Neil Skolnik, MD

The need to improve the quality of care while lowering its cost is at the root of every major initiative in health care today. While new models of care are evolving to meet this need, new technology applications are being developed simultaneously to make these models viable. The electronic health record is both the means and the end of these revolutionary processes.

An EHR’s raison d’être is to collect and share data important for the treatment of patients. This seemingly simple function, however, rests on complex, multifaceted relationships that seek to balance caregivers’ needs against information systems’ capabilities. Driven forward by federal government mandates, the next several years promise to bring issues of EHR standardization, usability, and interoperability to the forefront of practicing physicians’ collective awareness.

EHR Development: Where Is It Going, and Why

While change is constant in health care – and exponential in technology – three EHR developmental imperatives are emerging in response to industry trends, as well as existing and imminent federal requirements:

• Interoperability. Standardization – the prerequisite for sharing records between and among IT systems – has been an important, though hard-to-achieve, goal of EHR development since 1991, when the Institute of Medicine’s report, "The Computer-Based Patient Record: An Essential Technology for Health Care," introduced the idea of "an electronic patient record ... specifically designed to support users through availability of complete and accurate data, alerts, reminders, clinical decision support systems, links to medical knowledge and other aids."

Since that time, several organizations have worked to further the development of standards, with some success as evidenced by standardization of lab results, medication names, allergies, and demographic data. Other data elements, such as physician progress notes that require multiple concepts to express, are proving more problematic. The challenge: ensuring interoperability for public health reporting and research without hindering or further complicating the physician "conversation." Meeting this challenge demands ongoing, industry-level standards development.

• Usability. As federal mandates increase quality and reporting requirements, EHR solutions must evolve to help rather than hinder physicians’ efforts to meet them. For example, an EHR that requires numerous "clicks" to order a single medication is not going to streamline a physician’s workflow. The problem is finding ways to objectively measure something as seemingly subjective as usability.

However, the issue is now on the federal radar and fast becoming a must-have for EHR products. Certification organizations increasingly are looking for ways to measure and mandate usability of EHR products, from the National Institute of Standards and Technology’s (NIST) search for sources "to fully develop and execute a project to create a usability framework for health information technology (HIT) systems" to the Certification Commission for Healthcare Information Systems’ (CCHIT) 2011 Usability Testing Guide for Comprehensive Ambulatory EHRs.

• Care coordination. Despite spending one-sixth of our entire gross domestic product on health care, the United States falls far short of being the healthiest society in the world. One reason: We spend the vast majority of our resources treating the symptoms rather than the causes of disease. Care coordination across all elements of the complex health care system (for example, subspecialty care, hospitals, home health agencies, nursing homes, etc.) and the patient’s community is essential to creating a shift from treatment to prevention – and EHRs are essential to care coordination.

In addition, care coordination is a key characteristic of the patient-centered medical home, an emerging care concept based on evidence, driven by data, focused on health and wellness, and centered on the needs of the patient.

These three imperatives – interoperability, usability, and care coordination – are driving EHR development. As such, they also are key considerations in the selection of an EHR solution.

Functional Matters: Choosing an EHR Solution

The 2009 American Recovery and Reinvestment Act’s (ARRA) HITECH Act may have brought EHRs to the forefront of health care discussion, but it did not alter their primary function – improving the quality of care. To ensure this result, physicians should look for the following in an EHR product:

• Certification: Certification assures a product has met core criteria considered essential by a broad range of stakeholders, which is key to maximizing the system’s value. One-time certification is not enough; annual certification evidences the continual development necessary for the product’s ongoing viability.

The sole organization designated by the Department of Health and Human Services (HHS) since 2006, CCHIT is the industry’s leading EHR certification body and the de facto standard for usability and other criteria. However, with the advent of ARRA and the resulting need to preclude any conflict of interest, HHS now will oversee multiple certification organizations. The Office of the National Coordinator (ONC) for Health Information Technology is developing its own certification criteria with NIST, which will assess conformity and accredit certification bodies.

 

Still, those that now possess CCHIT usability ratings and certification have positioned themselves in the forefront of the certification process.

• Structured data: Structured data reside in fixed fields within a record or file. These discrete data fields (for example, blood pressure, body mass index, and height/weight) establish the predetermined data types and understood relationships necessary for efficient quality reporting. Since 2008, the Centers for Medicare and Medicaid Services has allowed reporting of quality measures data to a qualified registry. As early as this year, CMS could begin accepting direct EHR-based quality reporting. As early as 2012, CMS could mandate it. EHRs built on unstructured data (as is found in many transcription/dictation systems) will not support compliance.

• Meaningful use guarantees: Incentives should not be the sole reason why physicians deploy EHRs, but the ability to secure incentives must not be overlooked. EHR vendors with a commitment to – and a plan for – meeting meaningful use criteria as they are established will offer guarantees to that effect.

• Clinical decision support: Evidence-based practice is the inevitable future of health care. EHRs with clinical prompts and reminders support best practice and systemize the use of evidence at the point of care.

• Support for coordinated care: Increasingly, EHRs will serve as the foundation for data registries, health information exchange, and other means to assure patients get the indicated care when and where they need and want it, and in a culturally and linguistically appropriate manner. Expanded patient data access – via secure communication portals, for instance – also will require more robust data controls to ensure secure data exchange. However, it will enable patient-centric care through greater patient involvement.

Health care is a dynamic industry, driven by the needs – changing and continuous – of its stakeholders. Developing, choosing, and deploying EHRs will continue to challenge. Keeping standardization, usability, and interoperability as the prime focus of all development and purchase decisions ultimately will smooth the path for everyone.

Dr. Corley is the chief medical officer for NextGen Healthcare Information Systems, an electronic health record vendor. Dr. Skolnik is associate director of the family medicine residency program at Abington (Pa.) Memorial Hospital and professor of family and community medicine at Temple University, Philadelphia. He is also editor-in-chief of Redi-Reference Inc., a software company that creates medical handheld references.

References

1. The Computer-Based Patient Record: An Essential Technology for Health Care Committee on Improving the Patient Record, Division of Health Care Services, Institute of Medicine Richard S. Dick, Elaine B. Steen; eds. 190 pages. Washington, D.C.: National Academy Press; 1991.

2. National Institute of Standards and Technology. Health Information Technology Usability Framework. Federal Business Opportunity. Solicitation Number: AMD-10-SS39 Web.

The need to improve the quality of care while lowering its cost is at the root of every major initiative in health care today. While new models of care are evolving to meet this need, new technology applications are being developed simultaneously to make these models viable. The electronic health record is both the means and the end of these revolutionary processes.

An EHR’s raison d’être is to collect and share data important for the treatment of patients. This seemingly simple function, however, rests on complex, multifaceted relationships that seek to balance caregivers’ needs against information systems’ capabilities. Driven forward by federal government mandates, the next several years promise to bring issues of EHR standardization, usability, and interoperability to the forefront of practicing physicians’ collective awareness.

EHR Development: Where Is It Going, and Why

While change is constant in health care – and exponential in technology – three EHR developmental imperatives are emerging in response to industry trends, as well as existing and imminent federal requirements:

• Interoperability. Standardization – the prerequisite for sharing records between and among IT systems – has been an important, though hard-to-achieve, goal of EHR development since 1991, when the Institute of Medicine’s report, "The Computer-Based Patient Record: An Essential Technology for Health Care," introduced the idea of "an electronic patient record ... specifically designed to support users through availability of complete and accurate data, alerts, reminders, clinical decision support systems, links to medical knowledge and other aids."

Since that time, several organizations have worked to further the development of standards, with some success as evidenced by standardization of lab results, medication names, allergies, and demographic data. Other data elements, such as physician progress notes that require multiple concepts to express, are proving more problematic. The challenge: ensuring interoperability for public health reporting and research without hindering or further complicating the physician "conversation." Meeting this challenge demands ongoing, industry-level standards development.

• Usability. As federal mandates increase quality and reporting requirements, EHR solutions must evolve to help rather than hinder physicians’ efforts to meet them. For example, an EHR that requires numerous "clicks" to order a single medication is not going to streamline a physician’s workflow. The problem is finding ways to objectively measure something as seemingly subjective as usability.

However, the issue is now on the federal radar and fast becoming a must-have for EHR products. Certification organizations increasingly are looking for ways to measure and mandate usability of EHR products, from the National Institute of Standards and Technology’s (NIST) search for sources "to fully develop and execute a project to create a usability framework for health information technology (HIT) systems" to the Certification Commission for Healthcare Information Systems’ (CCHIT) 2011 Usability Testing Guide for Comprehensive Ambulatory EHRs.

• Care coordination. Despite spending one-sixth of our entire gross domestic product on health care, the United States falls far short of being the healthiest society in the world. One reason: We spend the vast majority of our resources treating the symptoms rather than the causes of disease. Care coordination across all elements of the complex health care system (for example, subspecialty care, hospitals, home health agencies, nursing homes, etc.) and the patient’s community is essential to creating a shift from treatment to prevention – and EHRs are essential to care coordination.

In addition, care coordination is a key characteristic of the patient-centered medical home, an emerging care concept based on evidence, driven by data, focused on health and wellness, and centered on the needs of the patient.

These three imperatives – interoperability, usability, and care coordination – are driving EHR development. As such, they also are key considerations in the selection of an EHR solution.

Functional Matters: Choosing an EHR Solution

The 2009 American Recovery and Reinvestment Act’s (ARRA) HITECH Act may have brought EHRs to the forefront of health care discussion, but it did not alter their primary function – improving the quality of care. To ensure this result, physicians should look for the following in an EHR product:

• Certification: Certification assures a product has met core criteria considered essential by a broad range of stakeholders, which is key to maximizing the system’s value. One-time certification is not enough; annual certification evidences the continual development necessary for the product’s ongoing viability.

The sole organization designated by the Department of Health and Human Services (HHS) since 2006, CCHIT is the industry’s leading EHR certification body and the de facto standard for usability and other criteria. However, with the advent of ARRA and the resulting need to preclude any conflict of interest, HHS now will oversee multiple certification organizations. The Office of the National Coordinator (ONC) for Health Information Technology is developing its own certification criteria with NIST, which will assess conformity and accredit certification bodies.

 

Still, those that now possess CCHIT usability ratings and certification have positioned themselves in the forefront of the certification process.

• Structured data: Structured data reside in fixed fields within a record or file. These discrete data fields (for example, blood pressure, body mass index, and height/weight) establish the predetermined data types and understood relationships necessary for efficient quality reporting. Since 2008, the Centers for Medicare and Medicaid Services has allowed reporting of quality measures data to a qualified registry. As early as this year, CMS could begin accepting direct EHR-based quality reporting. As early as 2012, CMS could mandate it. EHRs built on unstructured data (as is found in many transcription/dictation systems) will not support compliance.

• Meaningful use guarantees: Incentives should not be the sole reason why physicians deploy EHRs, but the ability to secure incentives must not be overlooked. EHR vendors with a commitment to – and a plan for – meeting meaningful use criteria as they are established will offer guarantees to that effect.

• Clinical decision support: Evidence-based practice is the inevitable future of health care. EHRs with clinical prompts and reminders support best practice and systemize the use of evidence at the point of care.

• Support for coordinated care: Increasingly, EHRs will serve as the foundation for data registries, health information exchange, and other means to assure patients get the indicated care when and where they need and want it, and in a culturally and linguistically appropriate manner. Expanded patient data access – via secure communication portals, for instance – also will require more robust data controls to ensure secure data exchange. However, it will enable patient-centric care through greater patient involvement.

Health care is a dynamic industry, driven by the needs – changing and continuous – of its stakeholders. Developing, choosing, and deploying EHRs will continue to challenge. Keeping standardization, usability, and interoperability as the prime focus of all development and purchase decisions ultimately will smooth the path for everyone.

Dr. Corley is the chief medical officer for NextGen Healthcare Information Systems, an electronic health record vendor. Dr. Skolnik is associate director of the family medicine residency program at Abington (Pa.) Memorial Hospital and professor of family and community medicine at Temple University, Philadelphia. He is also editor-in-chief of Redi-Reference Inc., a software company that creates medical handheld references.

References

1. The Computer-Based Patient Record: An Essential Technology for Health Care Committee on Improving the Patient Record, Division of Health Care Services, Institute of Medicine Richard S. Dick, Elaine B. Steen; eds. 190 pages. Washington, D.C.: National Academy Press; 1991.

2. National Institute of Standards and Technology. Health Information Technology Usability Framework. Federal Business Opportunity. Solicitation Number: AMD-10-SS39 Web.

The need to improve the quality of care while lowering its cost is at the root of every major initiative in health care today. While new models of care are evolving to meet this need, new technology applications are being developed simultaneously to make these models viable. The electronic health record is both the means and the end of these revolutionary processes.

An EHR’s raison d’être is to collect and share data important for the treatment of patients. This seemingly simple function, however, rests on complex, multifaceted relationships that seek to balance caregivers’ needs against information systems’ capabilities. Driven forward by federal government mandates, the next several years promise to bring issues of EHR standardization, usability, and interoperability to the forefront of practicing physicians’ collective awareness.

EHR Development: Where Is It Going, and Why

While change is constant in health care – and exponential in technology – three EHR developmental imperatives are emerging in response to industry trends, as well as existing and imminent federal requirements:

• Interoperability. Standardization – the prerequisite for sharing records between and among IT systems – has been an important, though hard-to-achieve, goal of EHR development since 1991, when the Institute of Medicine’s report, "The Computer-Based Patient Record: An Essential Technology for Health Care," introduced the idea of "an electronic patient record ... specifically designed to support users through availability of complete and accurate data, alerts, reminders, clinical decision support systems, links to medical knowledge and other aids."

