral research data on health systems
and improved public health outcomes (HealthIT 2015). There are different stages
in which meaningful use is implemented. In the first stage, the criteria are
focused on getting patient data electronically, use that information to better
coordinate care with patients and their families and be on the lookout for any
conditions that may occur (HealthIT 2013). The second stage involves having
more health information exchange, having electronic prescriptions and sending
patient information electronically across different settings (HealthIT 2013).
The third stage involves improving the health of the population, having
patients access tools to better track their health and being able to make
decisions on conditions that have a high priority (HealthIT 2013). Overall, the
first stage involves obtaining data electronically, the second stage involves
having clinical processes be advanced and the third stage is to improve health
Patients should be the aggregation point for all their
health data since their data is derived from their gender, age, height, family
medical history, allergies, diet, pre-existing conditions and the environment
in which they live in. With all of this information, research can be done to
see how some, or even many, of these factors play a key role in leading to
illnesses such as heart disease, which is the number one killer not just in the
United States, but in the world. There are many factors that play into this
such as lack of physical exercise, diet and old age. When health data is
aggregated, it can then come up with a predictive model on whether or not a
patient has a high chance of getting heart disease or any other illness.
Patients should be the pivotal point when it comes to data aggregation. Their
information drives what medications they need to be prescribed and how they
should be treated for any illnesses that they may have. EHRs are derived from
patient data as well as doctor’s notes or tips that the patient can read on a
personal device. This will lead to better outcomes and more patient
satisfaction with his or her healthcare.
There are many challenges that PHRs face. One challenge is
that there are privacy concerns regarding personal health records. If the data
is used outside the healthcare provider’s institution or even leaked, this
would cause a loss of data integrity and the patients would not be comfortable
providing their information to certain healthcare providers. If any patient
data was leaked, this would lead to lawsuits and due to data negligence, which
would then result in a loss of finances among those healthcare providers. Another
challenge is determining which information is relevant to show the patient. Patients
and physicians may disagree on what information is important and what is not,
so the question here lies whether or not patients should decide what
information they want to see and if patients could add their own data into the
PHR and review it with their physician (Beard et al., 2011). Another challenge
is the terminology used in PHRs, because patients may not understand what many
of the medical terms mean. Medical professionals would need to describe
conditions and treatments in laments terms. Another challenge of PHRs is who
controls the data, whether it be the healthcare provider or the patient. 41% of
physicians say that patients should have control on what the new physician sees
in his or her record, while 54% of patients agree with this (Beard et al., 2011).
It comes down to whether there should be shared custodianship with the patient’s
health records (Beard et al., 2011).
The Blue Button on FHIR Project was made in 2010 and was a
partnership between the Veteran’s Administration and the Centers for Medicare
and Medicaid Services (CMS 2017). It provides an API that allows many
beneficiaries to have their Medicare claims connected to trusted research
programs, services and applications (CMS 2017). The idea was formulated to
allow veterans and others on Medicare to download their personal health
information since it was hard for them to get access to private medical
records. It made the process of seeing and carrying medical records more
effective. The patients would only need to download their health records by
clicking a blue button that would download their information in a text file.
Interoperability allows for the exchange of electronic information
between computer systems while meaningful use is to promote the widespread use
of electronic records. There is a relationship in the interoperability of
information exchange along with meaningful use. When a patient’s EHR is sent to
another hospital in a different region, state, or country, it allows for that
data to be interoperable since it can be transferred from one place to another.
It is meaningful since it contains data that is prevalent to the patient’s
overall health as well as promoting information exchange. The level of
interoperability within an organization can determine how its’ meaningful use
compliance and incentives are achieved (Oracle 2010). Interoperability has been
involving with each stage of meaningful use, which is allowing for physicians
to gain more accurate and useful patient data when they receive their records
from another provider (Oracle 2010).
The Health Information Exchange (HIE) allows for healthcare
providers, such as doctors and nurses, to share and access a patient’s medical
information through electronic means (HealthIT 2014). This helps to avoid any
errors that can occur such as prescribing the wrong medications or even testing
for the same condition twice. It allows healthcare providers as well as
patients to save money when information is stored and shared electronically.
Privacy plays a major role in the Health Information Exchange. There are
regulations by HIPAA which state that there should be privacy regulations
enforced in both electronic and paper documents of patient data (PrivacyRights
2017). HIE must notify the patient on how his or her information will be used
when it is exchanged with another entity. In HIPAA, the security regulations
only apply to records that are electronically sent (PrivacyRights 2017).
Security regulations are also set in place when information is exchanged. The
patient information is encrypted that way it does not fall into the wrong
individuals and only those authorized to see that patient’s information would
be able to see it (PrivacyRights 2017). Therefore, security in HIE ensures that
someone’s medical information would only be seen by those who are authorized to
see it and the patient would be told who has access to see his or her records.
Trust also plays a key role in HIE. When patients are aware of the parties that
have access to their records, they want to make sure that all parties will not
send their information outside unless told by the patient. When there is no
trust in the HIE, patients would be hesitant to give their information to their
healthcare providers, not knowing how their information may be used.
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