Still, those that now possess CCHIT usability ratings and certification have positioned themselves in the forefront of the certification process.
• Structured data: Structured data reside in fixed fields within a record or file. These discrete data fields (for example, blood pressure, body mass index, and height/weight) establish the predetermined data types and understood relationships necessary for efficient quality reporting. Since 2008, the Centers for Medicare and Medicaid Services has allowed reporting of quality measures data to a qualified registry. As early as this year, CMS could begin accepting direct EHR-based quality reporting. As early as 2012, CMS could mandate it. EHRs built on unstructured data (as is found in many transcription/dictation systems) will not support compliance.
• Meaningful use guarantees: Incentives should not be the sole reason why physicians deploy EHRs, but the ability to secure incentives must not be overlooked. EHR vendors with a commitment to – and a plan for – meeting meaningful use criteria as they are established will offer guarantees to that effect.
• Clinical decision support: Evidence-based practice is the inevitable future of health care. EHRs with clinical prompts and reminders support best practice and systemize the use of evidence at the point of care.
• Support for coordinated care: Increasingly, EHRs will serve as the foundation for data registries, health information exchange, and other means to assure patients get the indicated care when and where they need and want it, and in a culturally and linguistically appropriate manner. Expanded patient data access – via secure communication portals, for instance – also will require more robust data controls to ensure secure data exchange. However, it will enable patient-centric care through greater patient involvement.
Health care is a dynamic industry, driven by the needs – changing and continuous – of its stakeholders. Developing, choosing, and deploying EHRs will continue to challenge. Keeping standardization, usability, and interoperability as the prime focus of all development and purchase decisions ultimately will smooth the path for everyone.
Dr. Corley is the chief medical officer for NextGen Healthcare Information Systems, an electronic health record vendor. Dr. Skolnik is associate director of the family medicine residency program at Abington (Pa.) Memorial Hospital and professor of family and community medicine at Temple University, Philadelphia. He is also editor-in-chief of Redi-Reference Inc., a software company that creates medical handheld references.
References
1. The Computer-Based Patient Record: An Essential Technology for Health Care Committee on Improving the Patient Record, Division of Health Care Services, Institute of Medicine Richard S. Dick, Elaine B. Steen; eds. 190 pages. Washington, D.C.: National Academy Press; 1991.
2. National Institute of Standards and Technology. Health Information Technology Usability Framework. Federal Business Opportunity. Solicitation Number: AMD-10-SS39 Web.