EHR Requirements

Under the American Recovery and Reinvestment Act of 2009, the federal government, through the Department of Health and Human Services, established incentive programs under Medicare and Medicaid for eligible professionals (EPs) and hospitals to switch to an Electronic Health Records (EHR) system capable of providing health delivery information within and among hospitals and EPs electronically. In short, the program sets requirements to be phased-in beginning in 2010 and 2011 that will eventually switch over all medical records from paper to electronic format, without compromising patient confidentiality. There are a total of 40 preliminary EHR certifications in to be phased-in to meet the requirements in three major areas. There will be a total of 49 when the EHR certification program is fully implemented.

First Stage Example

• The first stage of certification is to include computerized order entry by the provider by electronically recording, storing, retrieving and modifying electronic records covering the areas of medications, laboratory imaging and radiology imaging. The objective is to maintain a current list of more than 80 percent of all one-time or first time patients admitted to the hospital or held for observation in the emergency room.

General EHR Certifications

• General Certifications include EHR implementation in the areas of drug to drug checks, drug to allergy interaction checks, drug formulation checks, maintenance of current problem lists, maintenance of an active patient medication lists, an active medication allergy list, a record and chart of vital signs, smoking status, laboratory results, overall patient lists, medication reconciliation, immunization registries, public health records, education resource uses, access controls, prior emergency room access, an automatic log-off, an audit log, authentication, general encryption and specialized encryption when exchanging electronic health information. An accounting of disclosure is optional.

Specific Certification Criteria for Complete EHRs Including Ambulatory Treatment

• Meeting the specific criteria under the current final rules requires computerized provider order entry, the ability to prescribe medications electronically, a demographic record, computerized patient reminders, clinical decision support, an electronic copy of health information, timely clinical summaries, the ability to exchange clinical information and summary of a patient's record and calculation and submission of clinical quality measures.

Complete EHRs Designed for Inpatient Settings

• Meeting Medicare and Medicaid requirements for inpatient EHR requires computerized provider order entry, a record of demographics, clinical decision support, an electronic copy of health information, an electronic copy of discharge instructions, the ability to electronically exchange clinical information and patient summary records, all reportable lab results, advance medical orders and the ability to calculate and submit clinical quality measures electronically.