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Making Electronic Health Records Meaningful

Jennifer Fisher Wilson
[+] Article and Author Information

Potential Financial Conflicts of Interest: None disclosed.


Ann Intern Med. 2009;151(4):293-296. doi:10.7326/0003-4819-151-4-200908180-00026
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While debate over health care reform continues in Washington, major changes are already under way. The American Recovery and Reinvestment Act signed by President Obama in February included legislation that could transform how clinical information is accessed, communicated, and stored—and in the process change medical practice in essential ways. The Health Information Technology for Economic and Clinical Health (HITECH) Act promotes the idea that technology, such as electronic health records (EHRs), can make health care more evidence-based and efficient and less error-prone.

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EHRs: Assuring Meaningful Isn't Risk-full
Posted on September 22, 2009
Reed D. Gelzer
Advocates for Documentation Integrity & Compliance
Conflict of Interest: None Declared

To Jennifer Fisher Wilson Science Reporter Annals of Internal Medicine

Good day Ms. Wilson,

I appreciated your article, "Making Electronic Health Records Meaningful", as a comprehensive and well-written high level overview of current EHR initiatives and policies. However, the small list of problems you mention would merit further review and elaboration for the ACP constituency.

As a nearly five year veteran of the HL7 EHR Standards process, and after 3 years of service on CCHIT workgroups, I hasten to convey to you and to your constituents that it is critical for those proceeding with EHR implementations to understand that there is a large body of additional risks to implementing these systems. These risks will persist for, in my opinion, at least another 3-5 years, as that is how long it is likely to take for EHR standards to be meaningfully taken up and implemented by EHR Certification and by EHR vendors. Currently, for example, Certified EHRs are permitted to violate documentation principles that no physician would ever knowingly do, like obliterating the original version of an amended record. These risks can be mitigated, but only by due diligence that the current administration is unlikely to highlight.

Recent public communications to the HITECH Policy Committee from the Health Level 7 (HL7) Electronic Health Records Technical Committee illustrate the problem in the context of Meaningful Use deliberations. These highlighted that, before there can be meaningful use, there must be trustworthy patient care information, which is not assured by many of today's top EHRs, due in part to the absence of uptake of existing standards.

Due diligence tools for assuring that currently non-standardized, minimally Certified EHRs meet basic functional requirements that are already standard in other records management domains. Two sources are AHIMA and my firms, both of which distribute these tools at no cost and with no promotional consideration except accurate attribution of the original source.

As many take up the call to migrate to electronic health records despite their non-standardized state, at the minimum those well-intended physicians should be warned that the EHR marketplace remains well described as one where the buyer/user must beware. A well-designed EHR, properly used, can provide information to improve quality and efficiency in patient care but return on investment includes risk, which currently, remains significant and, where not carefully used, potentially very high, as shown by the April 2009 Medical Economics article entitled "The Problem with EHRs and Coding" (1).

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