Since that time, several organizations have worked to further the development of standards, with some success as evidenced by standardization of lab results, medication names, allergies, and demographic data. Other data elements, such as physician progress notes that require multiple concepts to express, are proving more problematic. The challenge: ensuring interoperability for public health reporting and research without hindering or further complicating the physician "conversation." Meeting this challenge demands ongoing, industry-level standards development.

• Usability. As federal mandates increase quality and reporting requirements, EHR solutions must evolve to help rather than hinder physicians’ efforts to meet them. For example, an EHR that requires numerous "clicks" to order a single medication is not going to streamline a physician’s workflow. The problem is finding ways to objectively measure something as seemingly subjective as usability.

However, the issue is now on the federal radar and fast becoming a must-have for EHR products. Certification organizations increasingly are looking for ways to measure and mandate usability of EHR products, from the National Institute of Standards and Technology’s (NIST) search for sources "to fully develop and execute a project to create a usability framework for health information technology (HIT) systems" to the Certification Commission for Healthcare Information Systems’ (CCHIT) 2011 Usability Testing Guide for Comprehensive Ambulatory EHRs.

• Care coordination. Despite spending one-sixth of our entire gross domestic product on health care, the United States falls far short of being the healthiest society in the world. One reason: We spend the vast majority of our resources treating the symptoms rather than the causes of disease. Care coordination across all elements of the complex health care system (for example, subspecialty care, hospitals, home health agencies, nursing homes, etc.) and the patient’s community is essential to creating a shift from treatment to prevention – and EHRs are essential to care coordination.

In addition, care coordination is a key characteristic of the patient-centered medical home, an emerging care concept based on evidence, driven by data, focused on health and wellness, and centered on the needs of the patient.

These three imperatives – interoperability, usability, and care coordination – are driving EHR development. As such, they also are key considerations in the selection of an EHR solution.

Functional Matters: Choosing an EHR Solution

The 2009 American Recovery and Reinvestment Act’s (ARRA) HITECH Act may have brought EHRs to the forefront of health care discussion, but it did not alter their primary function – improving the quality of care. To ensure this result, physicians should look for the following in an EHR product:

• Certification: Certification assures a product has met core criteria considered essential by a broad range of stakeholders, which is key to maximizing the system’s value. One-time certification is not enough; annual certification evidences the continual development necessary for the product’s ongoing viability.

The sole organization designated by the Department of Health and Human Services (HHS) since 2006, CCHIT is the industry’s leading EHR certification body and the de facto standard for usability and other criteria. However, with the advent of ARRA and the resulting need to preclude any conflict of interest, HHS now will oversee multiple certification organizations. The Office of the National Coordinator (ONC) for Health Information Technology is developing its own certification criteria with NIST, which will assess conformity and accredit certification bodies.

 

Still, those that now possess CCHIT usability ratings and certification have positioned themselves in the forefront of the certification process.

• Structured data: Structured data reside in fixed fields within a record or file. These discrete data fields (for example, blood pressure, body mass index, and height/weight) establish the predetermined data types and understood relationships necessary for efficient quality reporting. Since 2008, the Centers for Medicare and Medicaid Services has allowed reporting of quality measures data to a qualified registry. As early as this year, CMS could begin accepting direct EHR-based quality reporting. As early as 2012, CMS could mandate it. EHRs built on unstructured data (as is found in many transcription/dictation systems) will not support compliance.

• Meaningful use guarantees: Incentives should not be the sole reason why physicians deploy EHRs, but the ability to secure incentives must not be overlooked. EHR vendors with a commitment to – and a plan for – meeting meaningful use criteria as they are established will offer guarantees to that effect.

• Clinical decision support: Evidence-based practice is the inevitable future of health care. EHRs with clinical prompts and reminders support best practice and systemize the use of evidence at the point of care.

• Support for coordinated care: Increasingly, EHRs will serve as the foundation for data registries, health information exchange, and other means to assure patients get the indicated care when and where they need and want it, and in a culturally and linguistically appropriate manner. Expanded patient data access – via secure communication portals, for instance – also will require more robust data controls to ensure secure data exchange. However, it will enable patient-centric care through greater patient involvement.

Health care is a dynamic industry, driven by the needs – changing and continuous – of its stakeholders. Developing, choosing, and deploying EHRs will continue to challenge. Keeping standardization, usability, and interoperability as the prime focus of all development and purchase decisions ultimately will smooth the path for everyone.

Dr. Corley is the chief medical officer for NextGen Healthcare Information Systems, an electronic health record vendor. Dr. Skolnik is associate director of the family medicine residency program at Abington (Pa.) Memorial Hospital and professor of family and community medicine at Temple University, Philadelphia. He is also editor-in-chief of Redi-Reference Inc., a software company that creates medical handheld references.

References

1. The Computer-Based Patient Record: An Essential Technology for Health Care Committee on Improving the Patient Record, Division of Health Care Services, Institute of Medicine Richard S. Dick, Elaine B. Steen; eds. 190 pages. Washington, D.C.: National Academy Press; 1991.

2. National Institute of Standards and Technology. Health Information Technology Usability Framework. Federal Business Opportunity. Solicitation Number: AMD-10-SS39 Web.

The need to improve the quality of care while lowering its cost is at the root of every major initiative in health care today. While new models of care are evolving to meet this need, new technology applications are being developed simultaneously to make these models viable. The electronic health record is both the means and the end of these revolutionary processes.

An EHR’s raison d’être is to collect and share data important for the treatment of patients. This seemingly simple function, however, rests on complex, multifaceted relationships that seek to balance caregivers’ needs against information systems’ capabilities. Driven forward by federal government mandates, the next several years promise to bring issues of EHR standardization, usability, and interoperability to the forefront of practicing physicians’ collective awareness.

EHR Development: Where Is It Going, and Why

While change is constant in health care – and exponential in technology – three EHR developmental imperatives are emerging in response to industry trends, as well as existing and imminent federal requirements:

• Interoperability. Standardization – the prerequisite for sharing records between and among IT systems – has been an important, though hard-to-achieve, goal of EHR development since 1991, when the Institute of Medicine’s report, "The Computer-Based Patient Record: An Essential Technology for Health Care," introduced the idea of "an electronic patient record ... specifically designed to support users through availability of complete and accurate data, alerts, reminders, clinical decision support systems, links to medical knowledge and other aids."

Since that time, several organizations have worked to further the development of standards, with some success as evidenced by standardization of lab results, medication names, allergies, and demographic data. Other data elements, such as physician progress notes that require multiple concepts to express, are proving more problematic. The challenge: ensuring interoperability for public health reporting and research without hindering or further complicating the physician "conversation." Meeting this challenge demands ongoing, industry-level standards development.

• Usability. As federal mandates increase quality and reporting requirements, EHR solutions must evolve to help rather than hinder physicians’ efforts to meet them. For example, an EHR that requires numerous "clicks" to order a single medication is not going to streamline a physician’s workflow. The problem is finding ways to objectively measure something as seemingly subjective as usability.

However, the issue is now on the federal radar and fast becoming a must-have for EHR products. Certification organizations increasingly are looking for ways to measure and mandate usability of EHR products, from the National Institute of Standards and Technology’s (NIST) search for sources "to fully develop and execute a project to create a usability framework for health information technology (HIT) systems" to the Certification Commission for Healthcare Information Systems’ (CCHIT) 2011 Usability Testing Guide for Comprehensive Ambulatory EHRs.

• Care coordination. Despite spending one-sixth of our entire gross domestic product on health care, the United States falls far short of being the healthiest society in the world. One reason: We spend the vast majority of our resources treating the symptoms rather than the causes of disease. Care coordination across all elements of the complex health care system (for example, subspecialty care, hospitals, home health agencies, nursing homes, etc.) and the patient’s community is essential to creating a shift from treatment to prevention – and EHRs are essential to care coordination.

In addition, care coordination is a key characteristic of the patient-centered medical home, an emerging care concept based on evidence, driven by data, focused on health and wellness, and centered on the needs of the patient.

These three imperatives – interoperability, usability, and care coordination – are driving EHR development. As such, they also are key considerations in the selection of an EHR solution.

Functional Matters: Choosing an EHR Solution

The 2009 American Recovery and Reinvestment Act’s (ARRA) HITECH Act may have brought EHRs to the forefront of health care discussion, but it did not alter their primary function – improving the quality of care. To ensure this result, physicians should look for the following in an EHR product:

• Certification: Certification assures a product has met core criteria considered essential by a broad range of stakeholders, which is key to maximizing the system’s value. One-time certification is not enough; annual certification evidences the continual development necessary for the product’s ongoing viability.

The sole organization designated by the Department of Health and Human Services (HHS) since 2006, CCHIT is the industry’s leading EHR certification body and the de facto standard for usability and other criteria. However, with the advent of ARRA and the resulting need to preclude any conflict of interest, HHS now will oversee multiple certification organizations. The Office of the National Coordinator (ONC) for Health Information Technology is developing its own certification criteria with NIST, which will assess conformity and accredit certification bodies.

 

Still, those that now possess CCHIT usability ratings and certification have positioned themselves in the forefront of the certification process.

• Structured data: Structured data reside in fixed fields within a record or file. These discrete data fields (for example, blood pressure, body mass index, and height/weight) establish the predetermined data types and understood relationships necessary for efficient quality reporting. Since 2008, the Centers for Medicare and Medicaid Services has allowed reporting of quality measures data to a qualified registry. As early as this year, CMS could begin accepting direct EHR-based quality reporting. As early as 2012, CMS could mandate it. EHRs built on unstructured data (as is found in many transcription/dictation systems) will not support compliance.

• Meaningful use guarantees: Incentives should not be the sole reason why physicians deploy EHRs, but the ability to secure incentives must not be overlooked. EHR vendors with a commitment to – and a plan for – meeting meaningful use criteria as they are established will offer guarantees to that effect.

• Clinical decision support: Evidence-based practice is the inevitable future of health care. EHRs with clinical prompts and reminders support best practice and systemize the use of evidence at the point of care.

• Support for coordinated care: Increasingly, EHRs will serve as the foundation for data registries, health information exchange, and other means to assure patients get the indicated care when and where they need and want it, and in a culturally and linguistically appropriate manner. Expanded patient data access – via secure communication portals, for instance – also will require more robust data controls to ensure secure data exchange. However, it will enable patient-centric care through greater patient involvement.

Health care is a dynamic industry, driven by the needs – changing and continuous – of its stakeholders. Developing, choosing, and deploying EHRs will continue to challenge. Keeping standardization, usability, and interoperability as the prime focus of all development and purchase decisions ultimately will smooth the path for everyone.

Dr. Corley is the chief medical officer for NextGen Healthcare Information Systems, an electronic health record vendor. Dr. Skolnik is associate director of the family medicine residency program at Abington (Pa.) Memorial Hospital and professor of family and community medicine at Temple University, Philadelphia. He is also editor-in-chief of Redi-Reference Inc., a software company that creates medical handheld references.

References

1. The Computer-Based Patient Record: An Essential Technology for Health Care Committee on Improving the Patient Record, Division of Health Care Services, Institute of Medicine Richard S. Dick, Elaine B. Steen; eds. 190 pages. Washington, D.C.: National Academy Press; 1991.

2. National Institute of Standards and Technology. Health Information Technology Usability Framework. Federal Business Opportunity. Solicitation Number: AMD-10-SS39 Web.

The need to improve the quality of care while lowering its cost is at the root of every major initiative in health care today. While new models of care are evolving to meet this need, new technology applications are being developed simultaneously to make these models viable. The electronic health record is both the means and the end of these revolutionary processes.

An EHR’s raison d’être is to collect and share data important for the treatment of patients. This seemingly simple function, however, rests on complex, multifaceted relationships that seek to balance caregivers’ needs against information systems’ capabilities. Driven forward by federal government mandates, the next several years promise to bring issues of EHR standardization, usability, and interoperability to the forefront of practicing physicians’ collective awareness.

EHR Development: Where Is It Going, and Why

While change is constant in health care – and exponential in technology – three EHR developmental imperatives are emerging in response to industry trends, as well as existing and imminent federal requirements:

• Interoperability. Standardization – the prerequisite for sharing records between and among IT systems – has been an important, though hard-to-achieve, goal of EHR development since 1991, when the Institute of Medicine’s report, "The Computer-Based Patient Record: An Essential Technology for Health Care," introduced the idea of "an electronic patient record ... specifically designed to support users through availability of complete and accurate data, alerts, reminders, clinical decision support systems, links to medical knowledge and other aids."

Since that time, several organizations have worked to further the development of standards, with some success as evidenced by standardization of lab results, medication names, allergies, and demographic data. Other data elements, such as physician progress notes that require multiple concepts to express, are proving more problematic. The challenge: ensuring interoperability for public health reporting and research without hindering or further complicating the physician "conversation." Meeting this challenge demands ongoing, industry-level standards development.

• Usability. As federal mandates increase quality and reporting requirements, EHR solutions must evolve to help rather than hinder physicians’ efforts to meet them. For example, an EHR that requires numerous "clicks" to order a single medication is not going to streamline a physician’s workflow. The problem is finding ways to objectively measure something as seemingly subjective as usability.

