Health Care Informatics

LESSON 16 Transition to Electronic Health Record LECTURE NOTES ______________________________________________________________________________________

The push for the conversion from paper-based to electronic health records is clear and definite.

The mandate comes from the federal government in terms of regulatory requirements, financial

incentives, and a desire to reduce costs and improve quality. Research and experience has

indicated that a fully deployed electronic health record system will achieve these desired

outcomes. The ability to enhance the productivity of personnel is another business outcome that

health care providers will need to consider. However, there are major challenges and barriers to

achieving full implementation of interoperable electronic health records.

Costs of Care The costs of health care in the United States are reported to be almost 17% of the gross national

product (GNP), or about $7000 per capita for every person in the country. The costs for health

care continue to rise faster than consumer inflation.

This makes the cost of health care in the United States the highest in the world and about double

the cost of the next highest country. The perception has been that the health care delivery system

in the United States is the best in the world, yet the outcomes indicate otherwise.

While the costs are high, quality measures are not a priority and, depending on the metric, the

United States is found to rank in the low teens when compared to other developed nations. This

is not the outcome that is desired, nor are the costs sustainable.

Higher health care costs cause products made in the United States to be higher than other

countries, simply because of these high costs, and make those products less competitive in the

world market as well. Higher costs do not translate into better care and outcomes.

Efforts by the government to address health care coverage and costs go back to the 1950s when

Congress and President Eisenhower discussed the creation of a health care program for the

country. Major legislation to reform a portion of health care was eventually passed in 1965 in

the form of the Medicare and Medicaid programs. Medicare is for health care payments for the

population over age 65, and Medicaid is for the poor. Both of these programs were a step

forward in assuring coverage for these two groups.

Efforts by other public policy makers had not been successful in assuring access to health care

services, including a plan in 1993 by President Clinton. In 2009, President Obama and Congress

finally passed a comprehensive plan for health care reform that addresses the costs of health care,

access to health care, and outcomes to be achieved in the health care system. Use of electronic

health care records was a significant strategy in the reform plan.

The debate over the direction for this legislation, the issue of costs, and quality outcomes will

last for a while since the cost increase curve for health care needs to change and access needs to

be expanded. With the United States facing other major challenges as well, hopefully, the

commitment to improving outcomes and reducing costs will continue.

Starting in January 2011, demographics indicate that 10,000 Baby Boomers a day are turning age

65 and becoming eligible for Medicare, which is a taxpayer-supported health care payment

system. For the next 20 years, Boomers will continue to age until all 77 million are enrolled in

the Medicare program, which is almost double the current number in Medicare. This will create

even more health care costs and access challenges for the country.

Veterans Administration Healthcare (VAH) has a perceived reputation for providing less than

perfect health care for America’s veterans. Historically, that might have been an accurate

observation, but no longer is that factual. Today, the VAH is considered to be a model integrated

health care delivery system, both in terms of the cost of care and the measurement of outcomes

to patients.

One of the root causes for this change has been the adoption of a fully operational electronic

health record system, which started about 20 years ago. The electronic health record software

system, called VISTA, is deployed across the country to all VAH locations, including hospitals

and clinics. This allows veterans to be treated at any location, and the employees of the VAH

can access any veteran’s health care record. This system prevents duplicated services, finds

conflicts in medications, tracks outcomes, and provides enhanced support to health care

providers in the VAH.

VISTA software was developed by the VAH and is available for anyone to use free of charge

because it was created using federal, taxpayer funds. The tool has been refined, developed, and

updated for the past 20 years and will continue to evolve. It is online and can be downloaded,

yet it is not widely used outside of the VAH system. This is a resource and model that other

providers should review, and they should consider adopting a similar system.

As previously mentioned, the pressure caused by the high cost of health information staff is

considered to be a challenge. Other direct care staff will also be a problem that health care

leaders will need to address.

This high cost of health care staff is a major driving reason for health care cost increases. If the

productivity of health care staff can be enhanced using electronic technology, this would be an

outcome that could reduce the overall costs of care. Another opportunity to reduce costs is to

prevent the duplication of tests. A comprehensive and fully deployed electronic health care

record system could reduce or eliminate these unnecessary costs of care.

Crossing the Quality Chasm In 2001, the Institute of Medicine (IOM) continued its series of reports on improving health care

outcomes and reducing the costs of care. Crossing the Quality Chasm (IOM, 2001) declared that

100,000 lives could be saved each year in the health care delivery system if certain quality

improvement processes were widely adopted by health care providers. The recommendations

included the need for a fully integrated and interoperable electronic health record system.

The IOM’s report in 2006, Preventing Medication Errors (IOM, 2006), continued the research

and recommendations on how to prevent avoidable errors in dispensing medications to patients.

Again, a major recommendation was to use technology to order, confirm, and dispense

medications in the health care setting.

For the past decade, researchers and health care professionals have examined how quality might

be improved. A key driver is the ability to use technology to enhance the standardization of

protocols in health care organizations. The technology available for the electronic health care

record system has the ability to meet that need effectively and cost efficiently.

WORKS CITED

Institute of Medicine. (2001). Crossing the quality chasm. Washington, DC: National Academies

Press (http://www.nap.edu).

Institute of Medicine. (2006). Preventing medication errors. Washington, DC: National

Academies Press (http://www.nap.edu).