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Electronic Health Records

Evaluating EHR systems

What practice owners should consider when looking at electronic health records systems. By Vivek Jain


assage of the HITECH Act provides medical practices a windfall of incentives (ranging up to $44,000) to adopt and use a certifi ed electronic health record (EHR) system in a meaningful way. Because of this, there has been a renewed effort from solution providers to promote solutions as a one-stop shop for all the needs of the practices. At the same time, practices are trying to implement a solution and reap the benefi ts ASAP. However, before the practices start scout- ing and evaluating products, it is important to understand that the implementation of an EHR product is a complex activity requiring dedicated effort and due diligence. The numbers of implementations that fail in the fi rst year of their implementation provide testimony to this. This article outlines a few criteria that every medical practice owner should look for in an EHR system in order to make an informed decision.

Setting the expectations First, practices should clearly understand, defi ne and highlight the reasons for an EHR implementation, and the benefi ts they expect from the implementation. The HITECH act and the monetary benefi ts should not be the criteria or the purpose for the implementation. The practices should start with the list of work fl ows they would like to get automated. The work fl ows can be evaluated based on their importance and their impact on the effi ciency and profi tability of the practice.

Standards compliance

The healthcare industry boasts one of the strongest compliance standards. The standards are based around two major factors: privacy of patient data; and interop- erability and effi ciency of the integrated systems (i.e., payers, pharmacies).

Some of the most important standards that an EHR product should be compliant with include:

HIPAA Title II of the HIPAA Act, known as the Administra- tive Simplifi cation (AS) provisions, establishes national standards for electronic health care transactions and

22 August 2010

national identifi ers for providers, health insurance plans and employers. The act requires the patient information be kept private and secure. The Act also proposes strict civil and criminal penalties for violations. The standards are meant to improve the effi ciency and effectiveness of the nation’s healthcare system by encouraging the widespread use of electronic data interchange.

The HITECH act of 2009 proposes changes to the

HIPPA Title II, extending the HIPAA rules to business associates of covered entities.

Meaningful usage (MU)

One of the preconditions (under the HITECH act) for availing the incentives is based on the EHR system meeting the various compliance details set by the ONC, and hence physicians have to ensure that the product be- ing considered has the basic MU covered. The rules were fi nalized last month. The details can be found at http://


HIPAA has mandated that the new standards (ICD-10) be adopted by practices by October 2013. Therefore, it is imperative that an EHR product is at least ICD-9 compli- ant and has the necessary apparatus and plan laid out for a future upgrade to ICD-10 before the set timelines.

Certifi cation by federally recognized agency Practices should ensure that the product is certifi ed by a federally recognized certifying agency. However, Health and Human Services (HHS) has yet to announce the list of these agencies.


It is strongly recommended that practice owners insist that the EHR solution be certifi ed, and the vendor should ensure that the product will be kept up to date with the latest releases in a timely manner without any signifi cant cost to the practice owners.


Since EHR products are intended to increase the ef-

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