HHS opens doors to greater interoperability of EMRs
HHS opens doors to greater interoperability of EMRs
Decision will help facilitate physician office/hospital communication
Thanks to a recent decision by the U.S. Department of Health and Human Services (HHS), physicians will be allowed to accept donations of electronic prescribing software, electronic health records software, and training services from hospitals and health plans under expanded safe harbors to the anti-kickback statute. This, quality experts say, will lead to enhanced quality and patient safety across the health care continuum as interoperability between electronic medical records (EMRs) in physicians' offices and hospitals increases.
In order to be covered in the new safe harbors, electronic health records (EHR) software must be certified as being interoperable with other systems, and electronic prescribing software from one supplier must not restrict or limit compatibility with other systems. The exceptions to the anti-kickback statute were to go into effect October 7.
"I think this will definitely increase interoperability," says James M. Walker, MD, FACP, chief medical information officer for Danville, PA-based Geisinger Health Systems, a physician-led organization that currently employs its own EMR serving more than 2 million patients in 40 counties. "I think probably the most important form that it will take is that organizations that have already implemented high-performance EMRs or are in the process of doing so will be able to share that work with other organizations. It will have the effect of making large [electronic] neighborhoods interoperable."
"One of the key issues has been to get community electronic health systems in place, and in effect someone had to sponsor the doctors," notes Jack Kowitt, chief information officer at Parkland Health and Hospital System in Dallas. "Previously, we couldn't give them systems because it was construed as an incentive to get them to admit their patients to our hospitals. This makes it easier to develop communitywide health records, access, and so forth."
Lydia Washington, MS, RHIA, CPHIMS, Professional Practice Resource Manager at the Chicago-based American Health Information Management Association, is taking a wait-and-see attitude. "One of the intentions is obviously to lower the barriers to physician adoption by letting hospitals share systems with physicians," she notes. "However, it all remains to be seen how this will wash out; physicians have not fully embraced it yet. Still, the government is pushing electronic prescribing and EMRs, and this makes it a little easier to acquire the technology."
What it could mean
Experts agree that greater interoperability could make a significant contribution to the effort to improve quality and enhance patient safety.
"We've had an outpatient EMR completed in 41 clinic sites for several years. All the results and about 80% of our notes are created electronically, and essentially all orders are entered in the system," says Walker. "The benefits are fundamentally [greater] communication. I can see all the patient's notes from their kidney doctor, their heart doctor, and so on. It's extremely easy for me to take 10 seconds and send a note to the cardiologist and say, 'I'd like to increase their Lisinopril — do you have any problem?'"
Interoperability, he adds, "means not ordering extra tests, and knowing where everybody is with the patient; that is enormously powerful."
"Outpatient doctors spend a tremendous amount of time trying to figure out what has been done and what hasn't," adds Kowitt. "If you simply create [an electronic] report and send it to the patient's primary care provider and say, 'Here's what we did, here are their meds, here's why we changed them,' that would be a very simple, powerful intervention to improve care. The same is true of lab tests — you can immediately share what you found, what other tests were pending, what medications the patient needs to continue taking and at what level. In addition, with an EMR, a hospital can do a lot to make that handoff back to the patient's doctor really reliable."
"One of the really big opportunities is information exchange and increased efficiencies," adds Washington. "The physicians would have a little more information at their disposal, through, for example, clinical decision support tools, which increase patient safety."
So, for example, says Washington, an EMR can provide alerts and reminders drawn from evidence-based best practices. "Part of it is prevention, warning if a patient has an allergy, but it also reminds you, for example, that it is time for your diabetic's hemoglobin A1c to be done," she offers.
Kowitt agrees. "One provider may not have a complete allergy record on the patient," he notes. "One provider may not have a list of all the meds a patient is on, so this will broaden their knowledge, and give a greater picture of the patient's condition."
In addition, he says, all records of hospital admissions would be included. "The physician can then see what happened in the hospital and what the last discharge summary was," notes Kowitt. "This will absolutely help in terms of compliance to discharge instructions."
The movement toward pay for performance will be enhanced by the ability to generate data that allow you to make positive changes in the care process, Washington adds. "You can document care, see the gaps in quality, and you can close those gaps more easily if you have the data to do so," she explains. "You can also benchmark that data and show improvement."
Since the adoption of EMRs is still relatively new, however, Kowitt says there's not a lot of hard data to support all of these assertions. "They make everybody feel much more comfortable," he concedes. "But in my opinion, there has not yet been sufficient research done on these systems and their impact. Everybody anecdotally agrees [they are beneficial], but we still need to have a study on a massive scale."
The role of the quality manager
If a hospital is just beginning to get involved in interoperability with local physician offices, the quality manager has a critical role to play.
"It's critical that they become deeply involved in specifying the EMRs," says Walker. "I sit on the patient safety committee in our organization, and it often happens that specific needs like infection control, fall prevention, or improved performance issues like antibiotics within an hour of surgery arise. If you are aware of those needs and get them in writing and are part of the project plan, it's relatively easy to get them built into the EHR. If you are not involved, obviously that's a problem."
What should a quality manager push in terms of system capabilities? "One of the most critical functions is meds reconciliation," says Walker. "When you are admitted, you should know what the home meds were and what you were given at the other hospital if you are being transferred. And, when you are ready to go home, the system should be able to ensure careful documentation of changes in medications."
"One thing I see people fail to recognize is that there is a basic difference in work flow processes between hospitals and physicians offices," says Washington. "You can't both use the same system, but they do have to be able to talk to each other — be interoperable. So when you buy or select a system, you have to take into account what those work flows are in order to make a good decision."
"They have to be sure there is a capability to capture data to support their quality programs," adds Kowitt. "We must have dozens of quality initiatives going on here, and I sit on the quality committee so I can learn what kinds of things the quality team is doing and what kinds of data they need to be extracted to help measure QI."
Quality managers, he says, "should participate in these meetings and make their needs known. In watching the system design, they can come up with improvements or add something new to support their quality programs."
The bad news, says Walker, is that what should happen and what does happen are not always the same thing. "The quality manager should be in a position to help the organization decide what to buy. They ought to be able to ask if a given system is going to help their team capture and report all the prevention data, disease management data, and so forth that is needed. But my experience is that it's fairly unusual for them to be involved — not through any evil intention, but because the people who run these projects often do not think in these terms."
Why is that? "It takes a while for people to perceive the full potential of an EMR," he explains.
For more information, contact:
James M. Walker, MD, FACP, Chief Medical Information Officer, Geisinger Health Systems, Danville, PA. Phone: (570) 271-6750. E-mail: [email protected].
Lydia Washington, MS, RHIA, CPHIMS, Professional Practice Resource Manager, American Health Information Management Association, 233 N. Michigan Avenue, 21st Floor, Chicago, IL 60601-5800. Phone: (312) 233-1100.
Jack Kowitt, Chief Information Officer, Parkland Health and Hospital System, 5201 Harry Hines Blvd., Dallas, TX 75235. Phone: (214) 590-8000.
Thanks to a recent decision by the U.S. Department of Health and Human Services (HHS), physicians will be allowed to accept donations of electronic prescribing software, electronic health records software, and training services from hospitals and health plans under expanded safe harbors to the anti-kickback statute.Subscribe Now for Access
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