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EHRs: Challenges and Opportunities As Medicare’s EHR incentive program moves forward,

ASCs could face an altered technological landscape. BY JONATHAN BEAL


ealth care providers don’t always communicate fully with each other—sometimes because they use disparate information systems that don’t talk to one another. For example, a patient’s medical history from pre- vious visits to his or her doctor’s of- fice may not be available immediately when the patient is hospitalized. Like- wise, the information from the hospital stay may not be automatically avail- able to the physical therapy providers that care for the patient at home after the hospitalization.

This lack of communication can lead to redundant medical tests or other medical services. As a result, lawmakers included steps to fos- ter interoperability among health information systems in the 2009 Health Information Technology for Economic and Clinical Health (HI- TECH) Act. The act includes an in- centive/penalty program to encour- age doctors and hospitals to adopt electronic health record (EHR) sys- tems that are capable of electroni- cally

exchanging information to

improve care. ASCs and other pro- viders, such as skilled nursing facil- ities and home health providers, are not included in this program. Those providers, however, will

be affected as the information sys- tems of hospitals and doctor’s of- fices become more interconnected. For example, the program requires physicians

to make use of EHRs

that meet interoperability and other requirements in 50 percent or more of their patient visits, including vis- its that take place in ASCs and other locations that are not eligible for in- centive payments. This means that physicians who use ASCs extensively

comprehensive interoperability in a timely manner leaving our health care system trapped in information silos, much like it was before the incentive payments.” In contrast, other observers, such as the Health Information and Management Sys- tems Society, point to the continued growth in adoption of interoperable systems as evidence that the program is beginning to work. Ultimately, time will tell whether

the government program is successful in

achieving interoperability among hospital and physician health informa- tion systems. But if other aspects of our lives are any indication, it is inevitable that consumers will begin to expect in- teroperability of their health records. The ultimate goal of interoperabil- ity and universal portability of health care data is likely be achieved only if all providers—not just physicians and hospitals—are part of the process. This means that ASCs and other provider groups that have been left on

Those providers [that are not included in this program], however, will be affected as the information systems of hospitals and doctor’s offices become more interconnected.”

may push the facilities to adopt tech- nologies that interface with their practice’s EHR systems or to be able to use portable devices loaded with their office systems so that they comply with the requirement that appropriate EHR is available during a visit to an ASC. Opinions differ about how effec-

tive this program has been in actually achieving interoperability. In an Oc- tober 2012 letter to the US Depart- ment of Health and Human Services (HHS), members of the US House of Representatives called for fund- ing under the EHR incentive/pen- alty program to be stopped because the program has “fail[ed] to achieve

the sideline by programs designed to promote interoperability will need to look at ways to meet their own health information needs while developing strategies to exchange information with the health information infra- structures of others. This will be a complicated task, especially as the development of health information systems will be in flux as Medi- care’s expansive EHR promotion program plays out and technological advances are made. ASCA will con- tinue to work to keep its members informed about new developments and to represent the diverse interests of ASCs in ongoing discussions of EHR development.


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