However, the issue is now on the federal radar and fast becoming a must-have for EHR products. Certification organizations increasingly are looking for ways to measure and mandate usability of EHR products, from the National Institute of Standards and Technology’s (NIST) search for sources "to fully develop and execute a project to create a usability framework for health information technology (HIT) systems" to the Certification Commission for Healthcare Information Systems’ (CCHIT) 2011 Usability Testing Guide for Comprehensive Ambulatory EHRs.

• Care coordination. Despite spending one-sixth of our entire gross domestic product on health care, the United States falls far short of being the healthiest society in the world. One reason: We spend the vast majority of our resources treating the symptoms rather than the causes of disease. Care coordination across all elements of the complex health care system (for example, subspecialty care, hospitals, home health agencies, nursing homes, etc.) and the patient’s community is essential to creating a shift from treatment to prevention – and EHRs are essential to care coordination.

In addition, care coordination is a key characteristic of the patient-centered medical home, an emerging care concept based on evidence, driven by data, focused on health and wellness, and centered on the needs of the patient.

These three imperatives – interoperability, usability, and care coordination – are driving EHR development. As such, they also are key considerations in the selection of an EHR solution.

Functional Matters: Choosing an EHR Solution

The 2009 American Recovery and Reinvestment Act’s (ARRA) HITECH Act may have brought EHRs to the forefront of health care discussion, but it did not alter their primary function – improving the quality of care. To ensure this result, physicians should look for the following in an EHR product:

• Certification: Certification assures a product has met core criteria considered essential by a broad range of stakeholders, which is key to maximizing the system’s value. One-time certification is not enough; annual certification evidences the continual development necessary for the product’s ongoing viability.

The sole organization designated by the Department of Health and Human Services (HHS) since 2006, CCHIT is the industry’s leading EHR certification body and the de facto standard for usability and other criteria. However, with the advent of ARRA and the resulting need to preclude any conflict of interest, HHS now will oversee multiple certification organizations. The Office of the National Coordinator (ONC) for Health Information Technology is developing its own certification criteria with NIST, which will assess conformity and accredit certification bodies.

 

Still, those that now possess CCHIT usability ratings and certification have positioned themselves in the forefront of the certification process.

• Structured data: Structured data reside in fixed fields within a record or file. These discrete data fields (for example, blood pressure, body mass index, and height/weight) establish the predetermined data types and understood relationships necessary for efficient quality reporting. Since 2008, the Centers for Medicare and Medicaid Services has allowed reporting of quality measures data to a qualified registry. As early as this year, CMS could begin accepting direct EHR-based quality reporting. As early as 2012, CMS could mandate it. EHRs built on unstructured data (as is found in many transcription/dictation systems) will not support compliance.

• Meaningful use guarantees: Incentives should not be the sole reason why physicians deploy EHRs, but the ability to secure incentives must not be overlooked. EHR vendors with a commitment to – and a plan for – meeting meaningful use criteria as they are established will offer guarantees to that effect.

• Clinical decision support: Evidence-based practice is the inevitable future of health care. EHRs with clinical prompts and reminders support best practice and systemize the use of evidence at the point of care.

• Support for coordinated care: Increasingly, EHRs will serve as the foundation for data registries, health information exchange, and other means to assure patients get the indicated care when and where they need and want it, and in a culturally and linguistically appropriate manner. Expanded patient data access – via secure communication portals, for instance – also will require more robust data controls to ensure secure data exchange. However, it will enable patient-centric care through greater patient involvement.

Health care is a dynamic industry, driven by the needs – changing and continuous – of its stakeholders. Developing, choosing, and deploying EHRs will continue to challenge. Keeping standardization, usability, and interoperability as the prime focus of all development and purchase decisions ultimately will smooth the path for everyone.

Dr. Corley is the chief medical officer for NextGen Healthcare Information Systems, an electronic health record vendor. Dr. Skolnik is associate director of the family medicine residency program at Abington (Pa.) Memorial Hospital and professor of family and community medicine at Temple University, Philadelphia. He is also editor-in-chief of Redi-Reference Inc., a software company that creates medical handheld references.

References

1. The Computer-Based Patient Record: An Essential Technology for Health Care Committee on Improving the Patient Record, Division of Health Care Services, Institute of Medicine Richard S. Dick, Elaine B. Steen; eds. 190 pages. Washington, D.C.: National Academy Press; 1991.

2. National Institute of Standards and Technology. Health Information Technology Usability Framework. Federal Business Opportunity. Solicitation Number: AMD-10-SS39 Web.

The need to improve the quality of care while lowering its cost is at the root of every major initiative in health care today. While new models of care are evolving to meet this need, new technology applications are being developed simultaneously to make these models viable. The electronic health record is both the means and the end of these revolutionary processes.

An EHR’s raison d’être is to collect and share data important for the treatment of patients. This seemingly simple function, however, rests on complex, multifaceted relationships that seek to balance caregivers’ needs against information systems’ capabilities. Driven forward by federal government mandates, the next several years promise to bring issues of EHR standardization, usability, and interoperability to the forefront of practicing physicians’ collective awareness.

EHR Development: Where Is It Going, and Why

While change is constant in health care – and exponential in technology – three EHR developmental imperatives are emerging in response to industry trends, as well as existing and imminent federal requirements:

• Interoperability. Standardization – the prerequisite for sharing records between and among IT systems – has been an important, though hard-to-achieve, goal of EHR development since 1991, when the Institute of Medicine’s report, "The Computer-Based Patient Record: An Essential Technology for Health Care," introduced the idea of "an electronic patient record ... specifically designed to support users through availability of complete and accurate data, alerts, reminders, clinical decision support systems, links to medical knowledge and other aids."

Since that time, several organizations have worked to further the development of standards, with some success as evidenced by standardization of lab results, medication names, allergies, and demographic data. Other data elements, such as physician progress notes that require multiple concepts to express, are proving more problematic. The challenge: ensuring interoperability for public health reporting and research without hindering or further complicating the physician "conversation." Meeting this challenge demands ongoing, industry-level standards development.

• Usability. As federal mandates increase quality and reporting requirements, EHR solutions must evolve to help rather than hinder physicians’ efforts to meet them. For example, an EHR that requires numerous "clicks" to order a single medication is not going to streamline a physician’s workflow. The problem is finding ways to objectively measure something as seemingly subjective as usability.

However, the issue is now on the federal radar and fast becoming a must-have for EHR products. Certification organizations increasingly are looking for ways to measure and mandate usability of EHR products, from the National Institute of Standards and Technology’s (NIST) search for sources "to fully develop and execute a project to create a usability framework for health information technology (HIT) systems" to the Certification Commission for Healthcare Information Systems’ (CCHIT) 2011 Usability Testing Guide for Comprehensive Ambulatory EHRs.

• Care coordination. Despite spending one-sixth of our entire gross domestic product on health care, the United States falls far short of being the healthiest society in the world. One reason: We spend the vast majority of our resources treating the symptoms rather than the causes of disease. Care coordination across all elements of the complex health care system (for example, subspecialty care, hospitals, home health agencies, nursing homes, etc.) and the patient’s community is essential to creating a shift from treatment to prevention – and EHRs are essential to care coordination.

In addition, care coordination is a key characteristic of the patient-centered medical home, an emerging care concept based on evidence, driven by data, focused on health and wellness, and centered on the needs of the patient.

These three imperatives – interoperability, usability, and care coordination – are driving EHR development. As such, they also are key considerations in the selection of an EHR solution.

Functional Matters: Choosing an EHR Solution

The 2009 American Recovery and Reinvestment Act’s (ARRA) HITECH Act may have brought EHRs to the forefront of health care discussion, but it did not alter their primary function – improving the quality of care. To ensure this result, physicians should look for the following in an EHR product:

• Certification: Certification assures a product has met core criteria considered essential by a broad range of stakeholders, which is key to maximizing the system’s value. One-time certification is not enough; annual certification evidences the continual development necessary for the product’s ongoing viability.

The sole organization designated by the Department of Health and Human Services (HHS) since 2006, CCHIT is the industry’s leading EHR certification body and the de facto standard for usability and other criteria. However, with the advent of ARRA and the resulting need to preclude any conflict of interest, HHS now will oversee multiple certification organizations. The Office of the National Coordinator (ONC) for Health Information Technology is developing its own certification criteria with NIST, which will assess conformity and accredit certification bodies.

 

Still, those that now possess CCHIT usability ratings and certification have positioned themselves in the forefront of the certification process.

• Structured data: Structured data reside in fixed fields within a record or file. These discrete data fields (for example, blood pressure, body mass index, and height/weight) establish the predetermined data types and understood relationships necessary for efficient quality reporting. Since 2008, the Centers for Medicare and Medicaid Services has allowed reporting of quality measures data to a qualified registry. As early as this year, CMS could begin accepting direct EHR-based quality reporting. As early as 2012, CMS could mandate it. EHRs built on unstructured data (as is found in many transcription/dictation systems) will not support compliance.

• Meaningful use guarantees: Incentives should not be the sole reason why physicians deploy EHRs, but the ability to secure incentives must not be overlooked. EHR vendors with a commitment to – and a plan for – meeting meaningful use criteria as they are established will offer guarantees to that effect.

• Clinical decision support: Evidence-based practice is the inevitable future of health care. EHRs with clinical prompts and reminders support best practice and systemize the use of evidence at the point of care.

• Support for coordinated care: Increasingly, EHRs will serve as the foundation for data registries, health information exchange, and other means to assure patients get the indicated care when and where they need and want it, and in a culturally and linguistically appropriate manner. Expanded patient data access – via secure communication portals, for instance – also will require more robust data controls to ensure secure data exchange. However, it will enable patient-centric care through greater patient involvement.

Health care is a dynamic industry, driven by the needs – changing and continuous – of its stakeholders. Developing, choosing, and deploying EHRs will continue to challenge. Keeping standardization, usability, and interoperability as the prime focus of all development and purchase decisions ultimately will smooth the path for everyone.

Dr. Corley is the chief medical officer for NextGen Healthcare Information Systems, an electronic health record vendor. Dr. Skolnik is associate director of the family medicine residency program at Abington (Pa.) Memorial Hospital and professor of family and community medicine at Temple University, Philadelphia. He is also editor-in-chief of Redi-Reference Inc., a software company that creates medical handheld references.

References

1. The Computer-Based Patient Record: An Essential Technology for Health Care Committee on Improving the Patient Record, Division of Health Care Services, Institute of Medicine Richard S. Dick, Elaine B. Steen; eds. 190 pages. Washington, D.C.: National Academy Press; 1991.

2. National Institute of Standards and Technology. Health Information Technology Usability Framework. Federal Business Opportunity. Solicitation Number: AMD-10-SS39 Web.

The highly anticipated time has finally arrived: On April 18, the Centers for Medicare and Medicaid Services launched the attestation program for reporting stage 1 milestones of "meaningful use."

Under the American Recovery and Reinvestment Act of 2009 (ARRA), this will allow providers who have implemented a certified electronic health record to cash in on the Medicare incentives promised for so long. Finally, that $44,000 seems within reach!

To claim the incentive dollars, practices should navigate to the CMS Web site and begin reporting. The site provides detailed instructions, tutorials, and step-by-step screenshots on what to expect throughout the process.

Providers are required to report on 15 core measures, 5 out of 10 additional measures from a menu of options, and 6 clinical quality measures. Each step differs in what information must be provided, and records need to be maintained in case of audit.

The ARRA incentive program is administered at the state level, and therefore the timeline for reimbursement varies based on practice location. Those skeptical about ever seeing the money should be reassured that many have already begun realizing the financial rewards of their EHR: The CMS reports it has already disbursed $65 million since the beginning of 2011 to providers in certain states.

If you find yourself fortunate enough to be among that group, consider yourself lucky. But before taking a much-needed rest on your proverbial laurels, remember what’s looming just around the corner: stage 2.

The wrangling already has begun over the stage 2 requirements. Not surprisingly, there are many who are concerned about the timing of implementation. They argue that it is unrealistic to expect physicians to begin thinking about stage 2 when many have not yet begun to use an EHR in a significant way. If the original timeline is maintained, physicians will need to collect stage 2 data in 2012 to receive bonuses in 2013. But many providers have stated that they will not be able to even consider stage 1 reporting until 2012 at the earliest.

As long as the process is started by next year, practices will still be able to maximize the incentives – but there is no question that the sooner an EHR is adopted, the better the chance of financial reward.

Conversion to electronic records does not occur overnight. It is time consuming to choose the right EHR, and once selected, the transition to actual "meaningful use" can take several months or more. In addition, even in the best of situations, unforeseen roadblocks can significantly slow down the process. Eventually, failure to meet meaningful use will result in reimbursement penalties, and the advent of stage 2 criteria is a reminder that the clock is ticking.

The content of the stage 2 criteria is another concern, with experts disagreeing on what should actually be included. To make things worse, other recent health initiatives have significantly complicated this process.

On March 31, the Department of Health and Human Services released the proposed rule for accountable care organizations (ACOs).

As described, an ACO will be a group of providers that assume responsibility for a defined population of Medicare patients, with the goal of increasing quality of care and decreasing delivery costs. If successful, the providers will share in the cost savings.

While ACOs sound like a good idea on the surface, they will come with a new and completely different set of reporting requirements. Certified EHRs that have been designed around "meaningful use" may not have the capabilities necessary for ACOs, especially when it comes to provider communications and transition of care. This may mean significant software revisions and system upgrades that are both time consuming and expensive.

Many are calling for an alignment of the stage 2 requirements with those of ACOs, as accountable care organizations represent a model that will endure long after "meaningful use" has come and gone. Dr. Farzad Mostashari, who just succeeded Dr. David Blumenthal as the National Coordinator for Health Information Technology, stated recently that he would like to see meaningful use as a "jump-start on what you’re going to need to do to be successful as an ACO." This is probably a best-case scenario for stage 2.

