Introduction
It is important to note that electronic health records (EHRs) open a wide range of opportunities to improve patient care, enhance healthcare performance, stimulate clinical research, and facilitate clinical practice. However, despite EHR’s core advantages, there are additional concerns in regard to the security and safety of patient data, which is why understanding and analyzing the current legislative frameworks is critical. The given assessment will primarily focus on the HITECH Act of 2009 and EHR’s implications on healthcare quality, safety, patient outcome, and the role of the informatics nurse specialist (INS).
The HITECH Act of 2009
The main points of the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 include four key provisions or subtitles. The first section focuses on the promotion of healthcare efficiency, safety, and quality with an emphasis on the utilization of health information technology by setting core standards (Tan, 2018). The next subtitle is about the assessment, testing, and analysis of health information technology, which is followed by monetary incentives through loans, grants, and other instruments covered by subtitle C. Lastly, the HITECH Act of 2009 addresses the concerns and issues of data security as well as privacy of patient health data (Tan, 2018). It contains provisions of health IT safety and the act’s relationship with other legal frameworks. The meaningful use (MU) incentive program is embedded in the act, and it enables a greater range of financial benefits to the providers of healthcare by integrating EHRs in the most appropriate and meaningful manner.
HITECH’s Impact
Therefore, the HITECH Act and meaningful use incentive program directly and strongly incentivized healthcare organizations to adopt health technology to achieve its core objective of efficiency, safety, and quality. A study found that “recent gains in EHR adoption can be attributed specifically to HITECH, which suggests that the act could serve as a model for ways to drive the adoption of other valuable technologies” (Adler-Milstein & Jha, 2017, p. 1416). In other words, the HITECH Act was one of the most powerful forces pushing healthcare organizations to adopt EHRs substantiating the meaningful use of the incentive program. Another study found that there was a significant facilitation of EHR adoption and implementation prompted by the HITECH Act of 2009, which translated to almost 40% improvement in quality of care if the latter is accompanied with proper training (Lin et al., 2019, p. 1). Thus, it is evident that the HITECH and the regulation were highly effective at facilitating the overall adoption of EHRs across all major healthcare provider sectors throughout the United States.
EHR’s Impact
EHR has positively impacted the overall quality of care by standardizing data, automating various health data collection and transfer processes, and increasing the accuracy of retrieval. It is reported that the “adoption of EHRs has enabled an array of opportunities for improvement and innovation including enhanced medical documentation for quality improvement … clinical decision support, and the development of health data registries” (Colquhoun et al., 2020, p. 1134). Thus, EHR’s influence on healthcare quality is multifaceted ranging from clinical care to documentation to information management.
However, when it comes to patient safety outcomes, EHRs can both positively and negatively impact the given metric. It was found that “rather than increasing their efficiency, EHRs have become a burden for the physicians as they ultimately increase their error rate and reduce output rate affecting patient safety” (Aldosari, 2017, p. 230). Despite the continuous and gradual improvement of the EHR system, the usefulness and utilization of the instrument’s full potential are solely dependent on the competence of the medical professional. It is stated that “proper training to the physicians on judicious usage of these EHR functions is required to extract maximum benefit” (Aldosari, 2017, p. 230). Otherwise, EHR will continue to be a mere burdensome element of the documentation process, which can increase the instances of medical errors as well as decrease patient safety.
Clinical Decision Support
An example of a clinical decision support tool within an EHR is a clinical decision support system or CDSS. For instance, it was reported that these support instruments “have been used to assist clinicians in making wise antimicrobial treatment decisions and to assist the antimicrobial stewardship program with identification of patients for potential intervention” (Cohen et al., 2017, p. 1197). In other words, considering there are many microbial infections that require adjustments on the basis of a patient’s medical history and current condition, the sheer body of data can be optimized to support a clinician. The result is that there are fewer medical errors and more accurate decisions made by medical professionals. CDSS makes it easier to derive effective stewardship decisions by combining both patient identification and antimicrobial treatment knowledge.
The example is illustrative of how the tool functions under the provided clinical setting of microbial infections. It is stated that “these systems may use medication administration or ordering data, microbiology data, estimates of creatinine clearance, drug allergy information, drug cost information and other information to guide clinician prescribing … antimicrobial therapy” (Cohen et al., 2017, p. 1197). Therefore, CDSS enables a clinician to account for a larger set of critical factors, which is normally impossible or difficult to perform. In addition, the instrument can identify suboptimal therapies among patients already undergoing some form of treatment procedures. CDSS analyzes and utilizes datasets in regards to several predetermined parameters to automatically provide the most optimal treatment modality, which enables a more precise and accurate clinical stewardship for the clinician.
Informatics Nurse Specialist
The role of the informatics nurse specialist in the current setting is to deliver and transfer medical information into the field of information technology. These nursing professionals enable optimal care delivery in the existing organization by ensuring that data quality is properly assessed, processes and guides are implemented, and new workflows are established. INS was vital in helping the medical teams to become accustomed to and proficient at using various medical systems, such as EHRs and their constituents, such as CDSS.
Conclusion
In conclusion, the HITECH Act of 2009 was among the most effective incentive programs to promote and facilitate the adoption of EHR systems across all healthcare providers in the US. The regulation of meaningful use ensured that EHRs directly benefited healthcare organizations in an impactful manner instead of being a superficial measure. EHR’s influence on healthcare quality was and continues to be multifaceted, ranging from clinical care to documentation to information management. Thus, in general, the technology has positively impacted the overall quality of care by standardizing data, automating various health data collection and transfer processes, and increasing the accuracy of retrieval. EHR’s CDSS makes it easier to derive effective stewardship decisions by combining both patient identification and antimicrobial treatment knowledge.
References
Adler-Milstein, J., & Jha, A. K. (2017). HITECH Act drove large gains in hospital electronic health record adoption. Health Affairs, 36(8), 1416-1422. Web.
Aldosari, B. (2017). Patients’ safety in the era of EMR/EHR automation. Informatics in Medicine Unlocked, 9, 230-233. Web.
Cohen, J., Powderly, W. G., & Opal, S. M. (2017). Infectious diseases (4th ed.). Elsevier.
Colquhoun, D. A., Shanks, A. M., Kapeles, S. R., Shah, N., Saager, L., Vaughn, M. T., Buehler, K., Burns, M. L., Tremper, K. K., Freundlich, R. E., Aziz, M., Kheterpal, S., & Mathis, M. R. (2020). Considerations for integration of perioperative electronic health records across institutions for research and quality improvement: The approach taken by the multicenter perioperative outcomes group. Anesthesia & Analgesia, 130(5), 1133-1146. Web.
Lin, Y. K., Lin, M., & Chen, H. (2019). Do electronic health records affect quality of care? Evidence from the HITECH Act. Information Systems Research, 30(1), 1-13. Web.
Tan, J. (2018). Handbook of research on emerging perspectives on healthcare information systems and informatics. IGI Global.