On a near-annual basics, federal agencies provide updates on EHR adoption that serve as a bellwether of the healthcare’s industry technical capabilities, most notably the Office of the National Coordinator for Health Information Technology.
However, reliance on these facts and figures can be problematic as a result of varying definitions of EHR technology.
As recently as May 31, ONC published EHR adoption data via the Health IT Dashboard reporting that 83.8 percent of hospitals were using a basic EHR system and that 96 percent possessed a certified EHR technology.
At first glance, the two figures are significant. A reader could easily infer that hospital EHR use is near ubiquitous. However, upon further review, that is not the case. The proof is in the pudding and the pudding is semantics.
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What is a basic EHR?
The ONC data brief serves as a cautionary tale into health IT statistics. In this case, word choice is at the crux of the matter.
Semantics are important to understand why those two percentages are difference and how their significance matters, and a reader is forgiven for misreading them and then scratching her head.
The appendix to the brief clearly indicates the EHR functionalities warranting whether an EHR system is basic or comprehensive certified EHR technology needs to wait a moment.
According to the federal agency responsible for promoting provider health IT use, a basic EHR system includes the following EHR functions:
- Patient demographics
- Problem lists
- Medication lists
- Discharge summaries
- Computerized physician order entry for medications
- Viewable lab, radiology, and diagnostic test results
In comparison, a comprehensive EHR has the following EHR functions in addition to the aforementioned:
- Physician notes
- Nursing assessments
- Advance directives
- CPOE for medications for lab reports, radiology tests, consultation reports, and nursing orders
- Viewable radiology images, diagnostic test images, and consultant reports
- Decision support of clinical guidelines and reminders, drug allergy results, drug-drug interactions, drug lab interactions, and drug dosing support
On the one hand, the EHR captures simple structured data. On the other, this structured data has the support of additional images and information. In neither case is the capacity for EHR interoperability and health information exchange a defining feature.
Then comes the matter of possession of certified EHR technology, or CEHRT. ONC defines CEHRT as “EHR technology that meets the technological capability, functionality, and security requirements adopted by the Department of Health and Human Services.” That’s not much to go.
The ONC definition, however, does indicated that CERHT “includes the capability to securely work with other certified EHR systems to share information.”
Additionally, the federal agency provides an explanation of CEHRT possession as “either the physical possession of the medium on which a certified EHR system resides or a legally enforceable right by a health care provider to access and use, at its discretion, the capabilities of a certified EHR system.”
Possession may be nine-tenths of the law in criminal law, but in a healthcare setting it means nothing unless it contributes to care delivery and coordination in the pursuit of improving patient outcomes.
In the example of hospital EHR adoption, these healthcare organizations have ready access to EHR technology for documenting the basics of patient care yet lack the ability to exchange this information with other providers. For patients receiving care from disparate providers, this should not come as a relief. Given the growing emphasis on use cases for current and nascent technology, the takeaway from this ONC data brief is that its findings are relatively meaningless.
Date: July 29, 2016