Electronic medical records (EMR) are digital, computerized reports containing the medical and demographic data of patients in clinics and hospitals. The Health Information Technology for Economic and Clinical Health (HITECH) Act passed by the United States Congress in 2009 provides financial incentives for eligible physicians and hospitals to convert to electronic health records, but the HITECH Act stipulates that providers demonstrate “meaningful use” of EMR in order to receive the incentive payment. In order to accomplish “meaningful use” of EMR, providers must meet 15 key objectives that are designed to improve coordination of patient care, enhance the quality and efficiency of care, prevent medical errors, ensure protection of privacy, and proactively engage patients in education and prevention strategies. Additionally, providers will need to satisfy at least five supplementary criteria from a list of 10 objectives that involve implementing preferred practice standards or “clinical decision support rules” that trigger certain tests, assessments, and management choices when certain clinical circumstances exist. Finally, “meaningful use” of EMR entails the reporting of clinical quality measures (CQM) to the Center for Medicare and Medicaid Services, the government agency that regulates those programs.
Most EMR software programs can achieve 10 or the 15 core objectives for “meaningful use” of EMR. For example, nearly every well-designed EMR system provides for the protection of electronic health information. Many systems allow the providers to electronically transmit prescriptions to pharmacies while checking for drug interactions and allergies. Recording and maintaining patient demographics and lists of the patient medications, allergies, problems, and use of tobacco and alcohol fulfills another five objectives. A final core goal involves the charting of growth, blood pressure, height, weight, and body mass index, but a practice for which these data are not generally relevant may simply assert that fact and still meet the objective.
Somewhat more challenging to existing EMR systems, “meaningful use” requires the reporting of a core set of CQMs to state and federal agencies for public health surveillance and quality control measures. These CQMS include immunization status, tobacco use and cessation, weight changes, and blood pressure measurements. Providers who choose not to implement these measures will face an escalating penalty in Medicare and Medicaid reimbursements, which can rise as high as five percent. The penalties will start in 2015 for providers that have not implemented EMR by that time. Furthermore, the incentive period for establishing “meaningful use” for EMR extends for only five years.
