Health Security Training

1. Health Security
Training: Electronic Health Records

2. Health Informatics Emerging
Technologies
 The debate over Electronic Health Records has been given
a new impetus by the recent American Recovery and
Reinvestment Act of 2009
 Concerns over safety, reliability, efficiency, and
implementation have come to the fore in discussions
concerning the future widespread use of Electronic Health
Records (EHRs)
 Evidence has shown, however, that EHRs are effective
means by which hospitals can ensure confidentiality.

3. Brief History of EHRs
 The first medical records were a development of
Hippocrates circa 5th century B.C. The Hippocratic
conception of a medical record facilitated key points of
accuracy, and disease etiology (Bemmel & Musen, 1997).
 In the 1970s, many government clinics began research into
computerized means of information storage including
COSTAR (Computer Stored Ambulatory Record), HELP
(Health Evaluation through Logical Processing), TMR (The
Medical Record), THERESA, and TDS developed by
Lockheed (MITRE, 2006).
 In the late 80s, researchers at the Beth Israel Deaconess
Medical Center developed one of the first fully functional
electronic health record systems.

4. Brief History of EHRs Continued
 Institute of Medicine, in 1991, began advocating the use of
electronic health records and recording systems in the
health industry (Luchetsla, 2010).
 In 2004, then President George W. Bush devised a plan for
the future implementation of electronic health records as a
means to balance budgetary concerns in the health
industry at the time.
 Part of the Obama administration’s economic goals have
been to reinvigorate efficiency in the health care industry
and the topic of EHRs, with associated savings, is an issue
being upheld.

5. AARA affect on HER Development
 The American Recovery and Reinvestment Act of 2009,
signed into law by President Obama, devoted 22.6 billion
dollars towards advancements in Health Information
Technologies in the coming years (APA, 2011).
 Specifically, a) four categories of violations reflect
increasing levels of culpability, b) four penalty tiers
significantly increase the minimum penalty amount for
each discrete violation, c) and a maximum penalty up to
1.5 million per violation of an identical provision has been
instituted (HITECH, 2009).

6. What Can We Lose?
 Arguments have been leveled against the integration of
EHRs into an operational system based on exorbitant costs
to the hospital and physicians (Goedert, 2011).
 Hypothetically, it may be more beneficial for small firms to
refrain from the mandatory electronic health record
systems and accept the 1% cut in Medicaid
reimbursements. There has been a growing trend of
physicians refusing to cover Medicaid patients due to the
slow and decreasing compensation from the program.

7. What Can We lose?
 The ARRA has an additional incentive plan, which includes
over $63,000 worth of Medicaid and Medicare bonuses to
physicians taking on these patients.
 Low incentives and the cost of implementation remain
obstacles for private physicians. If private physicians are
to be persuaded into converting to electronic health
records, it will be necessary to show other benefits which
may arise from the system’s use.

8. Benefits of Security
 HIPAA requires tighter security over digital media than with
paper records and for good reason, confidentiality is a
significant concern in the hospital setting
 Successful implementation of EHRs has been enough to
prevent security breaches when properly implemented
(Shield et al, 2010).
 This study shows that the appropriate implementation and
familiarity with electronic health record systems can be
quite successful among anxious patients and dismissive
physicians, as well as inquisitive individuals

9. Security Measures
 The ARRA legislation includes as avenues needing
improvement a) encryption techniques, and b) destruction
of previous data.
 Under the HIPPAA Security rule, the use of algorithmic
processes necessary to transform data to lower the
possibility of assigning meaning has been the guiding
encryption ideology.
 The National Institute of Standards and Technology judges
encryption techniques for this purpose and several have
been developed and considered secure under their
guidelines (Palecki, 2009).

10. The future of health care
 Backing from the government and incentives through
Medicare will allow larger corporations to make the change
to what has been deemed a more efficient method for
maintaining records, while being subsidized by the
government.
 Legislation passed under HIPAA and encouraged under
ARRA will ensure compliancy guidelines with the federal
government, but health staff must remain aware of the
possible issues, which may arise from the use of
technology.

11. Concluding remarks
 The inevitability of electronic health records is undeniable.
 With the advent of the computing age, digital recording
quickly outpaced its analog counterparts and in this decade
is poised to take over traditional health record systems.
 Despite criticisms with the novel concept, many
organizations believe that EHRs are the appropriate next
step in a fiscally responsible health care industry in the
U.S. do to the implicit efficiency and security

12. References
 APA. (2011). Medicare and Medicaid health record incentive
payment programs. American Psychologist Association,
Retrieved from http://www.psych.org/ehrincentive
 Goedert, J. (2011). Health affairs cover EHRs.
HDMBreakingNews, Retrieved from
http://www.healthdatamanagement.com/news/Health-
Affairs-Covers-EHRs-42114-1.html
 Bemmel J.H., &Musen, M. (1997). ed. Handbook of Medical
Informatics, Springer, The Netherlands. p. 99.
 HITECH. (2009). HITECH act enforcement interim final
rule. HHS.gov, Retrieved from
http://www.hhs.gov/ocr/privacy/hipaa/administrative/enfor
cementrule/hitechenforcementifr.html

13. References
 Luchetsla, J. E., (2010). Physician Champion Role in an
Electronic Health Record Implementation, a Case History.
Theses and Dissertations. P. 94.
 MITRE. (2006). NIH national center for research resources.
Center for Enterprise Modernization, Retrieved from
http://www.ncrr.nih.gov/publications/informatics/ehr.pdf
 Palecki, S. (2009). HHS issues HITECH guidance. Foulston
Siefkin, Retrieved from
http://www.foulston.com/lib/issueAlert.cfm?id=39
 Shield, R.R. (2010). Gradual electronic health record
implementation: new insights on physician and patient
adaptation. Annals of Family Medicine, 8(316), Retrieved
from
http://www.annfammed.org/cgi/content/abstract/8/4/316