Running head: PROJECT ASSIGNMENT 4 1

Meaningful use, myriad HIT systems and challenges in the way of interoperability of EHRs
Joann Charies
18SUNS HITT2327: Vendor Specific HITT Systems WEB
Midland College
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Abstract

The HITECH Act was designed in 2009 to encourage the implementation of meaningful

use of HIT. Meaningful use is a government-directed initiative to encourage the use of EHRs by

the medical professionals and health information industry. Myriad HIT systems function in a

collaborative way so that the EHRs are managed in a systemic way between different entities.

Meaningful use has led to an increase in the adoption of EHRs, which has demanded

interoperability in order to enhance the quality of care for patients. However, there are certain

challenges in the way of interoperability of EHR systems that are resistance in the way of

successful adoption of EHRs.

Problem statement

Although there is widespread adoption of meaningful use, yet there are barriers to circumvent to

achieve maximum acknowledgment of the EHRs.

Literature Review

The use of has become a challenging issue in healthcare because of meaningful use

requirements. The documentation of EHR can be difficult when multiple HER templates are used

to document conditions that are similar. The aim of this article is to assess and evaluate the

effectiveness of integrating five History of Present Illness (HPI) templates for upper respiratory

complaints into one general HPI template. For this purpose, a pretest/post-test design was

employed so that effectiveness of changes in the commonly employed HER templates could be

evaluated (Bariggs & Carter-Templeton, 2014).

A 16-item pretest was delivered to the participants and a 17 item post-test including open

ended questions was given. Survey questions were designed in accordance with Technology
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Acceptance Model questionnaire. The responses to the open ended questions indicated that

improvement is required in ease of use for participants that are employing new template. The

responses suggested that further work is required in order to make the template more descriptive

and clear.

Fadden (2017) has attempted to help physicians adopt and use EHRs in an effective

manner. Thus, a practical framework for the physicians to retrieve maximum output from EHR is

provided. For example, to simply the complicated process of navigation, the author suggests that

the information displayed on the screen must be handled through use of denser displays and

larger monitors with sharper resolution. Similarly, to overcome the challenging task of reviewing

patient information efficiently, attention should be paid on default filters that determine what

information is pulled into view on the opening of the chart.

It is important to identify an accurate diagnosis and communicate to the people effectively.

Crosswalks can help translate physician-entered data into most accurate ICD-10 or other codes.

Favorites functionality is a great way to save unusual orders that have marked detail variability

and it is easier to pull out information from the favorite list. Documentation can be supported

through computer macros, auto-text and third-party vendor templates.

Although there has been widespread adoption of electronic health records (EHRs) in a large

number of hospitals and clinics, their function and design could lead to errors and medical

mistakes Mary (2018). Therefore, it is important to perform voluntary and mandatory resting of

systems. According to the report by Pew Charitable trust, AMA and Medstar, the design,

customization, and use of EHRs by doctors, nurses and other clinical staff could lead to

inefficiencies related to workflow challenges.

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A major concern for the report writers is the customization that occurs after the

implementation of the system in order to be tailored according to specific workflows.

Customized EHRs are often distinct from the original version and therefore are questionable

regarding safety. A literature review was thus conducted for the report and expert panel

consisting of doctors, nurses, pharmacists, and health IT experts gave recommendations on how

to ease usability and assure safety regarding EHR software cycle which can be utilized as the

basis for a voluntary certification process for developers and HER implementers. They also

devised criteria for rapid safety test and devised sample test case scenarios based on reported

EHR safety challenges.

In a study by Taylor (2017), literature research was done to determine the current challenges and

devise solutions for effective utilization of EHRs in chiropractic practice. Databases that were

researched included Pubmed, Index of Chiropractic Literature, and Current Index to Nursing and

Allied Health Literature for a period of four months. The articles were categorized into common

solutions and problems, These were filtered by application to chiropractic or educational

organizations.

The search led to 45 papers consisting of case reports of HER implementation, past experiences

with the conversion from paper systems and implementation of EHRs in small scale offices and

chiropractic centers. There was a scarcity of literature directly linked to chiropractic EHRs.

Incorrect software use, defective implementation, workflow pressure, financial considerations,

and insufficient training negatively affected the quality of the record.

Documentation errors are quite obvious in the EHR software. A number of factors such as

improper utilization, difficulty integrating EHR into the clinical setting led to poor

implementation of the electronic version of the clinical record. The suggested solutions that
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could overcome documentation errors include EHR training, continued financial incentives, and

appropriate implementation process and utilization of available software features.

