Equipment & Gear, Patient Care, Training

How the American Recovery and Reinvestment Act of 2009 Will Affect EMS

Issue 12 and Volume 37.

EMS is an important component of healthcare and the practice of medicine. As such, it’s important for EMS to track and understand requirements in other areas of healthcare that will eventually work their way into our EMS operations and clinical care.

In this brief overview, let’s look at some of the requirements associated with the federal healthcare reform process under the American Recovery and Reinvestment Act of 2009 (ARRA), specifically the implementation of the “meaningful use” requirements associated with electronic health records (EHRs). These requirements are now being rolled out within hospitals and physicians’ offices with 2012 and 2013 implementation deadlines.

Currently, there’s no federal timeline for EMS to implement the meaningful use requirements. But at some point in the future, all healthcare providers will be required to be “meaningful users” of electronic health records. In many ways, EMS has led the healthcare industry in the development of a standards-based electronic health record system. These meaningful use requirements will result in some changes to our EMS EHR systems, but these changes should be minimal for those EMS agencies using EHR software that’s compliant with the National EMS Information System (NEMSIS) Version 3.

Let’s take a closer look at what “meaningful use” is and learn how we can all become “meaningful users” of electronic health records.

Criteria & Components
Meaningful use requirements call for the implementation and use of electronic health records to demonstrate quality of care, improve the process of care and anticipate health information exchange. The overall goals of meaningful use are to:
>> Improve quality, safety and efficiency of patient care;
>> Engage patients and families to participate in their healthcare process;
>> Improve care coordination;
>> Ensure privacy and security of personal health information; and
>> Improve public and population-based health.

Without going into extreme detail, let’s explore how EHR systems can be used to meet these goals.

Trust: Security is an important component to any health records system; however, a meaningful user of health information must earn and have the trust of its patients and customers. Meaningful users of health information must have information technology measures in place to ensure health information is safe and secure. They must also ensure the information is available to healthcare providers as they provide and coordinate clinical care. The meaningful use criteria were created to assure patients that their health information is secure yet available for use by their healthcare providers.

EHRs: A goal of ARRA is for every person’s current health record to be converted into an electronic health record by 2014. This was a mandate by both the Bush and Obama administrations and is the foundation for health information exchange as well as healthcare reform.

Health information exchange: To successfully complete the meaningful use requirements, hospitals and clinics must implement an EHR system and participate in health information exchange. Health information exchange is formally defined in ARRA as the movement of patient healthcare data (or documents) across healthcare organizations regardless of the software or information system used by the organization. Simply put, this is a requirement for hospitals and healthcare providers to be able to exchange patient-level health information with each other in a timely fashion based on the current healthcare needs of the patient.

Information security and information disclosure: The security requirements in the Health Insurance Portability and Accountability Act (HIPAA) of 1996 requires all personal health information to be protected and secured. This includes securely authenticating access to the information, encrypting the information during the exchange process, securely storing the information and releasing the information based on an appropriate need. Meaningful use strengthens HIPAA with specific requirements to track, monitor and disclose how health information has been used and disclosed.

In addition, meaningful use encourages the use of new technology to secure EHRs while maintaining or even improving the usability of the system. Through the use of barcodes, radio-frequency identification, smartcards and fingerprint scanners, software can maintain security while improving the user interface.

Promote EHR coordination and clinical use: If the ultimate goal of EHRs and the meaningful use criteria is to improve the quality, safety and efficiency of patient care, it should be no surprise that meaningful users must use EHRs in the clinical care they provide. Electronic health records combined with clinical decision rules have been shown to effectively reduce medical errors and improve the quality of care.

Health information exchange has the potential to improve the quality of care of patients that cross multiple healthcare providers. A great example from an EMS perspective would the ability of an EHR to follow a patient through the continuum of care associated with an acute illness or injury. A victim of a motor vehicle crash may be taken from the scene to a community hospital before being transferred by an air medical service to a trauma center for definitive care. In this example, a total of four healthcare organizations participated in the care of this one patient. EHRs that move with the patient document the care provided as the patient flows through the system of care. This can reduce errors, such as duplicate medication and CT scans, which expose the patient to unneeded radiation and increased healthcare costs.

Increased patient demographic information: Meaningful use requirements call for an increase in the amount of patient-specific demographic information that’s maintained within EHRs. Demographic information is information that describes the patient, their culture and their community. It helps us understand how a disease or common injury impacts communities and how frequently it occurs, as well as having the potential to help us learn how to focus resources to control it. By analyzing healthcare data along with demographic data, we can better focus prevention and public education programs to target health-related needs and improve the health of our overall population.

In Closing
Based on this limited overview of meaningful use, the basic concepts are what EMS has been promoting the past 10 years through NEMSIS. We have focused on standardizing the information we collect, moving to EHRs, sharing health information with the hospitals that receive our patients and applying what we learn from the system to improve our service delivery and care.
Hospitals and healthcare providers have had a difficult time meeting the meaningful use requirements and migrating to EHRs. Their EHR systems use Health Level Seven International (HL7) standards to meet these requirements. With a vision of the future, NEMSIS Version 3 was developed in parallel and in partnership with HL7. There’s an HL7 version of NEMSIS that will make this process much easier for EMS.

As we navigate through healthcare reform and move into the age of health information exchange, EMS will continue to be a “meaningful user” of electronic health records. EMS agencies using software compliant with NEMSIS Version 3 will be able to easily participate through its NEMSIS-based HL7 interface.