ABCs Of EHR for the Ambulatory Care Nurse, The

AAACN Viewpoint, Sep/Oct 2006 by Colorafi, Karen

"While national adoption rates for health information technology are slow climbing, we are seeing a widening gap between larger hospital and physician groups and their smaller counterparts. Physicians and providers face many barriers to adopting health information tools. We need to create incentives for providers to adopt electronic medical records and ensure the products they buy will do the job."

-David Brailer, MD, PhD

National Coordination for Health Information Technology

U.S. Department of Health and Human Services

You've got your coat on and your bag packed. The phone rings on your way out the door, and like any good ambulatory care nurse, you run back and answer it. It's your two o'clock patient calling. Mrs. Jones can't remember if the doctor said to take her new atenolol prescription in addition to the hydrochlorothiazide or instead of the hydrochlorothiazide. You take a deep breath. You were busy splinting little Bobby's ankle when Mrs. Jones left and have no idea what the doctor's medication orders were. Mrs. Jones' chart left the clinic an hour ago with the doctor. He had to leave to do an admission at the hospital and planned to finish his documentation tonight at home. You have no choice but to apologize and tell Mrs. Jones you'll get back to her tomorrow. Sound familiar?

In this day and age where you can shop online, pay your bills online, take American dollars out of a bank machine in Mexico, and print your airline boarding pass on your home computer, it is readily apparent that the health care industry has been slow to transition to electronic solutions. Virtually every other industry - financial, telecommunications, transportation, manufacturing - uses information technology (IT) solutions to help them address workflow issues, productivity, and safety concerns. Despite the lessons learned from their experience, only 14% of physician practices are electronic today, and just 14% more have any intention of becoming electronic within the next year (Morantz, 2005). Clearly, we have a long way to go to meet the President's goal of widespread electronic health record (EHR) adoption by 2014.

Presidential Order

When President Bush signed Executive Order 13335 on April 27, 2004, he established the Office of the National Coordinator of Health Information Technology. Not three months later, Dr. David Brailer, the newly appointed National Coordinator for Health Information Technology, released his strategic framework as a plan of action to ensure that all Americans have electronic health records within 10 years.

The framework for strategic action has a four-pronged approached. First, inform clinical practice. This is all about getting clinicians to use EHR technology. Strategies to improve widespread use include reducing the risk of investment, incentivizing early adopters, and promoting adoption in underserved and rural areas.

Second, nurses must interconnect clinicians. This strategy addresses the need to foster regional collaboration, develop national health information networks, and coordinate the federal health information systems.

Next, technology must be used to personalize care. Far from concerns about technology encouraging "cookie-cutter medicine," technology can allow the use of personal health records (PHRs) that patients themselves can maintain, can allow and promote telehealth systems, and can actually enhance consumer choice.

Finally, EHRs will undoubtedly improve population health by unifying public health surveillance systems, accelerating the dissemination of evidence-based research, and streamlining quality monitoring and reporting (Brailer, 2005).

The National Players

Nationally, there is tremendous support for what is known as the "HIT Movement," or health information technology movement. The Certification Commission for Healthcare Information Technology (CCHIT) has just released standards for certifying EHR products, which should make it easier for clinicians to know what they're getting when they make the decision to purchase an EHR. Multiple professional groups produce reports on the quality and ease of use of various EHR products that are available to ambulatory care practices (sometimes for a fee). In addition, professional associations like the American Academy of Family Physicians (www.centerforhit.org), the American College of Physicians (www.acponline.org), and the Health Information Management Systems Society (www.himss.org) are promoting the adoption of EHRs in ambulatory care through Webbased strategies and classroom-based sessions.

The Centers for Medicare & Medicaid Services (CMS) has recently embarked on a three-year project with the state Quality Improvement Organizations to promote the adoption of electronic health records in ambulatory primary care settings (www.doqit.org). The program, called DOQ-IT (which stands for Doctor's Office Quality Information Technology), aims to provide consulting services at no charge to primary care practices as they progress through the roadmap to fully implementing an EHR (see Figures 1 -3).