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Introduction to meaningful use of CEHRT

According to a report by the Institute of Medicine, there are almost 98000 mortalities in

America caused by medical errors. There are more deaths as a result of medical errors as

compared to deaths from HIV, breast cancer and vehicle associated road accidents.

Miscommunication led to almost 80% of the errors (Chin & Sakuda, 2012). Therefore, a major

transformation in healthcare was required. In 2009, the HITECH act was introduced that

supported the use of meaningful use of electronic health records and the concept was an effort

initiated by the center of Medicare and Medicaid Services in collaboration with the National

Coordinator for Health IT (ONC) and a provision of 17.2 billion dollars was allotted for EHR

use and HIE development. Meaningful use is referred to the adoption of certified EHR

technology in a meaningful way such that the certified EHR technology is consistent in allowing

electronic exchange of health information to improve the quality of care. In delivering certified

EHR technology, it is important for the provider to abide by the Health and Human Services

information related to the quality of care and other measures (CDC. Gov. 2017).

The concept of meaningful use is based on the five aspects to achieve the health outcomes which

are

1. Improving care coordination

2. Improving public health and population

3. Ensuring security and privacy protection for personal health information (PHI)

4. Engaging patients and families in their health

5. Improving quality, safety, efficiency, and reducing health disparities

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In 2011, the adoption rate of EHR technology was identified in different states and it was

revealed that it was 40% in Louisiana, 84% in North Dakota and 70.5% in Hawaii. There has

also an increase in the intent to utilize meaningful incentives from 40% in 2010 to 52% in 2011.

Most importantly, they would be aware of their health condition and the course of treatment

which will give them more of a chance to get involved in their own health care (Chin & Sakuda,

2012).

 Meaningful use for the patients

Through meaningful use, the patients would be guaranteed access to their own records for their

own requirements. Electronic access to medical records will save the time taken to call and

request the documents and increase the risk of waiting for a longer time to retrieve the

documents. The patients would be able to see if their information was misspelled or erroneous.

They would be able to access details of the provider and the required dates of service.

 Meaningful use for the providers

There are incentive programs developed for the healthcare providers to assist in the

adoption of meaningful use of CEHRT by the Office of National Coordinator of Health

Information Technology (ONC) and the Centers of Medicare and Medicaid Services

(CMS) (CEHRT, 2017). The program has also given standards in order to qualify for the

program. For example, the physicians require EHR that storage, retrieval, and sharing of

data should be in such a way that it is beneficial to the patient. The physicians need to get

certification to qualify for the incentive program and to get reductions in the Medicare

payments. Moreover, there should be attestation by the providers to acknowledge that

are not voluntarily involved in the restriction of interoperability of CEHRT. This

provision is termed as prevention of information blocking- attestation.

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In order to achieve and standardize the meaningful use, there are following guidelines given by

the Centers and Medicare and Medicaid Services.

1. Willful readiness to transform the paper record system to electronic records

2. Planning to sustain the right system and setup

3. Choosing the appropriate system for the practice. Some systems demand an installed

software while others can directly access online.

4. Testing of the system to make sure that the system will be functional after going live.

Staff training is also done using model patients to practice setting appointments, creating

and transferring electronic records.

5. Achieve the health outcomes associated with meaningful use related to safety,

quality,efficacy, care coordination, involving families and patients, ensuring security and

improving the health of overall population

6. Evaluation of the system to see it works best for the company in terms of meeting goals,

the requirement of training, adjustments for staff roles and responsibilities, reliability and

speediness of technology and need for hardware

Myriad HIT systems

The design of Health information IT is to support one another. The systems are meant for

providing services to the patients through internal customers such as the clinicians,

managers, administrators and other staff. Every individual has the right to access different

components of the system. For instance, after the physician produces the document, it is

to be accessed by the billing team through the billing software which is connected to the

EHR software.
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The billing team, in turn, analyze the note and associated charges and this claim is

then passed on to the insurance company for completing the payment through a clearing

house software. The claim is then electronically provided by the clearinghouse software

after connecting to the insurance company. Another healthcare provider for the same

patient may also require the doctor’s note. Sometimes, there is a patient portal which can

provide access to the patient for their own records. In absence of such facility, the staff

would require whether the other healthcare provider is in a position to accept the

electronic health records. There might be an issue of outdated systems and older versions

of software with the provider. In such cases, the information can be delivered through an

email or fax.

