Advocacy groups and politicians have raised a growing call for federal action to encourage increases in health care information technology in the past couple of years. These technological developments, generally affecting processes in health care or easier access to information, can promise cost savings and quality improvements.
However, before the government goes on to pick winners and losers, it’s important to understand the technology available and recognize the extent to which the market is implementing these innovations without government intrusion.
The terms electronic health record (EHR) and electronic medical record (EMR) are used interchangeably in the market, though an EMR is actually a particular type of EHR.
An EMR includes physician notes, test results, and computerized orders for tests and prescriptions. A clear advantage is removing the concern of illegible writing on prescriptions and notes. Another advantage is that electronic records are more easily accessible.
The need for easier access became evident during the Hurricane Katrina disaster. Hospitals and doctors’ offices were destroyed, and people had to abandon their homes. One of the few bright spots was that patients in the Veteran’s Administration system were able to access medical information because of the VA’s move to electronic records.
There are two categories of EMR. One consists of records originally produced on paper or another hard-copy form (such as x-rays, photographs, etc.) that have been scanned or otherwise converted to digital form. The other is “born digital” records—those originally captured electronically.
The advantage of “born digital” records is that they are not as vulnerable to errors in interpretation of handwriting and the like.
Need for Interoperability
A continuity of care record (CCR) provides a snapshot of a patient’s care and data. A CCR is intended to provide core health information about a patient and generally includes information about the patient’s demographics, insurance, diagnosis and problem list, medications, allergies, and ongoing care plan.
One of the buzzwords heard most often regarding technology in health care is “interoperability.” The real boon to patient care and quality of care would be medical records that easily follow a patient. Having medical information that can be accessed anywhere across different health systems is important.
Many of today’s systems, however, have been tailored to the specific needs of a particular medical network, and in many cases these networks cannot or will not interface with others. Think of it as being like a cell phone where AT&T customers could not speak to Cingular customers.
The challenge is to allow systems and networks to reach outside of their “walls” and share information without exposing the information to security breaches.
Smart cards are expected to gain ground in the health care arena as electronic records become more common. They will be needed to address the concerns that electronic records—residing in a single database as opposed to, for example, several file cabinets—are more vulnerable to data breaches.
The smart card is an electronic device that increases security, privacy, and control of individuals’ data. The microchip on the card is much less vulnerable to hacking or cloning than on cards with magnetic stripes. In order to gain access to data either on the chip or accessed by the chip, one must first have possession of the card, of course. In addition, some smart cards require a password or PIN number.
Cards with even greater security require biometric authentication, such as a fingerprint, to prove identity and provide authority to access private data.
Smart cards will increase administrative efficiency, reduce medical identification errors, improve patient care, and fight fraud. As much as 70 percent of the errors contributing to pending or denied insurance claims can be attributed to errors in the registration process. Smart cards can significantly reduce these errors by distinguishing among every John Smith presenting for registration, especially when biometric authentication is included.
Personal Health Records
A personal health record (PHR) is a detailed medical history allowing a person to organize and maintain health information in a consistent and usable format. The federal Health Insurance Portability and Accountability Act of 1996 (HIPAA) recognizes explicit rights regarding confidentiality of patients’ health information.
PHRs improve patient safety by enabling a patient to capture information from all their medical encounters—both within and external to a given network of health care providers. Then, sharing a PHR with a physician should allow the doctor a more comprehensive picture of the patient’s medical care.
PHRs can keep patients at the center of their care, enabling them to become more engaged in decision-making—a critical step in becoming an effective consumer of services and thereby keep both individual and systemwide costs down. One study found PHRs can save each patient as much as $300 annually by reducing duplicate medical tests.
Information technology is likely to be the backbone for a truly nationwide, consumer-friendly health care system instead of a multitude of health care providers acting independently. Having a system that provides a more-complete picture of a patient’s medical history should translate into better quality of care.
Pamela D. Mitroff, M.B.A. ([email protected]) is director of public relations and communications for Secure Services Corporation (SSC) in Downers Grove, Illinois.