A broad-based public and private initiative is promoting the development of a national system of interoperable electronic health records (EHRs). This initiative raises challenging issues for health care providers, public health authorities, consumers and regulators.
Push for National System of Electronic Health Records
In July the National Coordinator for Health Information Technology published a Framework for Strategic Action to guide the nation toward the adoption of widespread, interoperable EHRs within ten years. The Framework will build on steps already taken to promote this goal, among them:
- The federal government's Consolidated Health Informatics Initiative has announced standards in 20 areas for the electronic exchange of clinical health information to be adopted across the federal government.
- The Medicare Prescription Drug, Improvement and Modernization Act of 2003 requires the Secretary of the Department of Health and Human Services (HHS) to adopt standards and conduct pilot projects for electronic prescribing.
- The recently finalized "Stark" regulations, which restrict referrals for many health care services among providers with financial relationships, created an exception for relationships arising from participation in community-wide health information systems.
- Health Level Seven, an ANSI-accredited standards developing organization, has published a draft standard for a functional model of an electronic health record system.
- HHS and the College of American Pathologists have agreed to make SNOMED Clinical Terms available to U.S. users at no cost through the National Library of Medicine's Unified Medical Language System.
- HHS and private foundations are beginning to make available funding for statewide and local health information exchanges.
Issues Raised by National EHRs System
As the national system coalesces, issues that must be addressed include:
- Acquisition of EHRs Technology. Many technology implementations fail. Steps should be taken in the proposal and contracting process to minimize this risk.
- Form and Governance of Local Health Initiatives. The goal is to create a national health information infrastructure (NHII) by fostering regional collaborations of providers, health plans and public health authorities, and providing them with a set of common intercommunication tools. Participants must decide what form these collaborations will take.
- Regulatory Barriers to Health Information Networks. Participation in a health information sharing network must avoid creating financial relationships that prevent providers from making referrals to one another or expose them to sanctions.
- Health Information Privacy and Security. Health information sharing networks must assign responsibility for privacy and security consistent with federal and state laws, including HIPAA.
- Liability of Providers Participating in EHR Networks. The NHII is focused on quality, and participation is likely to become an aspect of community standards of care. Providers will need to establish standards for judging the reliability of health information in a shared system.
The NHII will focus on creating institutions that can set standards for health information technology and ease access to financing for acquisition. This will set the stage for widespread implementation. Every lawyer serving health care clients needs to watch the development of the system.