Over the next few months, there will be tremendous attention paid to how health care reform will shape the landscape of electronic health records. As care providers and EHR vendors lobby for delaying the implementation of stage 2, patients and consumer advocacy groups will continue to call for ever-advancing technology focused on better care at lower costs.

 

Regardless of the final guidelines, it is clear to see that information sharing and quality reporting will be essential components in care delivery as the march toward widespread implementation of electronic health records, encouraged by government financial incentives, moves ahead.

This column, "EHR Report," appears regularly in Family Practice News, a publication of Elsevier. Dr. Skolnik is associate director of the family medicine residency program at Abington (Pa.) Memorial Hospital and professor of family and community medicine at Temple University, Philadelphia. He is also editor-in-chief of Redi-Reference Inc., a software company that creates medical handheld references. Dr. Notte is in private practice in Chalfont, Pa. They are partners in EHR Practice Consultants, helping practices move to EHR systems. Contact them at [email protected]. Dr. Skolnik and Dr. Notte had no conflicts of interest to declare.

The highly anticipated time has finally arrived: On April 18, the Centers for Medicare and Medicaid Services launched the attestation program for reporting stage 1 milestones of "meaningful use."

Under the American Recovery and Reinvestment Act of 2009 (ARRA), this will allow providers who have implemented a certified electronic health record to cash in on the Medicare incentives promised for so long. Finally, that $44,000 seems within reach!

To claim the incentive dollars, practices should navigate to the CMS Web site and begin reporting. The site provides detailed instructions, tutorials, and step-by-step screenshots on what to expect throughout the process.

Providers are required to report on 15 core measures, 5 out of 10 additional measures from a menu of options, and 6 clinical quality measures. Each step differs in what information must be provided, and records need to be maintained in case of audit.

The ARRA incentive program is administered at the state level, and therefore the timeline for reimbursement varies based on practice location. Those skeptical about ever seeing the money should be reassured that many have already begun realizing the financial rewards of their EHR: The CMS reports it has already disbursed $65 million since the beginning of 2011 to providers in certain states.

If you find yourself fortunate enough to be among that group, consider yourself lucky. But before taking a much-needed rest on your proverbial laurels, remember what’s looming just around the corner: stage 2.

The wrangling already has begun over the stage 2 requirements. Not surprisingly, there are many who are concerned about the timing of implementation. They argue that it is unrealistic to expect physicians to begin thinking about stage 2 when many have not yet begun to use an EHR in a significant way. If the original timeline is maintained, physicians will need to collect stage 2 data in 2012 to receive bonuses in 2013. But many providers have stated that they will not be able to even consider stage 1 reporting until 2012 at the earliest.

As long as the process is started by next year, practices will still be able to maximize the incentives – but there is no question that the sooner an EHR is adopted, the better the chance of financial reward.

Conversion to electronic records does not occur overnight. It is time consuming to choose the right EHR, and once selected, the transition to actual "meaningful use" can take several months or more. In addition, even in the best of situations, unforeseen roadblocks can significantly slow down the process. Eventually, failure to meet meaningful use will result in reimbursement penalties, and the advent of stage 2 criteria is a reminder that the clock is ticking.

The content of the stage 2 criteria is another concern, with experts disagreeing on what should actually be included. To make things worse, other recent health initiatives have significantly complicated this process.

On March 31, the Department of Health and Human Services released the proposed rule for accountable care organizations (ACOs).

As described, an ACO will be a group of providers that assume responsibility for a defined population of Medicare patients, with the goal of increasing quality of care and decreasing delivery costs. If successful, the providers will share in the cost savings.

While ACOs sound like a good idea on the surface, they will come with a new and completely different set of reporting requirements. Certified EHRs that have been designed around "meaningful use" may not have the capabilities necessary for ACOs, especially when it comes to provider communications and transition of care. This may mean significant software revisions and system upgrades that are both time consuming and expensive.

Many are calling for an alignment of the stage 2 requirements with those of ACOs, as accountable care organizations represent a model that will endure long after "meaningful use" has come and gone. Dr. Farzad Mostashari, who just succeeded Dr. David Blumenthal as the National Coordinator for Health Information Technology, stated recently that he would like to see meaningful use as a "jump-start on what you’re going to need to do to be successful as an ACO." This is probably a best-case scenario for stage 2.

Over the next few months, there will be tremendous attention paid to how health care reform will shape the landscape of electronic health records. As care providers and EHR vendors lobby for delaying the implementation of stage 2, patients and consumer advocacy groups will continue to call for ever-advancing technology focused on better care at lower costs.

 

Regardless of the final guidelines, it is clear to see that information sharing and quality reporting will be essential components in care delivery as the march toward widespread implementation of electronic health records, encouraged by government financial incentives, moves ahead.

This column, "EHR Report," appears regularly in Family Practice News, a publication of Elsevier. Dr. Skolnik is associate director of the family medicine residency program at Abington (Pa.) Memorial Hospital and professor of family and community medicine at Temple University, Philadelphia. He is also editor-in-chief of Redi-Reference Inc., a software company that creates medical handheld references. Dr. Notte is in private practice in Chalfont, Pa. They are partners in EHR Practice Consultants, helping practices move to EHR systems. Contact them at [email protected]. Dr. Skolnik and Dr. Notte had no conflicts of interest to declare.

The highly anticipated time has finally arrived: On April 18, the Centers for Medicare and Medicaid Services launched the attestation program for reporting stage 1 milestones of "meaningful use."

Under the American Recovery and Reinvestment Act of 2009 (ARRA), this will allow providers who have implemented a certified electronic health record to cash in on the Medicare incentives promised for so long. Finally, that $44,000 seems within reach!

To claim the incentive dollars, practices should navigate to the CMS Web site and begin reporting. The site provides detailed instructions, tutorials, and step-by-step screenshots on what to expect throughout the process.

Providers are required to report on 15 core measures, 5 out of 10 additional measures from a menu of options, and 6 clinical quality measures. Each step differs in what information must be provided, and records need to be maintained in case of audit.

The ARRA incentive program is administered at the state level, and therefore the timeline for reimbursement varies based on practice location. Those skeptical about ever seeing the money should be reassured that many have already begun realizing the financial rewards of their EHR: The CMS reports it has already disbursed $65 million since the beginning of 2011 to providers in certain states.

If you find yourself fortunate enough to be among that group, consider yourself lucky. But before taking a much-needed rest on your proverbial laurels, remember what’s looming just around the corner: stage 2.

The wrangling already has begun over the stage 2 requirements. Not surprisingly, there are many who are concerned about the timing of implementation. They argue that it is unrealistic to expect physicians to begin thinking about stage 2 when many have not yet begun to use an EHR in a significant way. If the original timeline is maintained, physicians will need to collect stage 2 data in 2012 to receive bonuses in 2013. But many providers have stated that they will not be able to even consider stage 1 reporting until 2012 at the earliest.

As long as the process is started by next year, practices will still be able to maximize the incentives – but there is no question that the sooner an EHR is adopted, the better the chance of financial reward.

Conversion to electronic records does not occur overnight. It is time consuming to choose the right EHR, and once selected, the transition to actual "meaningful use" can take several months or more. In addition, even in the best of situations, unforeseen roadblocks can significantly slow down the process. Eventually, failure to meet meaningful use will result in reimbursement penalties, and the advent of stage 2 criteria is a reminder that the clock is ticking.

The content of the stage 2 criteria is another concern, with experts disagreeing on what should actually be included. To make things worse, other recent health initiatives have significantly complicated this process.

On March 31, the Department of Health and Human Services released the proposed rule for accountable care organizations (ACOs).

As described, an ACO will be a group of providers that assume responsibility for a defined population of Medicare patients, with the goal of increasing quality of care and decreasing delivery costs. If successful, the providers will share in the cost savings.

While ACOs sound like a good idea on the surface, they will come with a new and completely different set of reporting requirements. Certified EHRs that have been designed around "meaningful use" may not have the capabilities necessary for ACOs, especially when it comes to provider communications and transition of care. This may mean significant software revisions and system upgrades that are both time consuming and expensive.

Many are calling for an alignment of the stage 2 requirements with those of ACOs, as accountable care organizations represent a model that will endure long after "meaningful use" has come and gone. Dr. Farzad Mostashari, who just succeeded Dr. David Blumenthal as the National Coordinator for Health Information Technology, stated recently that he would like to see meaningful use as a "jump-start on what you’re going to need to do to be successful as an ACO." This is probably a best-case scenario for stage 2.

Over the next few months, there will be tremendous attention paid to how health care reform will shape the landscape of electronic health records. As care providers and EHR vendors lobby for delaying the implementation of stage 2, patients and consumer advocacy groups will continue to call for ever-advancing technology focused on better care at lower costs.

 

Regardless of the final guidelines, it is clear to see that information sharing and quality reporting will be essential components in care delivery as the march toward widespread implementation of electronic health records, encouraged by government financial incentives, moves ahead.

This column, "EHR Report," appears regularly in Family Practice News, a publication of Elsevier. Dr. Skolnik is associate director of the family medicine residency program at Abington (Pa.) Memorial Hospital and professor of family and community medicine at Temple University, Philadelphia. He is also editor-in-chief of Redi-Reference Inc., a software company that creates medical handheld references. Dr. Notte is in private practice in Chalfont, Pa. They are partners in EHR Practice Consultants, helping practices move to EHR systems. Contact them at [email protected]. Dr. Skolnik and Dr. Notte had no conflicts of interest to declare.

The highly anticipated time has finally arrived: On April 18, the Centers for Medicare and Medicaid Services launched the attestation program for reporting stage 1 milestones of "meaningful use."

Under the American Recovery and Reinvestment Act of 2009 (ARRA), this will allow providers who have implemented a certified electronic health record to cash in on the Medicare incentives promised for so long. Finally, that $44,000 seems within reach!

To claim the incentive dollars, practices should navigate to the CMS Web site and begin reporting. The site provides detailed instructions, tutorials, and step-by-step screenshots on what to expect throughout the process.

Providers are required to report on 15 core measures, 5 out of 10 additional measures from a menu of options, and 6 clinical quality measures. Each step differs in what information must be provided, and records need to be maintained in case of audit.

The ARRA incentive program is administered at the state level, and therefore the timeline for reimbursement varies based on practice location. Those skeptical about ever seeing the money should be reassured that many have already begun realizing the financial rewards of their EHR: The CMS reports it has already disbursed $65 million since the beginning of 2011 to providers in certain states.

If you find yourself fortunate enough to be among that group, consider yourself lucky. But before taking a much-needed rest on your proverbial laurels, remember what’s looming just around the corner: stage 2.

The wrangling already has begun over the stage 2 requirements. Not surprisingly, there are many who are concerned about the timing of implementation. They argue that it is unrealistic to expect physicians to begin thinking about stage 2 when many have not yet begun to use an EHR in a significant way. If the original timeline is maintained, physicians will need to collect stage 2 data in 2012 to receive bonuses in 2013. But many providers have stated that they will not be able to even consider stage 1 reporting until 2012 at the earliest.

As long as the process is started by next year, practices will still be able to maximize the incentives – but there is no question that the sooner an EHR is adopted, the better the chance of financial reward.

Conversion to electronic records does not occur overnight. It is time consuming to choose the right EHR, and once selected, the transition to actual "meaningful use" can take several months or more. In addition, even in the best of situations, unforeseen roadblocks can significantly slow down the process. Eventually, failure to meet meaningful use will result in reimbursement penalties, and the advent of stage 2 criteria is a reminder that the clock is ticking.

The content of the stage 2 criteria is another concern, with experts disagreeing on what should actually be included. To make things worse, other recent health initiatives have significantly complicated this process.

On March 31, the Department of Health and Human Services released the proposed rule for accountable care organizations (ACOs).

As described, an ACO will be a group of providers that assume responsibility for a defined population of Medicare patients, with the goal of increasing quality of care and decreasing delivery costs. If successful, the providers will share in the cost savings.

While ACOs sound like a good idea on the surface, they will come with a new and completely different set of reporting requirements. Certified EHRs that have been designed around "meaningful use" may not have the capabilities necessary for ACOs, especially when it comes to provider communications and transition of care. This may mean significant software revisions and system upgrades that are both time consuming and expensive.

Many are calling for an alignment of the stage 2 requirements with those of ACOs, as accountable care organizations represent a model that will endure long after "meaningful use" has come and gone. Dr. Farzad Mostashari, who just succeeded Dr. David Blumenthal as the National Coordinator for Health Information Technology, stated recently that he would like to see meaningful use as a "jump-start on what you’re going to need to do to be successful as an ACO." This is probably a best-case scenario for stage 2.

Over the next few months, there will be tremendous attention paid to how health care reform will shape the landscape of electronic health records. As care providers and EHR vendors lobby for delaying the implementation of stage 2, patients and consumer advocacy groups will continue to call for ever-advancing technology focused on better care at lower costs.

 

Regardless of the final guidelines, it is clear to see that information sharing and quality reporting will be essential components in care delivery as the march toward widespread implementation of electronic health records, encouraged by government financial incentives, moves ahead.

This column, "EHR Report," appears regularly in Family Practice News, a publication of Elsevier. Dr. Skolnik is associate director of the family medicine residency program at Abington (Pa.) Memorial Hospital and professor of family and community medicine at Temple University, Philadelphia. He is also editor-in-chief of Redi-Reference Inc., a software company that creates medical handheld references. Dr. Notte is in private practice in Chalfont, Pa. They are partners in EHR Practice Consultants, helping practices move to EHR systems. Contact them at [email protected]. Dr. Skolnik and Dr. Notte had no conflicts of interest to declare.

