EMRs, together with healthcare analytics, are seen as a possible remedy to escalating healthcare costs. In the United States, the major piece of legislation that has promoted the use of EMRs is the Health Information Technology for Economic and Clinical Health (HITECH) Act, passed in 2009 as part of the American Recovery and Reinvestment Act (Braunstein, 2014). The HITECH Act provides incentive payments to healthcare organizations that do two things:
- Adopt the use of "certified" electronic health records (EHRs)
- Use the EHRs in a meaningful fashion. Starting in 2015, healthcare providers who did not use EHRs were subject to penalization from their Medicare reimbursement
In order for an EHR to be certified, it must meet several dozen criteria. Examples of such criteria include those that support clinical practice, such as allowing for computerized physician order entry and recording demographic and clinical information about patients, such as medication lists, allergy lists, and smoking statuses. Other criteria focus on maintaining the privacy and security of medical information and they call for secure access, emergency access, and access timeout after a period of inactivity. The EHR should also be able to submit clinical quality measures to the appropriate authorities. Full lists of such criteria are available at www.healthit.gov.
It is not enough for providers to have access to a certified EHR; in order to receive incentive payments, providers must use the EHR in a meaningful fashion, as stipulated by the meaningful use requirements. Again, dozens of requirements exist, some of which are mandatory, and some optional. These requirements are distributed across the following five domains:
- Improving care coordination
- Reducing health disparities
- Engaging patients and their families
- Improving population and public health
- Ensuring adequate privacy and security
Thanks in part to the HITECH Act, the rise of EHRs will lead to an unprecedented volume of clinical information becoming available for subsequent analysis in efforts to cut costs and improve outcomes. Later in this chapter, we will explore the creation and formatting of this clinical information in more detail.