Progress along developmental tracks for electronic health records implementation in the United States

Abstract

The development and implementation of electronic health records (EHR) have occurred slowly in the United States. To date, these approaches have, for the most part, followed four developmental tracks: (a) Enhancement of immunization registries and linkage with other health records to produce Child Health Profiles (CHP), (b) Regional Health Information Organization (RHIO) demonstration projects to link together patient medical records, (c) Insurance company projects linked to ICD-9 codes and patient records for cost-benefit assessments, and (d) Consortia of EHR developers collaborating to model systems requirements and standards for data linkage. Until recently, these separate efforts have been conducted in the very silos that they had intended to eliminate, and there is still considerable debate concerning health professionals access to as well as commitment to using EHR if these systems are provided. This paper will describe these four developmental tracks, patient rights and the legal environment for EHR, international comparisons, and future projections for EHR expansion across health networks in the United States.

Validating of a Novel Method for Electronically Recording Overactive Bladder Symptoms in Men

“…With the broad use of electronic medical records, these data could be included as part of each patient's permanent record. Subsequently, data could be used to not only benefit the individual patient, but also be used for outcomes research to develop new treatment algorithms; and for clinical trials evaluating new treatment modalities …”

The Feasibility of the Nationwide Health Information Network

“…39 Family Educational Rights and Privacy Act overrides HIPAA and requires EHR networks such as RHIOs and NHIN to obtain the consent of parents and guardians of children younger than 18 years, compounding the already-troubling issue of obtaining the consent of all individuals 18 years or older for exchanging PHI electronically. 39 Rosenbaum et al 40 provided insight into rights and legal issues surrounding the electronic exchange of PHI, including the ownership of health information, disclosure of PHI, access to PHI by governmental agencies, and basic research access to patient records. An agreement was reached that HIPAA was designed to prevent patient confidentiality and discrimination abuse, although certain conflicts exist with HIPAA overruling states' efforts to safeguard PHI.…”

“…34 Patient privacy and the misuse of data Health Insurance Portability and Accountability Act of 1996, the legal epicenter of the public and professional attention in the health care industry, prohibits health care entities and their employees from disclosing any healthrelated information about a patient without authorization from the patient or their medical power of attorney; additional data security systems are needed to protect this sensitive patient information, while stiff legal and financial ramifications, along with a sullied public image, await violators of HIPAA. 39 Another legal aspect of the electronic exchange of Protected Health Information (PHI) within the United States is the Family Educational Rights and Privacy Act, which states that a child's parent or legal guardian must authorize the release of the child's school records to any agency or individual that requests them, if the child is younger than 18 years. The child's school records oftentimes contain PHI pertaining to cognitive development and immunization records.…”

Health Services Research and Data Linkages: Issues, Methods, and Directions for the Future

“…For an overview of PHRs and related data linkage and privacy issues, see: Halamka, Mandl, and Tang (2008), Tang et al (2006), Tang and Lansky (2005). For an overview of RHIOs and related data linkage and privacy issues, see: Hollar (2009), Miller and Miller (2007), Frohlich et al (2007), Holmquest (2007), and Glaser (2007).…”