Information Technology Reference
In-Depth Information
Chapter 2
Federal Policies and Initiatives
A number of new federal initiatives are designed to promote the adoption of electronic
health records and health information exchange, and to create new care models and
processes for chronic disease management enabled by these technologies. The health
informatics efforts are being managed by the Office of the National Coordinator for
Health Information Technology (ONC), a new federal agency created by the Bush
administration to implement the goal of universal adoption of electronic health records
by 2014. Major commercial health insurers have adopted their own versions of some
of these programs, suggesting their impact will be health system wide. Even though
I describe these initiatives separately, it is important to consider their potential cumu-
lative effect.
Certi fi ed Electronic Health Records
First, we need to deal with a terminology issue. Early on the term “electronic medi-
cal record” (EMR) was used to designate a computer-based patient chart. At that
time the focus was generally only on the physician. Technologies like the Internet
offer the prospect of engaging all stakeholders, including the patient, in a networked
healthcare system where data is shared and a more complete clinical and behavioral
picture is available to all. This complete picture is now called the “electronic health
record” (EHR). The EMR is a component of it. It also represents a shift in mindset
away from treating disease and toward maintaining health. [
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The federal “Meaningful Use” program we will discuss next requires that pro-
viders (“eligible professionals”) install a certified EHR. A detailed discussion of
certification is beyond the scope of this topic, but a section of the final rule pub-
lished by ONC provides a working definition: “An electronic record of health-
related information on an individual that: (A) Includes patient demographic and
clinical health information, such as medical history and problem lists; and (B) has
the capacity: (i) to provide clinical decision support; (ii) to support physician order
entry; (iii) to capture and query information relevant to healthcare quality; and
