Credit: Mary F. Calvert
Stephen Warren says EHRs have helped VA improve health outcomes for its patients.
About a decade ago, patients in the Veterans Affairs Department were below the national average in receiving inoculations for maladies such as influenza, pneumonia and shingles, a factor that influences mortality rates, health outcomes and quality of life. Today, the department is leading the nation in inoculation rates, with figures approaching 90 percent, and is seeing corresponding improvements in health outcomes and quality of life.
Electronic health records (EHRs) have played an important role in this improvement, says Stephen Warren, acting assistant secretary in the VA’s Office of Information Technology.
“The reason is that when a care provider is interacting with a veteran, a flag pops up in the patient’s electronic health record and says they’re due for a shot, so right there, during the encounter, you’re able to inoculate or vaccinate,” Warren says. “In the past, somebody would look at a record and send a little card via mail that said, next time you’re here, we’ll do that.”
Agencies with medical missions are finding that EHRs offer significant promise for patients and medical professionals, but many challenges stand in the way of their full adoption and integration.
Interoperability is the linchpin for realizing the potential of health information exchange (HIE). To advance objectives critical to healthcare reform, the medical community needs EHR interoperability at levels far more sophisticated than electronic data transmission through fax and email. This requires electronic data exchange through structured methods, based on common standards that allow disparate systems to communicate seamlessly, interpret data accurately and use it intelligently.
As VA’s success in using EHRs demonstrates, medical organizations have made progress in creating a roadmap for achieving widespread interoperability. Significant achievements include the creation of the Office of the National Coordinator for Health IT (ONC); development of the nationwide health information network (NHIN), a set of standards, specifications and policies for enabling HIE among public and private participants; passage of the Health IT for Economic and Clinical Health (HITECH) Act, which launched incentive programs for the meaningful use of EHRs; and establishment of national standards for secure data exchange, patient care summary structures and other medical information. Earlier this year, EHR adoption surpassed the 50 percent mark nationally.
“You can’t talk about health data exchange if you’re still faxing documents, and you can’t talk about interoperability until you make exchange electronic,” says Doug Fridsma, chief science officer and director of the Office of Science and Technology at the ONC, which oversees federal health IT initiatives. “Crossing that EHR adoption mark and developing standards that enable seamless exchange gives us the platform we need for accelerating progress toward meaningful use of shared data.”
“The second wave will be about how the medical community takes the information they get from EHR technology and uses analytical insight to make it meaningful in day-to-day interactions,” says Rishi Sood, a Gartner analyst.
The Infrastructure Behind the Benefits
EHRs can collect and organize patient information generated at physician’s offices, hospitals, labs, pharmacies and other provider facilities. This cohesive view improves outcomes by enabling diagnostic accuracy through better coordination across providers, point-of-care, and remote and mobile access.
Comprehensive EHR software integrates clinical decision-support tools that alert providers to administer preventive treatment during exams or that a specific prescription is dangerous. They increase efficiencies and cost savings by automating workflows and reducing administrative tasks, duplicative tests and travel.
To deliver these benefits while protecting privacy, EHRs require a highly available networked infrastructure running the standards-based technologies needed for any secure wireless environment. These include technologies for secure access control and authentication, networking management and monitoring, auditing and user platform support.
The growing use of mobile devices by both providers and patients will play a leading role in meaningful use of EHR data. However, anytime, anywhere access introduces security vulnerabilities. Mobile device management technologies and defense-in-depth security practices are critical to advancing EHR adoption.
For its part, the Defense Department has to manage these challenges as well as many unique to military engagements. “We’re doing a lot in the mobility area around enabling apps for handhelds and other devices,” says David Bowen, CIO of the Military Health System. Challenges include enabling access to EHR data from hostile environments with little or no networking capabilities.
What's Next for Electronic Health Records?
DOD and VA have encountered numerous challenges in their efforts to build an integrated EHR system to manage health data for soldiers and veterans. When their project to integrate EHRs proved untenable, they opted to make their existing systems interoperable. Since then, the DOD has announced its intention to deploy a commercial EHR, while the VA is moving ahead with plans to enhance its well-established EHR, the Veterans Health Information Systems and Technology Architecture.
Both will continue to improve interoperability between their systems as they pursue their own systems strategies. They’ll also expand the capabilities behind Blue Button, which lets patients access their EHRs in machine-readable formats and share them with doctors.
DOD and VA have been sharing large amounts of data for more than 10 years, says Bowen. “We probably share more health data than any two healthcare-related organizations in the world,” he says. “Much is in a computable format we can analyze, and we’re increasing the amount and types of data we exchange.”
One key EHR initiative is the Joint Legacy Viewer (JLV), an interface that provides VA and DOD personnel an integrated, read-only view of both organizations’ data. “The JLV we’ve deployed with the DOD provides an integrated view of data, whereas previously our data sets had to be viewed side by side,” Warren says.