Electronic Health Records: The National Perspective

In 2004, President George W. Bush called for the establishment of a national health information technology (HIT) program by the year 2014. As the American Medical Association (AMA) notes on its Web site, the magnitude of the President’s goal is not insignificant.

According to studies by the Medical Group Management Association and the RAND Corporation, only 20% of large and mid-size medical groups and 15% of small practices have adopted an electronic medical records (EMR) system.

Two terms have been used interchangeably for health information technology: EMRs and electronic health records, or EHRs. The Health Information and Management Systems Society (HIMSS), however, believes that the concepts of the two differ. The HIMSS identifies the EMR as the legal record created in hospitals and ambulatory environments that is the source of data for the EHR. According to the AMA, EHRs encompass data of the full patient history across providers and health systems.

To get the ball rolling on President Bush’s call to action, the US Department of Health and Human Services (HHS) established the Office of the National Coordinator for Health Information Technology (ONCHIT) in 2004 to support efforts across government and the private sector to develop the standards and infrastructure to support more effective use of information technology, with a goal of improved health care and reduced health care costs.

In November 2004, the ONCHIT requested national input on the development of a nationwide health information network, or NHIN, and how it could be governed, financed, operated, and supported. Nearly 5000 pages of information from 512 organizations and individuals resulted. According to the ONCHIT, the consensus was that an NHIN should be a private/public, decentralized organization that reflects the interests of all stakeholders (pubic and private), while safeguarding the privacy of personal health information and following standards.

Early on, the ONCHIT appointed an American Health Information Community (AHIC) to represent various stakeholder groups (payers, employers, physicians, etc.) in discussions around the adoption of HIT and the establishment of the NHIN. Late last year, the AHIC agreed on a set of health care information technology standards for maintenance of personal health records, transmission of laboratory results, and disease outbreak management.

At HHS’ request, the international standards-setting organization known as Health Level 7 (HL-7) has established a draft standard defining the functions needed for an EMR. And, in November 2005, the HHS awarded $18.6 million in contracts to four technology groups to design prototype NHIN architecture for health care information that can follow consumers throughout their lives.

Toward the President’s goal of private sector certification of health information technology products, the newly established nonprofit Certification Commission for Healthcare Information Technology (CCHIT) was awarded a three-year contract by the HHS in September 2005 to develop and evaluate certification criteria and create an inspection process for HIT in three areas: ambulatory electronic health records (EHRs) for the office-based physician or provider; inpatient EHRs for hospitals and health systems; and the network components through which they interoperate and share information.

Meanwhile, Congress has entered the fray with separate bills based in the House and Senate, covering such aspects as data storage, recommendations for a national committee to develop standards, and a permanent structure to govern national interoperability standards. The House and Senate versions differed in several other areas, however, and a fall meeting between lawmakers from both branches filed to resolve differences in the bills prior to congressional adjournment for the elections.

Sue Pondrom

©2007 The Triological Society