Presented by
Lisa Blumenauer,
Christina Corson, and
Deborah Lutz
Introduction
 Electronic Medical Records (EMRs) serve as a foundation for an overall
comprehensive health information technology (IT) system.
 The capabilities that the EMR would incorporate are clinical documentation,
health information, results management, order-entry management, clinical
decision support, electronic communication and connectivity, patient
support, administrative processes, reporting and disease surveillance.
 The physician’s notes can be entered into
standardized formats fostering a more complete
document.
 Images can be captured from computerized picture
archive systems and may be transmitted to
physicians at remote and various locations.
 Computerized physician order entry systems allow
the physicians to order labs, pharmacy and
radiology services electronically, therefore reducing
time for delivery of medical records and orders.
 EMRs may provide physicians with electronic
reminders, alerts to allergies to medications,
contraindications to medication, and access to
protocols and clinical guidelines.
 President George W. Bush called for an EMR for
most citizens by the year 2014 (Korbin and
Quattrone, 2007).
 He established a new office within the U.S.
Department of Health and Human Services – The
Office of the National Coordinator for Health
Information Technology.
 This individual would coordinate and promote
health IT.
 The office identified four goals to guide the
transition of paper medical records and EMRs in
both private and public health offices (Korbin and
Quattrone, 2007).
FourGoals to Guide
the Transition into
EMRs
 The adoption of EMRs for most citizens.
 The development of a secure EMR
network to allow the exchange of health
information among clinicians.
 The use of personal health records among
patients.
 The improvement of public health through
quality measurement and research.
 The implementation of EMRs can improve the quality of
care though the instant retrieval and exchange of medical
information and offers many advantages for coordination
of healthcare.
 EMRs can decrease re-testing (which saves charges),
review results without waiting for release of information
from another source, monitor quality improvement
results, increase patient participation and satisfaction, and
increase accountability form hospitals, providers
employers and payers (Licht, 2004).
 EMRs pose less risk than multiple medical histories in
different locations, all with possibly different information.
 EMRs improve patient care by ensuring that the correct
information is retrievable and legible (Licht, 2004).
 Despite all the potential benefits of the use of health IT,
there are no current estimates of the adoption of health
information technology across the U.S.
 Methods to speed the adoption of EMRs have received support among U.S.
policymakers. The American Recovery and Reinvestment Act of 2009 has made the
promotion of a national, interoperable health information system a priority (Jha, et
al., 2009).
 Health and Human Services (HHS) delivers a Framework for Strategic Action titled
“The Decade of Health Information Technology: Delivering Consumer-centric and
Information-rich Health Care”, which identifies the current physician self-referral
and anti-kickback protections as a significant obstacle and recommended their
alteration suggesting HHS could explore safe harbors or expectations to these laws.
 The U.S. General Accountability Office (GAO) issued a report entitled “HHS’s Efforts
to Promote Health Information Technology and Legal Barriers to Its Adoption,”
stating despite HH’s efforts to implement new information technologies, HHS has
done little to deal with laws that may inhibit the adoption of EMRs (Danello, 2006).
 The Health Insurance Portability and Accountability Act (HIPAA) enacted by the U.S.
Congress in 1996 is massive in scope with five separate Titles. Two of the Titles are
important for the covered entities of health care plans, clearinghouses and
providers. If a software vendor is HIPAA compliant, you need to be aware of which
rule they are compliant.
 Requirements are more detailed with the enactment of the Health Information
Technology for Economic and Clinical Health Act (HITECH Act 2009) as part of
The American Recovery and Reinvestment Act of 2009 (ARRA).
 Together these Acts form the basis for stimulus funds when “meaningful use” is
met.
 The HITECH Act focuses on the establishment of a national health infrastructure
and on providing incentives for the adoption of EMRs. In addition, provides
more strict privacy protections.
 Currently, there are significant civil and potential criminal penalties as well as
the potential for stimulus incentives to be denied for noncompliance.
 An estimated 85,000 medical lawsuits are filed annually.
 One of the many benefits to adopting EMRs is the potential to prevent medical
malpractice incidents and medical errors (Lynn, 2010).
 By providing better documentation, automatically checking for medication
effects and drug interactions, providing failsafe systems to track test results and
follow up with patients, EMRs can reduce the risk of malpractice.
 The Office of the National Coordinator for Health Information
Technology (ONC) issued a final rule to create a permanent certification
program for health information technology on January 3, 2010 (Merril,
2011).
 According to this rule, the ONC will use the permanent certification
program to authorize organizations to certify EMR tools, such as
complete EMRs and or EMR components beginning Jan 1, 2012.
 Some features of the permanent certification program include
accreditation by an ONC-Approved Accreditor (ONC-AA) in order to
become Authorized Certification Bodies to test and or certify health IT.
