EHR Mandate Profile

The National Electronic Health Records (EHR) mandate stands to revolutionize the way healthcare providers share patient information. This plan focuses on connecting clinicians with direct access to patient data, while patients themselves benefit from a more engaged position in contributing their values in the process of making decisions about their health (Kolodner, 2008, p. iii). This process culminates with broad directives focused on "Patient-focused Health Care," where a digital transition occurs focused on providing superior services to the patient along with more economical implementation and "Population Health," where access becomes simplified in better understanding pertinent issues as they relate to the general populace in areas such as "biomedical research, quality improvement, and emergency preparedness" (Kolodner, 2008, p. 1). Together, these two issues summarize the fundamental tents of the Electronic Health Record mandate.

These two issues are fortified by four essential functions. Collaborative governance consists of a focus that emphasizes "mechanisms for multi-stakeholder priority-setting and decision-making," along with creating "coordinated organizational processes supporting information use for population health" (Kolodner, 2008, p. 3). Adoption of the policies engenders active promotion of "nationwide deployment of . . . EHRs . . . and personal health records (PHRs) and other consumer health IT tools," a process that results in implementing these tools into active use (Kolodner, 2008, p. 3). Thirdly, interoperability strives to ensure that in the pursuance of each directive, electronic data transfers occur seamlessly between relevant parties (Kolodner, 2008, p. 3). Finally, and perhaps most importantly, privacy and security center around protecting patient data through advancing "privacy and security policies, principles, procedures, and protections" in order to maintain the integrity of the healthcare system (Kolodner, 2008, p. 3). These four functions combine to clearly articulate the intricacies of the EHR mandate.

At WellSpan York Hospital in York, PA, implementation of the EHR mandate appears to have achieved full operational status. Rules and regulations at York Hospital outline a plan for implementing the EHR mandate in phases in order to plan for the impending shifts (Herrold, 2013, p. 1). In the case of physicians, practitioners are expected to, except for exceptional circumstances, write medical orders directly into the EHR (Herrold, 2013, p. 10). The Cerner Millennium Power Chart application serves as the authentic reference source for all patient order consultation (Herrold, 2013, p. 1). With these rules, York Hospital actively promotes the adoption of the EHR mandate.

York Hospital also remains committed to ensuring the security and privacy of patient data. Practitioners must acquire written patient consent before accessing electronic records with patients with whom they share no current working relationship (Herrold, 2013, p. 3). Any initiative focused on electronic privacy would remain incomplete without a discussion of the policies as shaped through HIPAA. York Hospital outlines these policies on its website, describing the Health Information Exchange (HIE) as a place where approved health practitioners electronically access patient data according to national benchmarks. This further demonstrates a focus on the aforementioned EHR mandate through the implementation of the privacy and security function.

In my current position in the medical device industry, I occasionally visit York Hospital and get the opportunity to see first-hand how this organization implements EHR mandates. From my point of view, it appears that this facility has made meaningful strides towards integrating a patient-practitioner experience that facilitates clearer communication. One certain example of this lies in the WellSpan mobile application. Here, users can find their MyWellSpan patient portal allowing them to view reports from recent visits, discharge summaries, and lab results. In addition, this application allows patients to refill prescriptions, access walk-in urgent care appointments, and even view pictures of newborn children born in York. Apart from the clear description of EHR policies as outlined by Herrold, the WellSpan mobile application provides a tangible digital connection between patient and practitioner.

For an inside understanding of how progress was advancing on this mandate, I contacted Vice President and Chief Technology Officer of WellSpan Health, Michael R. Murphy. I wanted some direct knowledge about the challenges faced in implementing the EHR directives. Murphy acknowledged three broad challenges in the process; the first was a question of funding. Installation of broadband capabilities and finding grants or loans to fund these costs were a significant logistical maneuver. Secondly, there was significant demand for IT employees as workflow increased significantly. Although executive cooperation was never an issue, it did take some time to provide sufficient EHR training for employees at WellSpan. Murphy concluded with a networking emphasis based on superior security capabilities. With an active online system, no one wants to be held culpable for mismanaged personal information.

York Hospital implements policies that encourage Patient-focused Healthcare. There exists an organized methodology for sharing information. Through the implementation of the Cerner Millennium Power Chart, York Hospital administrators have mandated a complete adoption of EHR policies. Within the hospital, interoperability is only limited through exceptional circumstances as provided by HIPAA where patients may explicitly block the use of their data on the HIE. All electronic communication placed into action at York Hospital operates on a secure network. Through the completion of these four functions, York Hospital has crossed the breaking point where the momentum for applying this new communications interface is finally complete according to the Federal Health Plan.

In 2014 with a fully implemented EHR system, York Hospital employees face meaningful challenges in the areas of patient confidentiality and self-determination. Hospital policy clearly outlines the central role of the practitioner in maintaining patient privacy. The nursing role remains at the forefront of issues concerning conducted research, especially within the interest of population health as noted by Kolodner (2008, p. iii). In the continuing evolution of healthcare provisions and practices, practitioners with sensitive data have a responsibility to act in an ethical manner. This work has the potential to harm both the participants and the nurses acting in a research capacity through testing that may inadvertently cause physical harm or more nuanced negativity in social tension (Heigh & Williamson, 2009, p. 4). Heigh and Williamson (2009) expect nurses to engage in a research capacity that takes active measures to provide a clear outline of "informed consent, confidentiality, data protection, right to withdraw, potential benefits, [and] potential harms" (p. 4). These expectations are fundamental research standards that should become augmented as forms and data distribution become more easily shared through electronic communication.

On the national scene, political issues abound in relation to health care. Some organizations protesting the Affordable Healthcare Act would prefer to have the directives and associated fees removed even before they have been required to pay. This process is limited by the Anti-Injunction Act, which does not allow for the refunding of a tax until that tax has actually been paid. Another issue focuses on the government's individual mandate—critics question whether the government has the right to impose penalties on individuals due to economic inactivity. Indeed, a majority of states already contest this provision challenging the legitimacy of the federal government to punish people for opting out of a service they do not want. In spite of the apparent success of the EHR mandate, the future of healthcare still remains unclear.

References

Heigh, C., & Williamson, T. (2009, January 1). Research ethics. RCN Guidance for Nurses. Retrieved from http://www.rcn.org.uk/__data/assets/pdf_file/0007/388591/003138.pdf

Herrold, J. (2013, August 28). Medical staff rules and regulations. York Hospital. Retrieved from http://www.wellspan.org/media/3818/yhrulesregs.pdf

Kolodner, R. M. (2008). The ONC-coordinated federal health information technology strategic plan: 2008-2012. Department of Health and Human Services, 1, i-11.