What are the specific functionalities that are needed in an EHR?
As with anything complex, EHRs have a lot of options and features. The first step in determining the specific functionalities that are needed is to understand the basic features of an EHR. These include, but are not limited to: maintaining a single patient record, inputting patient demographics, managing the problem list, medication list, and past medical history, and entering clinical documentation.
The next step is to conduct a workflow analysis. This study should consider how a particular system will impact how task will change from the perspectives of the different end users. Examining the workflow can also be helpful in developing a written set of system specifications that can be used in the vendor selection process [see Health IT Selection and Implementation in Rural Settings module]. The goal of the workflow analysis should be to uncover inefficiencies, duplication of effort, and areas of excessive consumption of time and resources that the implementation of an EHR can alleviate. Some questions to consider include:
Based on the needs of the organization identified by the workflow analysis and other possible requirements determined by administration or users, specific EHR functionalities may be considered. An ambulatory practice may determine, for example, that certain immunizations are being missed for adults with chronic diseases and that immunization reminder functionality is necessary. Similarly, an ambulatory provider interested in participating in the Medicare e-Prescribing Incentive program would require the e-prescribing feature. As another example, a hospital may want to have lab results incorporated into the EHR to prevent providers from having to search for paper charts or use a different application to access this data.
When making a decision regarding necessary EHR features, the funding available as a result of the American Recovery and Reinvestment Act of 2009 (ARRA) should also be considered. The legislation authorizes payments for eligible professionals and hospitals participating in Medicare and Medicaid as an incentive to becoming "meaningful EHR users." According to the ARRA, the EHR should be certified by an accrediting organization and include functionality to capture patient demographics and clinical information, such as medical history and problem lists. It should also have the "capacity" to: 1) provide clinical decision support, 2) support physician order entry, 3) capture and query information relevant to health care quality, and 4) exchange electronic health information with, and integrate such information from other sources. Meaningful use in the ambulatory setting also includes adoption of e-prescribing technology. More information regarding the specific features and reporting requirements will be available as the regulatory framework for demonstrating "meaningful use" develops.
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