As a Healthcare Information management (HIM) professional for the past 40 years, I have experienced the transition of the paper medical record to today’s modern Electronic Health Record (EHR). The thought of having one’s entire clinical history recorded on paper that could easily have been misplaced or accidently destroyed always made me nervous. You could not simply go to the publisher and request another copy because there was only one original record. Thirty years ago, when the Institute of Medicine began promoting physicians to embrace electronic records, the general reaction was good idea but it would be difficult and too expensive. In 1996 the Healthcare Insurance Portability and Accountability Act (HIPAA) was introduced. This legislation began the shift for many healthcare providers and organizations to electronic clinical systems. In 2004, President Bush made mention of the EHR in his State of the Union address in which he called for industry-wide adoption of the EHR by 2014. President Bush’s mandate was supported by the American Recovery and Reinvestment Act of 2009, which directed funding and incentives to healthcare professionals and facilities who demonstrate “meaningful use” of a certified electronic health record system. In my opinion, this was the catalyst that triggered the EMR adoption.
Meaningful Use had many objectives including: improve quality, safety, efficiency, engage patients/family, create improved clinical outcomes, reduce medical error, and improve care coordination. I believe the “jury is still out” on the achievement of many of the objectives, but without question the rate of EMR adoption skyrocketed over the past seven years.
Over the course of my career I have had many conversations with physicians regarding their view of the EMR. Most of the physicians I speak with recognized the need for the EMR in their practice, but many stated they did not actually see the benefits and were somewhat disappointed in the time it took them away from the patient. Some even went as far as calling it “Meaningless Use”. Needless to say that since physician use of the EHR was linked to incentive reimbursement, most attempted to comply with the standards.
In the Fall of 2016 a new piece of legislation was put into final form—Medicare Access and Children’s Health Insurance Program Reauthorization Act (MACRA). This legislation repealed the Sustainable Growth Rate (SGR) formula and also puts in motion the process to transform physician payment from a system that rewards volume to one that recognizes quality and value. Physicians will now have more control and choice over how they get paid by participation in either a Merit-Based Incentive Payment System (MIPS) or an Alternative Payment Model (APM). The MIPS program combines existing quality and performance programs—Physician Quality Reporting System (PQRS), Value Based Modifier and Meaningful Use, and rolls them into a single performance program. I believe based on comments I have gathered from several physicians, this change is welcomed. MACRA will provide the physician with the ability to minimize provider burden by collecting data that are part of the existing clinical workflow.
As the EHR continues to evolve and clinical data growth accelerates at an exponential rate, it is important that this information is managed both compliantly and efficiently.
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