The Institute of Medicine estimated that approximately 98,000 Americans die each year from preventable medical errors.1
Medical errors are killing more people per year in the United States than breast cancer, AIDS, and motor vehicle accidents combined. Eighty percent of errors were initiated by miscommunication.2
A major transformation in the current 2A American health care system is underway, and the demand for more accountable care and better communication is creating the momentum to address the need for improvement in clinical care management, the capture of data for continuity of care, and the definition of measures to monitor costs and quality of care.
The Office of the National Coordinator for Health Information Technology (ONC) was created in 2004 to be a resource for the entire US health care system.3
In 2009, the ONC was mandated through the Health Information Technology for Economic and Clinical Health (HITECH) Act to support and coordinate efforts to improve health care through the adoption of health information technology (HIT) and the development of a nationwide health information exchange (HIE). This is the HIT component of the American Recovery and Reinvestment Act (ARRA) signed into law on February 17, 2009, with provisions of 17.2 billion dollars for EHR use and HIE development. The vision of the HITECH Act is to furnish tools to begin a transformation in our nation's health care system so that each patient can receive optimal care. The adoption of Meaningful Use of electronic patient data and the development of a nationwide exchange of health information over the next several years will serve to optimize and align our combined efforts to improve health outcomes, reduce costs, and increase patient, staff, and provider health care experience and satisfaction.
In 2011, the National Center for Health Statistics estimated that the rate of providers using any EHR was between 40% in Louisiana to 84% in North Dakota, with Hawai‘i having a 70.5% adoption rate.4
Any EHR system was defined as an affirmative response to the question, “Does this practice use electronic health records (not including billing records)?”
In comparison, a “basic EHR system” is one that has all of the following functionalities: patient history and demographics, patient problem list, physician clinical notes, comprehensive list of patient's medications and allergies, computerized orders for prescriptions, and ability to view laboratory and imaging results electronically. This may or may not include certified electronic health record technology as specified by ONC Certified Health IT Product List.5
Nationally, about 34% of physicians reported having a system that met the criteria for a basic system, up from 25% average in 2010. The lowest state was New Jersey at 16% and the highest was Minnesota at 61%. In Hawai‘i, the EHR adoption rate for a basic system is 46.3%.
Nationwide, approximately 52% of physicians reported intending to apply for Meaningful Use incentives, up from 41% in 2010. While the barriers to the implementation of EHRs include potentially high financial investments, an increase in initial physician and staff training time, workflow redesign efforts, and the need to hire new staff for HIT support, an EHR creates a database of information that will assist in the coordination of patient care and improvement of communication about shared patients among health care providers.
Benefits of using EHRs can include, but are not restricted to, reduced paperwork for patients and doctors, expanded access to affordable care, improved patient quality of care, prevention of medical errors, decrease in health care costs, increase in administrative efficiencies, and engagement of patients/families in their own health care.
An EHR converts a paper medical record into electronic format for faster communication, recall, and clinical decision-making. The goal of clinical decision support is designed to deploy electronic and non-electronic tools to effectively make use of best practices and evidence-based guidelines to help guide care in a more timely manner. Furthermore, the use electronic health records fundamentally changes a practice's communications by redesigning workflows that allow for better access to patient information almost immediately. Transcription costs will be reduced, patients with specific conditions can be more quickly identified and clinical decision support tools will be in place.