Barriers in the way of implementation of meaningful use of EHRs

The organization faces obstacles in the way of transformation leading to weakening of

the organization if the organization lacks readiness. In view of Meinert, slow adoption is

reflective of strong resistance among the physicians because physicians are the main role

players in the user group of EHR (Ajami & Bagheri-Tadi, 2013). Some of the factors

leading to resistance towards implementation of EHRs are listed below:

 Time

There is a scarcity of time available to physicians to become familiar with the EHRs, implement

and receive training to take maximum advantages. Physicians lack the time to fully make use of

systems and learn new features or involve in training sessions.

 Cost

There is an increased cost associated with owning an IT structure or utilizing external vendors

for the EHR services. The costs include monitoring, negotiating, coordination and purchase price
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costs. These costs might outweigh the benefits of EHRs. Costs appear to be the biggest barriers

in the way of EHRs adoption in medium to small-sized firms, which do not possess large IT

budgets. Thus, the high upfront financial costs serve as a primary barrier to EHR adoption.

 Lack of computer skill

There is a need for a considerable level of typing skills, familiarity and concentration for user

interface which is not normally present among normal computer users. Thus, the EHR systems

underestimate the level of computer skills required from the physicians and the practice appears

complicated to the physicians. Also, many physicians lack the good typing skills required to

enter medical information, notes, and prescriptions into the EHRs (Ajami & Bagheri-Tadi,

2013).

 Security and privacy concerns

There is a lot of evidence present about the risks associated with security and confidentiality of

the patient's information in the EHRs.

 Communication among users

Communication among users is a very significant aspect regarding the acceptability of the

systems by the users. It is important to encourage the users through social networks to facilitate

the innovation users to endorse social interaction which is an important tool to facilitate the

adoption of innovation.

 Negative effect on the doctor-patient relationship

There are issues related to the interaction between the patients and doctors regarding the use of

EHRs. High-Quality care can be achieved through good eye contact with the patient. It is
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reported by a large number of patients that they stop using EHRs because searching for buttons

and menus negatively affects encounter with the patients (Ajami & Bagheri-Tadi, 2013).

 Lack of Physical space

Because of already congested work organizations, there might be no space for a paper chart

while using EHRs, unavailability of private rooms for computer use, unsuitability of computer

stations for tall-users and absence of physicians at the computer stations.

 Technical assistance

There might be unavailability of support staff for technical assistance

 Interoperability

Interoperability is an important factor that improves the dissemination of medical knowledge

among physicians, reduce extra work of care providers and decrease the cost of EHRs.

 Mistrust for vendors

Lack of vendor support may also contribute towards resistance in the adoption of EHRs. Lack of

suitable vendors leads to non-viable products or competitors that can provide effective services.

Physicians suspect that the vendors will either run out of business or disappear from the market

as they are not qualified to deliver appropriate service.

 Patient satisfaction

Since more of the physician’s time will be spent in interacting with the computer as compared to

the patient, so the patients will be less satisfied with the physician-patient communication.
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Conclusion

Although EHR systems have many positive aspects of medical practice, yet their

utilization and adoption rate is quite low and face a lot of resistance by the physicians. The

electronic health record use demands the presence of certain user and system characteristics,

support from others and facilitation by the organization and environment. For attaining

maximum benefit regarding patient safety, it is important for the clinicians to effectively use

these systems by paying sufficient attention to all the factors mentioned in the study. Providing

training to medical students on EHR is one of the most effective solutions to accelerate the

adoption of EHR.
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References

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Bariggs, B. & Carter-Templeton, H. (2014). Electronic Health Record Customization: A Quality

Improvement Project. Online Journal of Nursing Informatics (OJNI), 18.

CDC. Gov (2017). Public Health and Promoting Interoperability Programs (formerly, known as

Electronic Health Records Meaningful Use). Retrieved from

https://www.cdc.gov/ehrmeaningfuluse/introduction.html

Chin, B. J., & Sakuda, C. M. (2012). Transforming and improving health care through

meaningful use of health information technology. Hawai'i journal of medicine & public

health : a journal of Asia Pacific Medicine & Public Health, 71(4 Suppl 1), 50–55.

Fadden, M. (2017). Lessons from the Road to EHR Usability. Family Practice Management,

24(3):21-24.

Mary, B. (2018). EHR Customization Can Result in Medical Errors, Incomplete Testing and

Certification. Retrieved from https://journal.ahima.org/2018/08/30/ehr-customization-can-result-in-

medical-errors-incomplete-testing-and-certification/

Taylor D. N. (2017). A Literature Review of Electronic Health Records in Chiropractic Practice:

Common Challenges and Solutions. Journal of chiropractic humanities, 24(1), 31–40.

doi:10.1016/j.echu.2016.12.001