The highly anticipated time has finally arrived: On April 18, the Centers for Medicare and Medicaid Services launched the attestation program for reporting stage 1 milestones of "meaningful use."

Under the American Recovery and Reinvestment Act of 2009 (ARRA), this will allow providers who have implemented a certified electronic health record to cash in on the Medicare incentives promised for so long. Finally, that $44,000 seems within reach!

To claim the incentive dollars, practices should navigate to the CMS Web site and begin reporting. The site provides detailed instructions, tutorials, and step-by-step screenshots on what to expect throughout the process.

Providers are required to report on 15 core measures, 5 out of 10 additional measures from a menu of options, and 6 clinical quality measures. Each step differs in what information must be provided, and records need to be maintained in case of audit.

The ARRA incentive program is administered at the state level, and therefore the timeline for reimbursement varies based on practice location. Those skeptical about ever seeing the money should be reassured that many have already begun realizing the financial rewards of their EHR: The CMS reports it has already disbursed $65 million since the beginning of 2011 to providers in certain states.

If you find yourself fortunate enough to be among that group, consider yourself lucky. But before taking a much-needed rest on your proverbial laurels, remember what’s looming just around the corner: stage 2.

The wrangling already has begun over the stage 2 requirements. Not surprisingly, there are many who are concerned about the timing of implementation. They argue that it is unrealistic to expect physicians to begin thinking about stage 2 when many have not yet begun to use an EHR in a significant way. If the original timeline is maintained, physicians will need to collect stage 2 data in 2012 to receive bonuses in 2013. But many providers have stated that they will not be able to even consider stage 1 reporting until 2012 at the earliest.

As long as the process is started by next year, practices will still be able to maximize the incentives – but there is no question that the sooner an EHR is adopted, the better the chance of financial reward.

Conversion to electronic records does not occur overnight. It is time consuming to choose the right EHR, and once selected, the transition to actual "meaningful use" can take several months or more. In addition, even in the best of situations, unforeseen roadblocks can significantly slow down the process. Eventually, failure to meet meaningful use will result in reimbursement penalties, and the advent of stage 2 criteria is a reminder that the clock is ticking.

The content of the stage 2 criteria is another concern, with experts disagreeing on what should actually be included. To make things worse, other recent health initiatives have significantly complicated this process.

On March 31, the Department of Health and Human Services released the proposed rule for accountable care organizations (ACOs).

As described, an ACO will be a group of providers that assume responsibility for a defined population of Medicare patients, with the goal of increasing quality of care and decreasing delivery costs. If successful, the providers will share in the cost savings.

While ACOs sound like a good idea on the surface, they will come with a new and completely different set of reporting requirements. Certified EHRs that have been designed around "meaningful use" may not have the capabilities necessary for ACOs, especially when it comes to provider communications and transition of care. This may mean significant software revisions and system upgrades that are both time consuming and expensive.

Many are calling for an alignment of the stage 2 requirements with those of ACOs, as accountable care organizations represent a model that will endure long after "meaningful use" has come and gone. Dr. Farzad Mostashari, who just succeeded Dr. David Blumenthal as the National Coordinator for Health Information Technology, stated recently that he would like to see meaningful use as a "jump-start on what you’re going to need to do to be successful as an ACO." This is probably a best-case scenario for stage 2.

Over the next few months, there will be tremendous attention paid to how health care reform will shape the landscape of electronic health records. As care providers and EHR vendors lobby for delaying the implementation of stage 2, patients and consumer advocacy groups will continue to call for ever-advancing technology focused on better care at lower costs.

 

Regardless of the final guidelines, it is clear to see that information sharing and quality reporting will be essential components in care delivery as the march toward widespread implementation of electronic health records, encouraged by government financial incentives, moves ahead.

This column, "EHR Report," appears regularly in Family Practice News, a publication of Elsevier. Dr. Skolnik is associate director of the family medicine residency program at Abington (Pa.) Memorial Hospital and professor of family and community medicine at Temple University, Philadelphia. He is also editor-in-chief of Redi-Reference Inc., a software company that creates medical handheld references. Dr. Notte is in private practice in Chalfont, Pa. They are partners in EHR Practice Consultants, helping practices move to EHR systems. Contact them at [email protected]. Dr. Skolnik and Dr. Notte had no conflicts of interest to declare.

The highly anticipated time has finally arrived: On April 18, the Centers for Medicare and Medicaid Services launched the attestation program for reporting stage 1 milestones of "meaningful use."

Under the American Recovery and Reinvestment Act of 2009 (ARRA), this will allow providers who have implemented a certified electronic health record to cash in on the Medicare incentives promised for so long. Finally, that $44,000 seems within reach!

To claim the incentive dollars, practices should navigate to the CMS Web site and begin reporting. The site provides detailed instructions, tutorials, and step-by-step screenshots on what to expect throughout the process.

Providers are required to report on 15 core measures, 5 out of 10 additional measures from a menu of options, and 6 clinical quality measures. Each step differs in what information must be provided, and records need to be maintained in case of audit.

The ARRA incentive program is administered at the state level, and therefore the timeline for reimbursement varies based on practice location. Those skeptical about ever seeing the money should be reassured that many have already begun realizing the financial rewards of their EHR: The CMS reports it has already disbursed $65 million since the beginning of 2011 to providers in certain states.

If you find yourself fortunate enough to be among that group, consider yourself lucky. But before taking a much-needed rest on your proverbial laurels, remember what’s looming just around the corner: stage 2.

The wrangling already has begun over the stage 2 requirements. Not surprisingly, there are many who are concerned about the timing of implementation. They argue that it is unrealistic to expect physicians to begin thinking about stage 2 when many have not yet begun to use an EHR in a significant way. If the original timeline is maintained, physicians will need to collect stage 2 data in 2012 to receive bonuses in 2013. But many providers have stated that they will not be able to even consider stage 1 reporting until 2012 at the earliest.

As long as the process is started by next year, practices will still be able to maximize the incentives – but there is no question that the sooner an EHR is adopted, the better the chance of financial reward.

Conversion to electronic records does not occur overnight. It is time consuming to choose the right EHR, and once selected, the transition to actual "meaningful use" can take several months or more. In addition, even in the best of situations, unforeseen roadblocks can significantly slow down the process. Eventually, failure to meet meaningful use will result in reimbursement penalties, and the advent of stage 2 criteria is a reminder that the clock is ticking.

The content of the stage 2 criteria is another concern, with experts disagreeing on what should actually be included. To make things worse, other recent health initiatives have significantly complicated this process.

On March 31, the Department of Health and Human Services released the proposed rule for accountable care organizations (ACOs).

As described, an ACO will be a group of providers that assume responsibility for a defined population of Medicare patients, with the goal of increasing quality of care and decreasing delivery costs. If successful, the providers will share in the cost savings.

While ACOs sound like a good idea on the surface, they will come with a new and completely different set of reporting requirements. Certified EHRs that have been designed around "meaningful use" may not have the capabilities necessary for ACOs, especially when it comes to provider communications and transition of care. This may mean significant software revisions and system upgrades that are both time consuming and expensive.

Many are calling for an alignment of the stage 2 requirements with those of ACOs, as accountable care organizations represent a model that will endure long after "meaningful use" has come and gone. Dr. Farzad Mostashari, who just succeeded Dr. David Blumenthal as the National Coordinator for Health Information Technology, stated recently that he would like to see meaningful use as a "jump-start on what you’re going to need to do to be successful as an ACO." This is probably a best-case scenario for stage 2.

Over the next few months, there will be tremendous attention paid to how health care reform will shape the landscape of electronic health records. As care providers and EHR vendors lobby for delaying the implementation of stage 2, patients and consumer advocacy groups will continue to call for ever-advancing technology focused on better care at lower costs.

 

Regardless of the final guidelines, it is clear to see that information sharing and quality reporting will be essential components in care delivery as the march toward widespread implementation of electronic health records, encouraged by government financial incentives, moves ahead.

This column, "EHR Report," appears regularly in Family Practice News, a publication of Elsevier. Dr. Skolnik is associate director of the family medicine residency program at Abington (Pa.) Memorial Hospital and professor of family and community medicine at Temple University, Philadelphia. He is also editor-in-chief of Redi-Reference Inc., a software company that creates medical handheld references. Dr. Notte is in private practice in Chalfont, Pa. They are partners in EHR Practice Consultants, helping practices move to EHR systems. Contact them at [email protected]. Dr. Skolnik and Dr. Notte had no conflicts of interest to declare.

The highly anticipated time has finally arrived: On April 18, the Centers for Medicare and Medicaid Services launched the attestation program for reporting stage 1 milestones of "meaningful use."

Under the American Recovery and Reinvestment Act of 2009 (ARRA), this will allow providers who have implemented a certified electronic health record to cash in on the Medicare incentives promised for so long. Finally, that $44,000 seems within reach!

To claim the incentive dollars, practices should navigate to the CMS Web site and begin reporting. The site provides detailed instructions, tutorials, and step-by-step screenshots on what to expect throughout the process.

Providers are required to report on 15 core measures, 5 out of 10 additional measures from a menu of options, and 6 clinical quality measures. Each step differs in what information must be provided, and records need to be maintained in case of audit.

The ARRA incentive program is administered at the state level, and therefore the timeline for reimbursement varies based on practice location. Those skeptical about ever seeing the money should be reassured that many have already begun realizing the financial rewards of their EHR: The CMS reports it has already disbursed $65 million since the beginning of 2011 to providers in certain states.

If you find yourself fortunate enough to be among that group, consider yourself lucky. But before taking a much-needed rest on your proverbial laurels, remember what’s looming just around the corner: stage 2.

The wrangling already has begun over the stage 2 requirements. Not surprisingly, there are many who are concerned about the timing of implementation. They argue that it is unrealistic to expect physicians to begin thinking about stage 2 when many have not yet begun to use an EHR in a significant way. If the original timeline is maintained, physicians will need to collect stage 2 data in 2012 to receive bonuses in 2013. But many providers have stated that they will not be able to even consider stage 1 reporting until 2012 at the earliest.

As long as the process is started by next year, practices will still be able to maximize the incentives – but there is no question that the sooner an EHR is adopted, the better the chance of financial reward.

Conversion to electronic records does not occur overnight. It is time consuming to choose the right EHR, and once selected, the transition to actual "meaningful use" can take several months or more. In addition, even in the best of situations, unforeseen roadblocks can significantly slow down the process. Eventually, failure to meet meaningful use will result in reimbursement penalties, and the advent of stage 2 criteria is a reminder that the clock is ticking.

The content of the stage 2 criteria is another concern, with experts disagreeing on what should actually be included. To make things worse, other recent health initiatives have significantly complicated this process.

On March 31, the Department of Health and Human Services released the proposed rule for accountable care organizations (ACOs).

As described, an ACO will be a group of providers that assume responsibility for a defined population of Medicare patients, with the goal of increasing quality of care and decreasing delivery costs. If successful, the providers will share in the cost savings.

While ACOs sound like a good idea on the surface, they will come with a new and completely different set of reporting requirements. Certified EHRs that have been designed around "meaningful use" may not have the capabilities necessary for ACOs, especially when it comes to provider communications and transition of care. This may mean significant software revisions and system upgrades that are both time consuming and expensive.

Many are calling for an alignment of the stage 2 requirements with those of ACOs, as accountable care organizations represent a model that will endure long after "meaningful use" has come and gone. Dr. Farzad Mostashari, who just succeeded Dr. David Blumenthal as the National Coordinator for Health Information Technology, stated recently that he would like to see meaningful use as a "jump-start on what you’re going to need to do to be successful as an ACO." This is probably a best-case scenario for stage 2.

Over the next few months, there will be tremendous attention paid to how health care reform will shape the landscape of electronic health records. As care providers and EHR vendors lobby for delaying the implementation of stage 2, patients and consumer advocacy groups will continue to call for ever-advancing technology focused on better care at lower costs.

 

Regardless of the final guidelines, it is clear to see that information sharing and quality reporting will be essential components in care delivery as the march toward widespread implementation of electronic health records, encouraged by government financial incentives, moves ahead.

This column, "EHR Report," appears regularly in Family Practice News, a publication of Elsevier. Dr. Skolnik is associate director of the family medicine residency program at Abington (Pa.) Memorial Hospital and professor of family and community medicine at Temple University, Philadelphia. He is also editor-in-chief of Redi-Reference Inc., a software company that creates medical handheld references. Dr. Notte is in private practice in Chalfont, Pa. They are partners in EHR Practice Consultants, helping practices move to EHR systems. Contact them at [email protected]. Dr. Skolnik and Dr. Notte had no conflicts of interest to declare.

The highly anticipated time has finally arrived: On April 18, the Centers for Medicare and Medicaid Services launched the attestation program for reporting stage 1 milestones of "meaningful use."

Under the American Recovery and Reinvestment Act of 2009 (ARRA), this will allow providers who have implemented a certified electronic health record to cash in on the Medicare incentives promised for so long. Finally, that $44,000 seems within reach!

To claim the incentive dollars, practices should navigate to the CMS Web site and begin reporting. The site provides detailed instructions, tutorials, and step-by-step screenshots on what to expect throughout the process.

Providers are required to report on 15 core measures, 5 out of 10 additional measures from a menu of options, and 6 clinical quality measures. Each step differs in what information must be provided, and records need to be maintained in case of audit.