 ONC-AA will be requiring to renew their statuses every three years
(Merril, 2011).
 The laws that govern the confidentiality of health care information require
proper system and data security.
 If the system is lacking in security, operation, or maintenance, a court could
determine that the records stored on that system are not sufficiently
reliable to be admissible in a legal proceeding (Merril, 2011).
 Healthcare providers have seen improvements in
the delivery of care as a result of health IT, obstacles
associated with organizations readiness still exist.
 Two major obstacles in the development and
dissemination of EMR networks area the federal
anti-kickback statute and the so-called “Stark” law,
named after U.S. Representative Fortney Stark (DCal), prohibiting physician self-referral (Danello,
2006).
 The anti-kickback statute included a number of
regulatory “safe harbors” applicable to EMRs
(Merril, 2011).
 If an arrangement fits within a safe harbor, it is immune from attack
under the statute.
 Failure to comply with all the requirements of a safe harbor does not
mean the arrangement is illegal, but rather that it is subject to a facts
and circumstances analysis.
 Practical limitations make it difficult to structure an EMR to fit within the
existing anti-kickback safe harbors.
 One approach to limit access to electronic records is to maintain two
levels of information, one with easy access for basic information and
another with limited access with more sensitive information.
 Another options require the entry of special codes or passwords and/or
data encryption and compression techniques.
 Advanced technology also permits biometrics-based authentication,
which relies on physical characteristics of the user, such as fingerprints
or voice patterns.
 New risks for malpractice.
 Data loss or destruction.
 Inappropriate corrections to the medical record.
 Inaccurate data entry.
 Unauthorized access.
 Errors related to problems that arise during the
transition to EMRs.
 The laws have not kept up with the pace of the technological advances of EMRs. If
statutes haven’t been updated in a particular state, an EMR may not technically comply
with the law.
 Inadequate security of confidential health care information can result in severe
emotional, financial, or adverse physical consequences for the patient which could result
in costly litigation and damages.
 Excessive restrictions may prevent a health care provider from retrieving essential
information when the patient needs it.
 Any provider that maintains or accesses EMRs must adopt and implement appropriate
policies, rules and regulations to govern their access and use to ensure their availability
and integrity over time (Lynn, 2010).
 Lack of physician participation can lead to implementation failure (Burchill, 2010).
 An outdated organizational strategic plan can lead to confusion of priorities based on
prior facility planning paradigms (Burchill, 2010).
 Vendor’s software may not have a sustainability plan or may not continue in the health
care marketplace (Burchill, 2010).
 We have provided evidence of how the presence of
electronic laws affects the adoption of EMRs.
 Since the American Recovery and Reinvestment Act
has made the promotion of a national and
interoperable health information system a priority,
health care organizations must be prepared to meet
the ambitious deadlines and transform the
coordination of care through EMRs.
 One side would assume that the use of EMRs may
facilitate a hospitals defense, by providing a broader
and more substantial standard of documentation.
 On the other side, it seems possible that the increase of
available evidence by the plaintiff’s attorney may increase the
medical malpractice risk associated with the adoption of
EMRs.
 Several obstacles such as risk for malpractice, data entry
errors, unauthorized access, litigation, and physician and
organization alignment will have to be overcome.
 Once these obstacles have been tackled, we feel the adoption
of EMRs will result in better quality of care and improved
patient safety.
 Therefore, we are in favor of adopting the use of EMRs.
References:
Burchell, K.R. (2010). ARRA and meaningful use: is your organization ready? Journal of Healthcare
Management, 55(4), 232-235.
Danello, P.F. (2006, September). Preparing for interoperability: EMR and the law.
Retrieved from http://www.healthmgttech.com/index.php/solutions/electronicmedical-records/preparing-for-interoperability-ehrs-and-the-law.html
Jha, A.K., DesRoches, C.M., Campbell, E.G., Donelan, K., Rao, S.R., Ferris, T.G.,
Shields, A., Rosenbaum, S., and Blumenthal, D. (2009). Use of electronic health
records in U.S. hospitals. Retrieved from http://www.nejm.org/doi/full/10.1056/
NEJMsa0900592#t=abstract
Korbin, J.B. and Quattrone, M.S. (2007, June 20). Litigation in the decade of electronic health
records. Retrieved from http://www.law.com/isp/ni/ PubArticleFriendlyNJ.isp?id
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Licht, T. (2004, September 19). Electronic medical records - health care's next challenge in
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19/133570.html
Lynn, J. (2010, December 29). Hippa lawsuit-phi by un-encrypted e-mail. Retrieved from
http://www.emrandhipaa.com/category/hipaa-lawsuits/
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