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The EHR in our emerging future

September 1, 2009
by Helene M. Cross
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Linking hospitals, clinics, and medical personnel to patient data

Ron Hunsicker, President and CEO of NAATP, recently predicted that “healthcare reform is going to be driven by research, evidence, information, outcomes and cost effectiveness.” The implication of technology is present in his words.

Fully integrated information systems, electronic medical records (EMR), and electronic health records (EHR) are part of all behavioral health providers' conversations these days. There is little controversy about the EMR, which is the electronic record used within an organization. Many providers already have such a system; some organizations have even developed proprietary systems, because, until recently, there were few software choices available. Most healthcare organizations want to be ‘paper-less’; they recognize the benefits related to quality, safety, and efficiency. Fortunately, there is greater vendor selection today than ever.

Congress has authorized $33 billion as incentives in the American Reinvestment and Recovery Act of 2009 intended to accelerate the adoption and meaningful use of “certified electronic health record technology” during the next several years. These will be paid out as “after the fact” reimbursements to qualified providers who implement EMRs. The initial goal is to replace the current paper and fragmented computer files maintained by the vast majority of healthcare providers and replace those with an electronic system that includes the patient's diagnoses, medical history, laboratory and test results, medications prescribed, payer claims data and other pertinent data.

The long-term goal appears to be to link hospitals, physicians and clinics via an interactive grid that allows patient information to be called up at a keystroke and transmitted anywhere-the definition of an EHR.

Use of an EHR often spurs much debate in our industry, partly due to issues of patient privacy. Some public policy advisors suggest that if we want to be included in healthcare reform, stimulus money and whatever else is ahead, we need to be prepared to participate in the EHR. EHRs are not futuristic dreams, they are operational now. Although our facility, Fairbanks, is not a participant due to 42 CFR Part 2, we are located in a community using a system that has proven outcomes.

The internationally recognized healthcare information pioneer, the Regenstreif Institute, Inc., of Indianapolis, Indiana, began to design and implement an EHR, the Indiana Network for Patient Care (INPC), in 1994 under the leadership and informatics scholarship of the Institute's director, Clement McDonald, MD. Dr. McDonald's vision was to provide medical information across institutions wherever the patient presents for care. Today, the INPC has 39 hospitals, 5 major hospital systems, 10,600 doctors, national and regional laboratories, local imaging centers, four homeless care systems, and county and state public health departments as participating entities. Shared data include all emergency department and outpatient visits, hospital discharges, laboratory results, radiology reports, inpatient medications, immunizations, plus more.

The collaborative operates under a mutual contract that adheres to all HIPAA requirements. The data are allowed to be used for clinical, public health, and research purposes. Clinicians have access to a tiny subset of the total population at any given time. The INPC knows when a patient has checked into a given facility because it receives all check-in messages. It uses that information to give physicians working within each facility access to the INPC records of patients who are physically present. For example, designated personnel would have access to a patient's record following admission to an emergency room for 24 hours after the admission.

The system's uses and outcomes are significant. One example was cited in the July-August AARP bulletin, which noted that “a medical computer network linking 6 million patients noted a surge in cases of an intestinal bug causing nausea and vomiting. Within 24 hours, it was traced to an Indianapolis grocery selling tainted custard-filled doughnuts.” Dr. John T. Finnell, a research scientist at Regenstrief and Associate Professor of Emergency Medicine at the Indiana University School of Medicine, cited an example of a patient admitted to the emergency department with a heart attack. The physician wanted to use heparin but changed his treatment with information from the INPC that the person had experienced head trauma two weeks earlier. Dr. Finnell suggested that even a small subset of addictions-related data would make a difference in the life of an emergency room patient by assisting physicians in providing disease management.

We can therefore see the future of healthcare emerging with the new electronic technologies. It's time for dialogue among addictions and mental health administrators and professionals to help determine our place in it.

Helene M. Cross is President/CEO of Fairbanks, a treatment facility based in Indianapolis, Indiana.

For further information, phone (317) 572-9387, email hcross@fairbankscd.org or visit http://www.fairbankscd.org.

Behavioral Healthcare 2009 September;29(8):40

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