The ARRA incentive program is administered at the state level, and therefore the timeline for reimbursement varies based on practice location. Those skeptical about ever seeing the money should be reassured that many have already begun realizing the financial rewards of their EHR: The CMS reports it has already disbursed $65 million since the beginning of 2011 to providers in certain states.

If you find yourself fortunate enough to be among that group, consider yourself lucky. But before taking a much-needed rest on your proverbial laurels, remember what’s looming just around the corner: stage 2.

The wrangling already has begun over the stage 2 requirements. Not surprisingly, there are many who are concerned about the timing of implementation. They argue that it is unrealistic to expect physicians to begin thinking about stage 2 when many have not yet begun to use an EHR in a significant way. If the original timeline is maintained, physicians will need to collect stage 2 data in 2012 to receive bonuses in 2013. But many providers have stated that they will not be able to even consider stage 1 reporting until 2012 at the earliest.

As long as the process is started by next year, practices will still be able to maximize the incentives – but there is no question that the sooner an EHR is adopted, the better the chance of financial reward.

Conversion to electronic records does not occur overnight. It is time consuming to choose the right EHR, and once selected, the transition to actual "meaningful use" can take several months or more. In addition, even in the best of situations, unforeseen roadblocks can significantly slow down the process. Eventually, failure to meet meaningful use will result in reimbursement penalties, and the advent of stage 2 criteria is a reminder that the clock is ticking.

The content of the stage 2 criteria is another concern, with experts disagreeing on what should actually be included. To make things worse, other recent health initiatives have significantly complicated this process.

On March 31, the Department of Health and Human Services released the proposed rule for accountable care organizations (ACOs).

As described, an ACO will be a group of providers that assume responsibility for a defined population of Medicare patients, with the goal of increasing quality of care and decreasing delivery costs. If successful, the providers will share in the cost savings.

While ACOs sound like a good idea on the surface, they will come with a new and completely different set of reporting requirements. Certified EHRs that have been designed around "meaningful use" may not have the capabilities necessary for ACOs, especially when it comes to provider communications and transition of care. This may mean significant software revisions and system upgrades that are both time consuming and expensive.

Many are calling for an alignment of the stage 2 requirements with those of ACOs, as accountable care organizations represent a model that will endure long after "meaningful use" has come and gone. Dr. Farzad Mostashari, who just succeeded Dr. David Blumenthal as the National Coordinator for Health Information Technology, stated recently that he would like to see meaningful use as a "jump-start on what you’re going to need to do to be successful as an ACO." This is probably a best-case scenario for stage 2.

Over the next few months, there will be tremendous attention paid to how health care reform will shape the landscape of electronic health records. As care providers and EHR vendors lobby for delaying the implementation of stage 2, patients and consumer advocacy groups will continue to call for ever-advancing technology focused on better care at lower costs.

 

Regardless of the final guidelines, it is clear to see that information sharing and quality reporting will be essential components in care delivery as the march toward widespread implementation of electronic health records, encouraged by government financial incentives, moves ahead.

This column, "EHR Report," appears regularly in Family Practice News, a publication of Elsevier. Dr. Skolnik is associate director of the family medicine residency program at Abington (Pa.) Memorial Hospital and professor of family and community medicine at Temple University, Philadelphia. He is also editor-in-chief of Redi-Reference Inc., a software company that creates medical handheld references. Dr. Notte is in private practice in Chalfont, Pa. They are partners in EHR Practice Consultants, helping practices move to EHR systems. Contact them at [email protected]. Dr. Skolnik and Dr. Notte had no conflicts of interest to declare.

The highly anticipated time has finally arrived: On April 18, the Centers for Medicare and Medicaid Services launched the attestation program for reporting stage 1 milestones of "meaningful use."

Under the American Recovery and Reinvestment Act of 2009 (ARRA), this will allow providers who have implemented a certified electronic health record to cash in on the Medicare incentives promised for so long. Finally, that $44,000 seems within reach!

To claim the incentive dollars, practices should navigate to the CMS Web site and begin reporting. The site provides detailed instructions, tutorials, and step-by-step screenshots on what to expect throughout the process.

Providers are required to report on 15 core measures, 5 out of 10 additional measures from a menu of options, and 6 clinical quality measures. Each step differs in what information must be provided, and records need to be maintained in case of audit.

The ARRA incentive program is administered at the state level, and therefore the timeline for reimbursement varies based on practice location. Those skeptical about ever seeing the money should be reassured that many have already begun realizing the financial rewards of their EHR: The CMS reports it has already disbursed $65 million since the beginning of 2011 to providers in certain states.

If you find yourself fortunate enough to be among that group, consider yourself lucky. But before taking a much-needed rest on your proverbial laurels, remember what’s looming just around the corner: stage 2.

The wrangling already has begun over the stage 2 requirements. Not surprisingly, there are many who are concerned about the timing of implementation. They argue that it is unrealistic to expect physicians to begin thinking about stage 2 when many have not yet begun to use an EHR in a significant way. If the original timeline is maintained, physicians will need to collect stage 2 data in 2012 to receive bonuses in 2013. But many providers have stated that they will not be able to even consider stage 1 reporting until 2012 at the earliest.

As long as the process is started by next year, practices will still be able to maximize the incentives – but there is no question that the sooner an EHR is adopted, the better the chance of financial reward.

Conversion to electronic records does not occur overnight. It is time consuming to choose the right EHR, and once selected, the transition to actual "meaningful use" can take several months or more. In addition, even in the best of situations, unforeseen roadblocks can significantly slow down the process. Eventually, failure to meet meaningful use will result in reimbursement penalties, and the advent of stage 2 criteria is a reminder that the clock is ticking.

The content of the stage 2 criteria is another concern, with experts disagreeing on what should actually be included. To make things worse, other recent health initiatives have significantly complicated this process.

On March 31, the Department of Health and Human Services released the proposed rule for accountable care organizations (ACOs).

As described, an ACO will be a group of providers that assume responsibility for a defined population of Medicare patients, with the goal of increasing quality of care and decreasing delivery costs. If successful, the providers will share in the cost savings.

While ACOs sound like a good idea on the surface, they will come with a new and completely different set of reporting requirements. Certified EHRs that have been designed around "meaningful use" may not have the capabilities necessary for ACOs, especially when it comes to provider communications and transition of care. This may mean significant software revisions and system upgrades that are both time consuming and expensive.

Many are calling for an alignment of the stage 2 requirements with those of ACOs, as accountable care organizations represent a model that will endure long after "meaningful use" has come and gone. Dr. Farzad Mostashari, who just succeeded Dr. David Blumenthal as the National Coordinator for Health Information Technology, stated recently that he would like to see meaningful use as a "jump-start on what you’re going to need to do to be successful as an ACO." This is probably a best-case scenario for stage 2.

Over the next few months, there will be tremendous attention paid to how health care reform will shape the landscape of electronic health records. As care providers and EHR vendors lobby for delaying the implementation of stage 2, patients and consumer advocacy groups will continue to call for ever-advancing technology focused on better care at lower costs.

 

Regardless of the final guidelines, it is clear to see that information sharing and quality reporting will be essential components in care delivery as the march toward widespread implementation of electronic health records, encouraged by government financial incentives, moves ahead.

This column, "EHR Report," appears regularly in Family Practice News, a publication of Elsevier. Dr. Skolnik is associate director of the family medicine residency program at Abington (Pa.) Memorial Hospital and professor of family and community medicine at Temple University, Philadelphia. He is also editor-in-chief of Redi-Reference Inc., a software company that creates medical handheld references. Dr. Notte is in private practice in Chalfont, Pa. They are partners in EHR Practice Consultants, helping practices move to EHR systems. Contact them at [email protected]. Dr. Skolnik and Dr. Notte had no conflicts of interest to declare.

Oral contraceptives are prescribed daily, yet emergency contraception options often are overlooked. Emergency contraception is used to prevent pregnancy after an unprotected or inadequately protected act of sexual intercourse. An open, informative conversation is an important way to increase awareness and knowledge to avoid unintended pregnancies.

Emergency contraception works by inhibiting or delaying ovulation and possibly by inhibiting implantation of the fertilized egg. It is effective only before a pregnancy is established – in the 5 days between intercourse and implantation of the fertilized egg – and is ineffective after implantation. There are no known risks to an established pregnancy or harm to the developing embryo, nor any increased risk for a future ectopic pregnancy.

The most commonly used regimens are combined estrogen-progestin and progestin-only pills. Ulipristal acetate, a progesterone agonist/antagonist, was approved for emergency contraception in 2010.

The estrogen-progestin regimen uses various oral contraceptive products in doses that are equal to two doses of 100 mcg of ethinyl estradiol plus 0.5 mg of levonorgestrel, taken as soon as possible after intercourse, up to 72 hours, with a second dose 12 hours after the first dose.

The progestin-only regimen contains 1.5 mg levonorgestrel in single-dose or two-dose protocols and can be acquired over the counter for women age 17 years and older; patients younger than 17 years require a prescription. The manufacturers of the progestin-only regimen are phasing out the two-dose protocol, because studies have shown that taking 1.5 mg one time is equally as effective as two 0.75-mg pills 12 hours apart.

Recent studies have shown that emergency contraception is modestly effective up to 5 days after intercourse. The newest approved regimen contains 30 mg of ulipristal acetate in a single dose, and studies have shown effectiveness for up to 5 days after intercourse.

It is estimated that emergency contraception can prevent approximately 75% of pregnancies that would otherwise occur, and the levonorgestrel-only regimen is approximately 50% more effective than the combined regimen.

Side effects from emergency contraception are short term in nature, with no serious side effects. Nausea and vomiting are most common and are found more often with the estrogen-progestin regimen than with the levonorgestrel or ulipristal acetate regimens. It is recommended that an antiemetic be prescribed prophylactically if the combined regimen is given. Irregular bleeding can occur with all of the regimens during the month after treatment. Other side effects include breast tenderness, dizziness, headache, cramping, and fatigue.

There are also no health conditions that are contraindications for emergency contraception, even those that would otherwise be a contraindication for oral contraception. No clinical examination or pregnancy testing is necessary before dispensing a prescription of emergency contraception – unless the woman was a victim of assault, when further sexually transmitted disease testing and counseling are important.

Emergency contraception may be used more than once, even within the same menstrual cycle; but it is not intended and not recommended to be used as long-term contraception.

Use of a copper intrauterine device (IUD) for emergency contraception has been reported since 1976, and has pregnancy rates of 0%-0.2% if inserted within 5 days of intercourse. The advantage of insertion of the copper IUD is that it can be retained for long-term contraception. Women who meet the standard criteria for insertion of an IUD and do not have any medical indications that would prohibit them from using the copper device may choose this alternative to hormonal treatment, although the risks and costs must be considered.

Because emergency contraception delays ovulation, it is possible that a woman can become pregnant later in the menstrual cycle. Women should begin using barrier contraceptives immediately after using emergency contraception to prevent pregnancy until normal menses resumes. Long-term hormonal methods – IUD, oral, Depo-Provera, or implant – should be administered after the next menstrual period, once it is confirmed that the patient is not pregnant.

 

Clinical follow-up is not necessary after the administration of emergency contraception. The woman should be advised that if her menstrual period is delayed by a week or more, she should consider the possibility that she may be pregnant, and see her practitioner. Evaluation is also necessary should the woman experience signs of a spontaneous abortion or ectopic pregnancy. In addition, women should be offered sexually transmitted disease screening in a follow-up appointment or at the time of administration of the emergency contraception.

The Bottom Line

Emergency contraception is underused, and the most important barrier to use is a lack of information. The levonorgestrel-only regimen is more effective than the combined regimen, with less nausea associated with it and is therefore the preferred regimen. Emergency contraception can be made available for up to 5 days after intercourse.

It is recommended that when initiating family planning or contraception discussions, emergency contraception options should be discussed and prescribed.

A list of commonly prescribed oral contraceptives that can be used for emergency contraception in the United States can be found at the following two excellent Web sites: http://ec.princeton.edu/ and http://ec.princeton.edu/questions/dose.html#dose.

References

• Emergency Contraception. ACOG Practice Bulletin 112, May 2010.

• Ella product Web site.

Dr. Ward is a first-year ob.gyn. resident at Abington (Pa.) Memorial Hospital. Dr. Skolnik is an associate director of the family medicine residency program at Abington Memorial Hospital.

Oral contraceptives are prescribed daily, yet emergency contraception options often are overlooked. Emergency contraception is used to prevent pregnancy after an unprotected or inadequately protected act of sexual intercourse. An open, informative conversation is an important way to increase awareness and knowledge to avoid unintended pregnancies.

Emergency contraception works by inhibiting or delaying ovulation and possibly by inhibiting implantation of the fertilized egg. It is effective only before a pregnancy is established – in the 5 days between intercourse and implantation of the fertilized egg – and is ineffective after implantation. There are no known risks to an established pregnancy or harm to the developing embryo, nor any increased risk for a future ectopic pregnancy.

The most commonly used regimens are combined estrogen-progestin and progestin-only pills. Ulipristal acetate, a progesterone agonist/antagonist, was approved for emergency contraception in 2010.

The estrogen-progestin regimen uses various oral contraceptive products in doses that are equal to two doses of 100 mcg of ethinyl estradiol plus 0.5 mg of levonorgestrel, taken as soon as possible after intercourse, up to 72 hours, with a second dose 12 hours after the first dose.

