According to HIMSS, an electronic health record (EHR) is a longitudinal electronic record of patient health information generated by one or more encounters in any care delivery setting. Included in this information are patient demographics, progress notes, problems, medications, vital signs, past medical history, immunizations, laboratory data and radiology reports.
The EHR automates and streamlines the clinician's workflow. The EHR has the ability to generate a complete record of a clinical patient encounter - as well as supporting other care-related activities directly or indirectly via interface - including evidence-based decision support, quality management, and outcomes reporting.
The American Recovery and Reinvestment Act of 2009 specifies 3 main components of meaningful use:
- The use of a certified EHR in a meaningful manner, such as e-prescribing.
- The use of certified EHR technology for electronic exchange of health information to improve quality of health care.
- The use of certified EHR technology to submit clinical quality and other measures.
Simply put, "meaningful use" means providers need to show they're using certified EHR technology in ways that can be measured significantly in quality and in quantity. (Source: CMS)
While meaningful use criteria apply only to providers eligible for HIT Incentives, having an interoperability-certified EHR and using it to exchange health information with clinical partners (hospitals, physicians, etc.) helps those providers become meaningful users, improves care coordination, and the quality of care to the populations served.
4 Will long-term care providers such as nursing homes be eligible for incentive payments under the Medicare and Medicaid EHR Incentive Program?
Nursing homes, per se, are not eligible. The following types of institutional providers are eligible for EHR incentive payments under Medicare and/or Medicaid, provided they meet the applicable criteria.
Under Medicare, institutional providers eligible for the EHR incentive payments include "subsection (d) hospitals," as defined under section 1886(d) of the Social Security Act, and critical access hospitals (CAHs). Under Medicaid, institutional providers eligible for the EHR incentive payments are acute care hospitals (which include CAHs and cancer hospitals) and children's hospitals.
However, under Medicare, eligible professionals (EP), which include physicians and physician assistants, may choose to assign their incentive payments to their employer or entity with which the EP has a contractual arrangement. Under Medicaid, EPs also can choose to assign their incentive payments to their employer or to other state-designated entities. (Source: HHS)
For more information about the Medicare and Medicaid EHR Incentive Program, please visit CMS.
There is no federal mandate or deadlines. Minnesota is the only state that has a state-wide mandate for health care providers to implement EHRs by January 2015 (please see: Minnesota). Appendix B, lists affected providers which include long-term care providers: Skilled Nursing and Assisted Living Facilities, as well as Home Health Agencies (please see: Minnesota - Appendix B).
The Medicare and Medicaid EHR Incentive Programs require the use of certified EHR technology. Standards, implementation specifications, and certification criteria for EHR technology have been adopted by the Secretary of the Department of Health and Human Services. EHR technology must be tested and certified by an Office of the National Coordinator (ONC) Authorized Testing and Certification Body (ATCB) in order for a provider to qualify for EHR incentive payments. (Source: CMS)
- ONC-ATCB 2011/2012 Certification Program.
- EHR Alternative Certification for Healthcare Provides (EACH).
Today we have 4 main HIT building block standards recognized by the industry that are applicable for LTPAC. These are:
- The Health Level 7 (HL7) Clinical Document Architecture (CDA) for the Continuity of Care Document (CCD) Standard (see HL7), which primarily allows the exchange of patient summaries electronically between settings mainly during transfers of care (e.g. LTPAC to a hospital, discharge from hospital to LTPAC).
- The National Council for Prescription Drug Programs (NCPDP) Script 10.6 Standard (see NCHVS), which allows LTC to electronically enter prescriptions and physician orders and send to pharmacy.
- The CDA Framework for Questionnaire Assessment (see HL7), which allows standardized capture and exchange of functional assessments, including federally mandated assessments like MDS, and OASIS.
- The CDA Personal Health Monitoring Report (see HL7),which allows the standardized exchange of health data collected by home, personal, telehealth, and remote patient monitoring devices with electronic and personal health records.