By Leslie Medley
Advance for Health Information Professionals
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President Obama, like every other president, has signified many changes he would like to see. Whether they are social, political or economic, the changes are always meant to push the American people a little further. We are asked to grab not what is within our grasp, but that which is just outside of our reach. To that end, sometimes the changes take hold and sometimes not.
One of the Obama Administration’s goals is to start modernizing health care. And through a series of stimulus packages that are in the billions of dollars, to incorporate an EHR system that may help reduce “preventable medical errors.” There are many obstacles to overcome to make an EHR effective, but the outcome could make a dramatic impact on health care. But what effect will it have on the MTs and medical transcription service organizations (MTSOs) out there?
One obstacle to overcome is privacy, or perhaps lack thereof in an EHR system. Multiple access points of patient data over an open network like the Internet increases possible loss of security. As electronic data may be more difficult to secure, it may even mandate a stricter HIPAA definition in protecting this patient data. HIPAA, which regulates the use and disclosure of certain information held by “covered entities,” establishes regulations for the use and disclosure of protected health information (PHI). And though security practices for networks have been established, wireless networks may pose a few more risks.
Another significant obstacle is older record integration with the newer EHR system. We have all seen it. The file rooms filled to the brim. Boxes half crushed with the lettering on the front written in black magic marker. And invariably the box where the Smith records are (Sl-Sz) was found in the Bs. These files need to be a part of the records for pre-existing conditions, histories and similar information. Scanning these documents is possible. But the process is extremely expensive and very time consuming. The differences in original sizes, as well as degradation of the material, may even make some of the scans illegible. In addition, destroying data in a shredder is foolproof, but destroying electronic data may be a little more concerning.
Add to this the ever increasing financial limitations as they relate to hardware, software and networking obligations to utilize an EHR on a system wide scale. Many facilities are experiencing a time of fiscal restraint right now; particularly smaller facilities or those that have a large network of hospitals to maintain. The available budgets may not allow for the basic infrastructure needed. However, with the advancement of certain software programming languages such as Java, innovative wireless technology may be able to defray some of the cost associated with the system upgrade.
Many standards are in place that will help to enable specific aspects of a future EMR. ASTM International Continuity of Care Record is a patient health summary standard based upon XML, allowing easy interoperability between different entities. ANSI X12 is a set of transaction protocols used for transmitting virtually any aspect of patient data. This is used for transmitting billing information, because several of the transactions became required by HIPAA for transmitting data to Medicare. DICOM is a heavily used standard for representing and communicating radiology images. HL7 messages are used for interchange between hospital and physician record systems and between EHR systems and practice management systems. HL7 Clinical Document Architecture documents are used to communicate documents such as physician notes and other material.
In conclusion, every facility has different and unique environments. Any EHR system will usually need to be custom designed. This is because some of the available EHRs are based on templates that are initially very broad in scope. These templates may then be customized with the vendor to better fit data entry based on a specialty, facility or other specified needs. There are also EHR systems available that do not use templates for data entry and therefore can be easily personalized by each individual user. This is where other data entry methods such as concept processing, voice recognition and transcription come into play. With an MT’s ability to grow and expand within his/her vocation, the doors that will open up within the health care community for qualified MTs will be many. If nothing else, maybe MTs can get back to having one PC on their desks and not three.
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