The progestin-only regimen contains 1.5 mg levonorgestrel in single-dose or two-dose protocols and can be acquired over the counter for women age 17 years and older; patients younger than 17 years require a prescription. The manufacturers of the progestin-only regimen are phasing out the two-dose protocol, because studies have shown that taking 1.5 mg one time is equally as effective as two 0.75-mg pills 12 hours apart.

Recent studies have shown that emergency contraception is modestly effective up to 5 days after intercourse. The newest approved regimen contains 30 mg of ulipristal acetate in a single dose, and studies have shown effectiveness for up to 5 days after intercourse.

It is estimated that emergency contraception can prevent approximately 75% of pregnancies that would otherwise occur, and the levonorgestrel-only regimen is approximately 50% more effective than the combined regimen.

Side effects from emergency contraception are short term in nature, with no serious side effects. Nausea and vomiting are most common and are found more often with the estrogen-progestin regimen than with the levonorgestrel or ulipristal acetate regimens. It is recommended that an antiemetic be prescribed prophylactically if the combined regimen is given. Irregular bleeding can occur with all of the regimens during the month after treatment. Other side effects include breast tenderness, dizziness, headache, cramping, and fatigue.

There are also no health conditions that are contraindications for emergency contraception, even those that would otherwise be a contraindication for oral contraception. No clinical examination or pregnancy testing is necessary before dispensing a prescription of emergency contraception – unless the woman was a victim of assault, when further sexually transmitted disease testing and counseling are important.

Emergency contraception may be used more than once, even within the same menstrual cycle; but it is not intended and not recommended to be used as long-term contraception.

Use of a copper intrauterine device (IUD) for emergency contraception has been reported since 1976, and has pregnancy rates of 0%-0.2% if inserted within 5 days of intercourse. The advantage of insertion of the copper IUD is that it can be retained for long-term contraception. Women who meet the standard criteria for insertion of an IUD and do not have any medical indications that would prohibit them from using the copper device may choose this alternative to hormonal treatment, although the risks and costs must be considered.

Because emergency contraception delays ovulation, it is possible that a woman can become pregnant later in the menstrual cycle. Women should begin using barrier contraceptives immediately after using emergency contraception to prevent pregnancy until normal menses resumes. Long-term hormonal methods – IUD, oral, Depo-Provera, or implant – should be administered after the next menstrual period, once it is confirmed that the patient is not pregnant.

 

Clinical follow-up is not necessary after the administration of emergency contraception. The woman should be advised that if her menstrual period is delayed by a week or more, she should consider the possibility that she may be pregnant, and see her practitioner. Evaluation is also necessary should the woman experience signs of a spontaneous abortion or ectopic pregnancy. In addition, women should be offered sexually transmitted disease screening in a follow-up appointment or at the time of administration of the emergency contraception.

The Bottom Line

Emergency contraception is underused, and the most important barrier to use is a lack of information. The levonorgestrel-only regimen is more effective than the combined regimen, with less nausea associated with it and is therefore the preferred regimen. Emergency contraception can be made available for up to 5 days after intercourse.

It is recommended that when initiating family planning or contraception discussions, emergency contraception options should be discussed and prescribed.

A list of commonly prescribed oral contraceptives that can be used for emergency contraception in the United States can be found at the following two excellent Web sites: http://ec.princeton.edu/ and http://ec.princeton.edu/questions/dose.html#dose.

References

• Emergency Contraception. ACOG Practice Bulletin 112, May 2010.

• Ella product Web site.

Dr. Ward is a first-year ob.gyn. resident at Abington (Pa.) Memorial Hospital. Dr. Skolnik is an associate director of the family medicine residency program at Abington Memorial Hospital.

Oral contraceptives are prescribed daily, yet emergency contraception options often are overlooked. Emergency contraception is used to prevent pregnancy after an unprotected or inadequately protected act of sexual intercourse. An open, informative conversation is an important way to increase awareness and knowledge to avoid unintended pregnancies.

Emergency contraception works by inhibiting or delaying ovulation and possibly by inhibiting implantation of the fertilized egg. It is effective only before a pregnancy is established – in the 5 days between intercourse and implantation of the fertilized egg – and is ineffective after implantation. There are no known risks to an established pregnancy or harm to the developing embryo, nor any increased risk for a future ectopic pregnancy.

The most commonly used regimens are combined estrogen-progestin and progestin-only pills. Ulipristal acetate, a progesterone agonist/antagonist, was approved for emergency contraception in 2010.

The estrogen-progestin regimen uses various oral contraceptive products in doses that are equal to two doses of 100 mcg of ethinyl estradiol plus 0.5 mg of levonorgestrel, taken as soon as possible after intercourse, up to 72 hours, with a second dose 12 hours after the first dose.

The progestin-only regimen contains 1.5 mg levonorgestrel in single-dose or two-dose protocols and can be acquired over the counter for women age 17 years and older; patients younger than 17 years require a prescription. The manufacturers of the progestin-only regimen are phasing out the two-dose protocol, because studies have shown that taking 1.5 mg one time is equally as effective as two 0.75-mg pills 12 hours apart.

Recent studies have shown that emergency contraception is modestly effective up to 5 days after intercourse. The newest approved regimen contains 30 mg of ulipristal acetate in a single dose, and studies have shown effectiveness for up to 5 days after intercourse.

It is estimated that emergency contraception can prevent approximately 75% of pregnancies that would otherwise occur, and the levonorgestrel-only regimen is approximately 50% more effective than the combined regimen.

Side effects from emergency contraception are short term in nature, with no serious side effects. Nausea and vomiting are most common and are found more often with the estrogen-progestin regimen than with the levonorgestrel or ulipristal acetate regimens. It is recommended that an antiemetic be prescribed prophylactically if the combined regimen is given. Irregular bleeding can occur with all of the regimens during the month after treatment. Other side effects include breast tenderness, dizziness, headache, cramping, and fatigue.

There are also no health conditions that are contraindications for emergency contraception, even those that would otherwise be a contraindication for oral contraception. No clinical examination or pregnancy testing is necessary before dispensing a prescription of emergency contraception – unless the woman was a victim of assault, when further sexually transmitted disease testing and counseling are important.

Emergency contraception may be used more than once, even within the same menstrual cycle; but it is not intended and not recommended to be used as long-term contraception.

Use of a copper intrauterine device (IUD) for emergency contraception has been reported since 1976, and has pregnancy rates of 0%-0.2% if inserted within 5 days of intercourse. The advantage of insertion of the copper IUD is that it can be retained for long-term contraception. Women who meet the standard criteria for insertion of an IUD and do not have any medical indications that would prohibit them from using the copper device may choose this alternative to hormonal treatment, although the risks and costs must be considered.

Because emergency contraception delays ovulation, it is possible that a woman can become pregnant later in the menstrual cycle. Women should begin using barrier contraceptives immediately after using emergency contraception to prevent pregnancy until normal menses resumes. Long-term hormonal methods – IUD, oral, Depo-Provera, or implant – should be administered after the next menstrual period, once it is confirmed that the patient is not pregnant.

 

Clinical follow-up is not necessary after the administration of emergency contraception. The woman should be advised that if her menstrual period is delayed by a week or more, she should consider the possibility that she may be pregnant, and see her practitioner. Evaluation is also necessary should the woman experience signs of a spontaneous abortion or ectopic pregnancy. In addition, women should be offered sexually transmitted disease screening in a follow-up appointment or at the time of administration of the emergency contraception.

The Bottom Line

Emergency contraception is underused, and the most important barrier to use is a lack of information. The levonorgestrel-only regimen is more effective than the combined regimen, with less nausea associated with it and is therefore the preferred regimen. Emergency contraception can be made available for up to 5 days after intercourse.

It is recommended that when initiating family planning or contraception discussions, emergency contraception options should be discussed and prescribed.

A list of commonly prescribed oral contraceptives that can be used for emergency contraception in the United States can be found at the following two excellent Web sites: http://ec.princeton.edu/ and http://ec.princeton.edu/questions/dose.html#dose.

References

• Emergency Contraception. ACOG Practice Bulletin 112, May 2010.

• Ella product Web site.

Dr. Ward is a first-year ob.gyn. resident at Abington (Pa.) Memorial Hospital. Dr. Skolnik is an associate director of the family medicine residency program at Abington Memorial Hospital.

Oral contraceptives are prescribed daily, yet emergency contraception options often are overlooked. Emergency contraception is used to prevent pregnancy after an unprotected or inadequately protected act of sexual intercourse. An open, informative conversation is an important way to increase awareness and knowledge to avoid unintended pregnancies.

Emergency contraception works by inhibiting or delaying ovulation and possibly by inhibiting implantation of the fertilized egg. It is effective only before a pregnancy is established – in the 5 days between intercourse and implantation of the fertilized egg – and is ineffective after implantation. There are no known risks to an established pregnancy or harm to the developing embryo, nor any increased risk for a future ectopic pregnancy.

The most commonly used regimens are combined estrogen-progestin and progestin-only pills. Ulipristal acetate, a progesterone agonist/antagonist, was approved for emergency contraception in 2010.

The estrogen-progestin regimen uses various oral contraceptive products in doses that are equal to two doses of 100 mcg of ethinyl estradiol plus 0.5 mg of levonorgestrel, taken as soon as possible after intercourse, up to 72 hours, with a second dose 12 hours after the first dose.

The progestin-only regimen contains 1.5 mg levonorgestrel in single-dose or two-dose protocols and can be acquired over the counter for women age 17 years and older; patients younger than 17 years require a prescription. The manufacturers of the progestin-only regimen are phasing out the two-dose protocol, because studies have shown that taking 1.5 mg one time is equally as effective as two 0.75-mg pills 12 hours apart.

Recent studies have shown that emergency contraception is modestly effective up to 5 days after intercourse. The newest approved regimen contains 30 mg of ulipristal acetate in a single dose, and studies have shown effectiveness for up to 5 days after intercourse.

It is estimated that emergency contraception can prevent approximately 75% of pregnancies that would otherwise occur, and the levonorgestrel-only regimen is approximately 50% more effective than the combined regimen.

Side effects from emergency contraception are short term in nature, with no serious side effects. Nausea and vomiting are most common and are found more often with the estrogen-progestin regimen than with the levonorgestrel or ulipristal acetate regimens. It is recommended that an antiemetic be prescribed prophylactically if the combined regimen is given. Irregular bleeding can occur with all of the regimens during the month after treatment. Other side effects include breast tenderness, dizziness, headache, cramping, and fatigue.

There are also no health conditions that are contraindications for emergency contraception, even those that would otherwise be a contraindication for oral contraception. No clinical examination or pregnancy testing is necessary before dispensing a prescription of emergency contraception – unless the woman was a victim of assault, when further sexually transmitted disease testing and counseling are important.

Emergency contraception may be used more than once, even within the same menstrual cycle; but it is not intended and not recommended to be used as long-term contraception.

Use of a copper intrauterine device (IUD) for emergency contraception has been reported since 1976, and has pregnancy rates of 0%-0.2% if inserted within 5 days of intercourse. The advantage of insertion of the copper IUD is that it can be retained for long-term contraception. Women who meet the standard criteria for insertion of an IUD and do not have any medical indications that would prohibit them from using the copper device may choose this alternative to hormonal treatment, although the risks and costs must be considered.

Because emergency contraception delays ovulation, it is possible that a woman can become pregnant later in the menstrual cycle. Women should begin using barrier contraceptives immediately after using emergency contraception to prevent pregnancy until normal menses resumes. Long-term hormonal methods – IUD, oral, Depo-Provera, or implant – should be administered after the next menstrual period, once it is confirmed that the patient is not pregnant.

Clinical follow-up is not necessary after the administration of emergency contraception. The woman should be advised that if her menstrual period is delayed by a week or more, she should consider the possibility that she may be pregnant, and see her practitioner. Evaluation is also necessary should the woman experience signs of a spontaneous abortion or ectopic pregnancy. In addition, women should be offered sexually transmitted disease screening in a follow-up appointment or at the time of administration of the emergency contraception.

 

The Bottom Line

Emergency contraception is underused, and the most important barrier to use is a lack of information. The levonorgestrel-only regimen is more effective than the combined regimen, with less nausea associated with it and is therefore the preferred regimen. Emergency contraception can be made available for up to 5 days after intercourse.

It is recommended that when initiating family planning or contraception discussions, emergency contraception options should be discussed and prescribed.

A list of commonly prescribed oral contraceptives that can be used for emergency contraception in the United States can be found at the following two excellent Web sites: http://ec.princeton.edu/ and http://ec.princeton.edu/questions/dose.html#dose.

References

• Emergency Contraception. ACOG Practice Bulletin 112, May 2010.

• Ella product Web site.

Dr. Ward is a first-year ob.gyn. resident at Abington (Pa.) Memorial Hospital. Dr. Skolnik is an associate director of the family medicine residency program at Abington Memorial Hospital.

Oral contraceptives are prescribed daily, yet emergency contraception options often are overlooked. Emergency contraception is used to prevent pregnancy after an unprotected or inadequately protected act of sexual intercourse. An open, informative conversation is an important way to increase awareness and knowledge to avoid unintended pregnancies.

Emergency contraception works by inhibiting or delaying ovulation and possibly by inhibiting implantation of the fertilized egg. It is effective only before a pregnancy is established – in the 5 days between intercourse and implantation of the fertilized egg – and is ineffective after implantation. There are no known risks to an established pregnancy or harm to the developing embryo, nor any increased risk for a future ectopic pregnancy.

