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The American Recovery and Reinvestment Act of 2009 (ARRA) , known popularly as “The Stimulus Bill,” was enacted by Congress on February 17, 2009. It contained in its title XIII a broad range of provisions called the Health Information Technology for Economic and Clinical Health Act (HITECH Act), which, taken together, were intended to promote the adoption and use of health information technology as a means of improving the quality and value of US health care. Among many provisions, the act designated that the Office of the National Coordinator for Health Information Technology (ONC) is the entity responsible for supporting and coordinating the effort to implement a nationwide health information technology infrastructure that would facilitate the use and exchange of health information. The HITECH Act also authorized incentive payments to health care providers through Medicare and Medicaid. These payments were intended to encourage the adoption and “meaningful use” of certified electronic health record (EHR) technology.
As a result of these provisions and incentives, interest in health care providers and organizations adopting EHRs intensified considerably. EHR systems would have to be certified for their users to qualify for extra Medicare and Medicaid payments. The ONC launched an effort to define “meaningful use” and to develop standards and certification criteria that EHR systems would have to meet. At this writing, the certification criteria and standards and the process for implementing them are not final, but incentive payments to providers for meaningful use of EHRs are set to begin in 2011.
The certification criteria and standards do not require that EHRs be linked to or include actual evidence from the literature of the health sciences. They do mention “clinical decision support systems” (CDSS or CDS) as a required capability or feature of EHRs within the adoption window of 2011 to 2015, but they do not specify that such systems be evidence based. However, CDSSs can be built on a knowledgebase that, among other possible sources, depends on evidence from the literature. The high-profile discussion of the use of EHRs has created an environment that, perhaps more that ever before, presents opportunities for health sciences libraries to participate more actively and essentially in the clinical enterprise in their institutions.
As these developments were taking place, the program, “Electronic Health Records (EHR) and Knowledge-Based Information: State-of-the-Art and Roles for Libraries in Health Information Technology,” was taking shape. The Association of Academic Health Sciences Libraries (AAHSL) Program and Education Committee met in San Antonio, Texas, in November 2008, on the very eve of the national elections, to plan programs for the 2009 annual AAHSL/Association of American Medical Colleges meeting to be held in Boston on November 7, 2009. At that time, it was not known that health care reform and major changes in federal policy regarding health information technology would take center stage in the coming year. The outcome of the elections was still very much in doubt, as were the priorities that would be set by an incoming administration. Nevertheless, the committee determined that a possible topic for the symposium might be an update on the EHR and AAHSL members' involvement in EHR implementation.
Even before the events that would subsequently unfold, there was considerable interest in the idea that academic medical center libraries were facing a potentially important new way in which they might deliver information resources and services, by linking them in some fashion to clinical information systems, including electronic medical or health records. Those on the committee were aware that a number of AAHSL members were already working along these lines. They felt that there might be a nucleus of librarians who could share what they were doing and that this might be part of a program that would highlight the state-of-the-art in EHR adoption, development, and integration with knowledge-based resources and services. By the time the program committee began to meet via conference call in the late winter and early spring of 2009, events described above had begun to unfold that made the decision to make EHRs the topic of the symposium seem very timely.
The program committee decided that the symposium would have two parts: a keynote speaker who would describe critical issues related to developing and implementing EHRs, including health information technology initiatives, meaningful use of electronic health records, and ways libraries might be involved in the effort to link evidence to clinical information systems, and a panel of librarians and information specialists who would describe efforts at their own institutions to link knowledge-based information and services, including education services, to EHRs. Seven AAHSL members responded to a call for participation. Five respondents—representing a variety of types of programs, institutions of various sizes and characteristics, and approaches at various stages of development—were selected for the final program.
The panel of presenters was:
Following the report on the keynote address are the written versions of four of the oral presentations delivered during the second part of the symposium. The first piece by Garrity offers his views on the challenges libraries face with respect to integrating information in the EHR. Coming from the perspective of a smaller, statewide medical school, Hart talks about the role that the library can play in supporting the adoption of EHRs through educating health professions students. Epstein describes her library's development of a clinical information tool to embed knowledge-based information resources in UPMC's electronic medical record (eRecord). A case study about the early process and the initial pilot product “Clinical-e” may be found elsewhere in this issue . Clinical-e was replaced in fall 2009 with a second, more robust, and visually pleasing information tool called Clinical Focus <http://www.hsls.pitt.edu/guides/clinical/>. The final two presenters, Welton and Williams, describe two different approaches to integrating evidence and knowledge-based resources and services into their institutions' clinical systems.
A special thanks to the other members of the 2009 AAHSL Program and Education Committee for planning this symposium: Barbara Epstein, AHIP, University of Pittsburgh, chair; Holly S. Buchanan, AHIP, FMLA, University of New Mexico; Jacqueline D. Doyle, AHIP, FMLA, University of Arizona; Nancy McKeehan, Medical University of South Carolina; Peggy Mullaly-Quijas, AHIP, University of Missouri, Kansas City; Neville Prendergast, Tulane University; and Connie Poole, AHIP, Southern Illinois University, AAHSL Board liaison.