CHAPTER 25

Although a majority of focus on implementation of electronic health records (EHRs) in the first two decades of the 21st century has been on acute care facilities and physician offices, their use in long-term care facilities has been increasing rapidly and is becoming more the norm. New and expanded innova- tive care delivery and payment models authorized by the Affordable Care Act have also supported the trans- formation to EHRs (1). The Institute of Medicine’s landmark reports, To Err Is Human: Building a Safer Health System (2), followed by Crossing the Quality Chasm: A New Health System for the Twenty-First Century (3), set the stage for the move away from paper health records, citing the danger to patients from mistakes that EHRs could help prevent. Measurement of patient outcomes—and research in health care in general—has been revolutionized by the ability to store data electronically and extract desired information in an instant. Concerns about resident/patient privacy and confidentiality have been somewhat mediated by federal and state laws designed to prevent unauthorized access to this information.

ELECTRONIC HEALTH RECORDS An EHR is an electronic version of a client’s medical history that is maintained over time and may include all of the key administrative clinical data relevant to that person’s care under a particular provider, includ- ing demographics, progress notes, problems, medica- tions, vital signs, past medical history, immunizations, laboratory data, and radiology reports. The EHR auto- mates access to information and has the potential to streamline the clinician’s workflow. The EHR can also support other care-related activities directly or indirectly through various interfaces, such as evi- dence-based decision support, quality management, and outcomes reporting.

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Electronic Health Records and Other Health Care Technologies

EHRs are the next step in the continued progress of health care that can strengthen the relationship between clients and clinicians. The timeliness and availability of data will enable providers to make better decisions and provide better care. EHRs can improve the client’s care by

reducing the incidence of medical error by improving the accuracy and clarity of medical records; and

making the health information available in real time for providers directing the resident’s care, reducing duplication of tests, reducing delays in treatment, and enabling clients to make better, well-informed decisions.

Technology and Public Policy The Health Information Technology for Economic and Clinical Health (HITECH) Act, a component of the American Recovery and Reinvestment Act of 2009, granted the US Department of Health and Human Services (HHS) the authority to establish programs to improve health care quality, safety, and efficiency through the promotion of health information technology (HIT), including EHRs and private and secure elec- tronic health information exchanges. It represents the nation’s first substantial commitment of federal resources to support the widespread adoption of EHRs. To receive federal incentive money, participants in the incentive program must meet the Centers for Medicare & Medicaid Services (CMS) criteria known as the Meaningful Use provision. Meaningful Use is the set of standards defined by CMS that governs the use of EHRs and allows eligible providers to earn incentive payments by meeting specific criteria (4). Presently eli- gible providers include physicians, dentists, nurse practitioners, certified nurse midwives, and physician assistants practicing in a federally qualified health