The most commonly used regimens are combined estrogen-progestin and progestin-only pills. Ulipristal acetate, a progesterone agonist/antagonist, was approved for emergency contraception in 2010.

The estrogen-progestin regimen uses various oral contraceptive products in doses that are equal to two doses of 100 mcg of ethinyl estradiol plus 0.5 mg of levonorgestrel, taken as soon as possible after intercourse, up to 72 hours, with a second dose 12 hours after the first dose.

The progestin-only regimen contains 1.5 mg levonorgestrel in single-dose or two-dose protocols and can be acquired over the counter for women age 17 years and older; patients younger than 17 years require a prescription. The manufacturers of the progestin-only regimen are phasing out the two-dose protocol, because studies have shown that taking 1.5 mg one time is equally as effective as two 0.75-mg pills 12 hours apart.

Recent studies have shown that emergency contraception is modestly effective up to 5 days after intercourse. The newest approved regimen contains 30 mg of ulipristal acetate in a single dose, and studies have shown effectiveness for up to 5 days after intercourse.

It is estimated that emergency contraception can prevent approximately 75% of pregnancies that would otherwise occur, and the levonorgestrel-only regimen is approximately 50% more effective than the combined regimen.

Side effects from emergency contraception are short term in nature, with no serious side effects. Nausea and vomiting are most common and are found more often with the estrogen-progestin regimen than with the levonorgestrel or ulipristal acetate regimens. It is recommended that an antiemetic be prescribed prophylactically if the combined regimen is given. Irregular bleeding can occur with all of the regimens during the month after treatment. Other side effects include breast tenderness, dizziness, headache, cramping, and fatigue.

There are also no health conditions that are contraindications for emergency contraception, even those that would otherwise be a contraindication for oral contraception. No clinical examination or pregnancy testing is necessary before dispensing a prescription of emergency contraception – unless the woman was a victim of assault, when further sexually transmitted disease testing and counseling are important.

Emergency contraception may be used more than once, even within the same menstrual cycle; but it is not intended and not recommended to be used as long-term contraception.

Use of a copper intrauterine device (IUD) for emergency contraception has been reported since 1976, and has pregnancy rates of 0%-0.2% if inserted within 5 days of intercourse. The advantage of insertion of the copper IUD is that it can be retained for long-term contraception. Women who meet the standard criteria for insertion of an IUD and do not have any medical indications that would prohibit them from using the copper device may choose this alternative to hormonal treatment, although the risks and costs must be considered.

Because emergency contraception delays ovulation, it is possible that a woman can become pregnant later in the menstrual cycle. Women should begin using barrier contraceptives immediately after using emergency contraception to prevent pregnancy until normal menses resumes. Long-term hormonal methods – IUD, oral, Depo-Provera, or implant – should be administered after the next menstrual period, once it is confirmed that the patient is not pregnant.

Clinical follow-up is not necessary after the administration of emergency contraception. The woman should be advised that if her menstrual period is delayed by a week or more, she should consider the possibility that she may be pregnant, and see her practitioner. Evaluation is also necessary should the woman experience signs of a spontaneous abortion or ectopic pregnancy. In addition, women should be offered sexually transmitted disease screening in a follow-up appointment or at the time of administration of the emergency contraception.

 

The Bottom Line

Emergency contraception is underused, and the most important barrier to use is a lack of information. The levonorgestrel-only regimen is more effective than the combined regimen, with less nausea associated with it and is therefore the preferred regimen. Emergency contraception can be made available for up to 5 days after intercourse.

It is recommended that when initiating family planning or contraception discussions, emergency contraception options should be discussed and prescribed.

A list of commonly prescribed oral contraceptives that can be used for emergency contraception in the United States can be found at the following two excellent Web sites: http://ec.princeton.edu/ and http://ec.princeton.edu/questions/dose.html#dose.

References

• Emergency Contraception. ACOG Practice Bulletin 112, May 2010.

• Ella product Web site.

Dr. Ward is a first-year ob.gyn. resident at Abington (Pa.) Memorial Hospital. Dr. Skolnik is an associate director of the family medicine residency program at Abington Memorial Hospital.

Oral contraceptives are prescribed daily, yet emergency contraception options often are overlooked. Emergency contraception is used to prevent pregnancy after an unprotected or inadequately protected act of sexual intercourse. An open, informative conversation is an important way to increase awareness and knowledge to avoid unintended pregnancies.

Emergency contraception works by inhibiting or delaying ovulation and possibly by inhibiting implantation of the fertilized egg. It is effective only before a pregnancy is established – in the 5 days between intercourse and implantation of the fertilized egg – and is ineffective after implantation. There are no known risks to an established pregnancy or harm to the developing embryo, nor any increased risk for a future ectopic pregnancy.

The most commonly used regimens are combined estrogen-progestin and progestin-only pills. Ulipristal acetate, a progesterone agonist/antagonist, was approved for emergency contraception in 2010.

The estrogen-progestin regimen uses various oral contraceptive products in doses that are equal to two doses of 100 mcg of ethinyl estradiol plus 0.5 mg of levonorgestrel, taken as soon as possible after intercourse, up to 72 hours, with a second dose 12 hours after the first dose.

The progestin-only regimen contains 1.5 mg levonorgestrel in single-dose or two-dose protocols and can be acquired over the counter for women age 17 years and older; patients younger than 17 years require a prescription. The manufacturers of the progestin-only regimen are phasing out the two-dose protocol, because studies have shown that taking 1.5 mg one time is equally as effective as two 0.75-mg pills 12 hours apart.

Recent studies have shown that emergency contraception is modestly effective up to 5 days after intercourse. The newest approved regimen contains 30 mg of ulipristal acetate in a single dose, and studies have shown effectiveness for up to 5 days after intercourse.

It is estimated that emergency contraception can prevent approximately 75% of pregnancies that would otherwise occur, and the levonorgestrel-only regimen is approximately 50% more effective than the combined regimen.

Side effects from emergency contraception are short term in nature, with no serious side effects. Nausea and vomiting are most common and are found more often with the estrogen-progestin regimen than with the levonorgestrel or ulipristal acetate regimens. It is recommended that an antiemetic be prescribed prophylactically if the combined regimen is given. Irregular bleeding can occur with all of the regimens during the month after treatment. Other side effects include breast tenderness, dizziness, headache, cramping, and fatigue.

There are also no health conditions that are contraindications for emergency contraception, even those that would otherwise be a contraindication for oral contraception. No clinical examination or pregnancy testing is necessary before dispensing a prescription of emergency contraception – unless the woman was a victim of assault, when further sexually transmitted disease testing and counseling are important.

Emergency contraception may be used more than once, even within the same menstrual cycle; but it is not intended and not recommended to be used as long-term contraception.

Use of a copper intrauterine device (IUD) for emergency contraception has been reported since 1976, and has pregnancy rates of 0%-0.2% if inserted within 5 days of intercourse. The advantage of insertion of the copper IUD is that it can be retained for long-term contraception. Women who meet the standard criteria for insertion of an IUD and do not have any medical indications that would prohibit them from using the copper device may choose this alternative to hormonal treatment, although the risks and costs must be considered.

Because emergency contraception delays ovulation, it is possible that a woman can become pregnant later in the menstrual cycle. Women should begin using barrier contraceptives immediately after using emergency contraception to prevent pregnancy until normal menses resumes. Long-term hormonal methods – IUD, oral, Depo-Provera, or implant – should be administered after the next menstrual period, once it is confirmed that the patient is not pregnant.

Clinical follow-up is not necessary after the administration of emergency contraception. The woman should be advised that if her menstrual period is delayed by a week or more, she should consider the possibility that she may be pregnant, and see her practitioner. Evaluation is also necessary should the woman experience signs of a spontaneous abortion or ectopic pregnancy. In addition, women should be offered sexually transmitted disease screening in a follow-up appointment or at the time of administration of the emergency contraception.

 

The Bottom Line

Emergency contraception is underused, and the most important barrier to use is a lack of information. The levonorgestrel-only regimen is more effective than the combined regimen, with less nausea associated with it and is therefore the preferred regimen. Emergency contraception can be made available for up to 5 days after intercourse.

It is recommended that when initiating family planning or contraception discussions, emergency contraception options should be discussed and prescribed.

A list of commonly prescribed oral contraceptives that can be used for emergency contraception in the United States can be found at the following two excellent Web sites: http://ec.princeton.edu/ and http://ec.princeton.edu/questions/dose.html#dose.

References

• Emergency Contraception. ACOG Practice Bulletin 112, May 2010.

• Ella product Web site.

Dr. Ward is a first-year ob.gyn. resident at Abington (Pa.) Memorial Hospital. Dr. Skolnik is an associate director of the family medicine residency program at Abington Memorial Hospital.

Oral contraceptives are prescribed daily, yet emergency contraception options often are overlooked. Emergency contraception is used to prevent pregnancy after an unprotected or inadequately protected act of sexual intercourse. An open, informative conversation is an important way to increase awareness and knowledge to avoid unintended pregnancies.

Emergency contraception works by inhibiting or delaying ovulation and possibly by inhibiting implantation of the fertilized egg. It is effective only before a pregnancy is established – in the 5 days between intercourse and implantation of the fertilized egg – and is ineffective after implantation. There are no known risks to an established pregnancy or harm to the developing embryo, nor any increased risk for a future ectopic pregnancy.

The most commonly used regimens are combined estrogen-progestin and progestin-only pills. Ulipristal acetate, a progesterone agonist/antagonist, was approved for emergency contraception in 2010.

The estrogen-progestin regimen uses various oral contraceptive products in doses that are equal to two doses of 100 mcg of ethinyl estradiol plus 0.5 mg of levonorgestrel, taken as soon as possible after intercourse, up to 72 hours, with a second dose 12 hours after the first dose.

The progestin-only regimen contains 1.5 mg levonorgestrel in single-dose or two-dose protocols and can be acquired over the counter for women age 17 years and older; patients younger than 17 years require a prescription. The manufacturers of the progestin-only regimen are phasing out the two-dose protocol, because studies have shown that taking 1.5 mg one time is equally as effective as two 0.75-mg pills 12 hours apart.

Recent studies have shown that emergency contraception is modestly effective up to 5 days after intercourse. The newest approved regimen contains 30 mg of ulipristal acetate in a single dose, and studies have shown effectiveness for up to 5 days after intercourse.

It is estimated that emergency contraception can prevent approximately 75% of pregnancies that would otherwise occur, and the levonorgestrel-only regimen is approximately 50% more effective than the combined regimen.

Side effects from emergency contraception are short term in nature, with no serious side effects. Nausea and vomiting are most common and are found more often with the estrogen-progestin regimen than with the levonorgestrel or ulipristal acetate regimens. It is recommended that an antiemetic be prescribed prophylactically if the combined regimen is given. Irregular bleeding can occur with all of the regimens during the month after treatment. Other side effects include breast tenderness, dizziness, headache, cramping, and fatigue.

There are also no health conditions that are contraindications for emergency contraception, even those that would otherwise be a contraindication for oral contraception. No clinical examination or pregnancy testing is necessary before dispensing a prescription of emergency contraception – unless the woman was a victim of assault, when further sexually transmitted disease testing and counseling are important.

Emergency contraception may be used more than once, even within the same menstrual cycle; but it is not intended and not recommended to be used as long-term contraception.

Use of a copper intrauterine device (IUD) for emergency contraception has been reported since 1976, and has pregnancy rates of 0%-0.2% if inserted within 5 days of intercourse. The advantage of insertion of the copper IUD is that it can be retained for long-term contraception. Women who meet the standard criteria for insertion of an IUD and do not have any medical indications that would prohibit them from using the copper device may choose this alternative to hormonal treatment, although the risks and costs must be considered.

Because emergency contraception delays ovulation, it is possible that a woman can become pregnant later in the menstrual cycle. Women should begin using barrier contraceptives immediately after using emergency contraception to prevent pregnancy until normal menses resumes. Long-term hormonal methods – IUD, oral, Depo-Provera, or implant – should be administered after the next menstrual period, once it is confirmed that the patient is not pregnant.

Clinical follow-up is not necessary after the administration of emergency contraception. The woman should be advised that if her menstrual period is delayed by a week or more, she should consider the possibility that she may be pregnant, and see her practitioner. Evaluation is also necessary should the woman experience signs of a spontaneous abortion or ectopic pregnancy. In addition, women should be offered sexually transmitted disease screening in a follow-up appointment or at the time of administration of the emergency contraception.

The Bottom Line

Emergency contraception is underused, and the most important barrier to use is a lack of information. The levonorgestrel-only regimen is more effective than the combined regimen, with less nausea associated with it and is therefore the preferred regimen. Emergency contraception can be made available for up to 5 days after intercourse.

 

It is recommended that when initiating family planning or contraception discussions, emergency contraception options should be discussed and prescribed.

A list of commonly prescribed oral contraceptives that can be used for emergency contraception in the United States can be found at the following two excellent Web sites: http://ec.princeton.edu/ and http://ec.princeton.edu/questions/dose.html#dose.

References

• Emergency Contraception. ACOG Practice Bulletin 112, May 2010.

• Ella product Web site.

Dr. Ward is a first-year ob.gyn. resident at Abington (Pa.) Memorial Hospital. Dr. Skolnik is an associate director of the family medicine residency program at Abington Memorial Hospital.

Oral contraceptives are prescribed daily, yet emergency contraception options often are overlooked. Emergency contraception is used to prevent pregnancy after an unprotected or inadequately protected act of sexual intercourse. An open, informative conversation is an important way to increase awareness and knowledge to avoid unintended pregnancies.

Emergency contraception works by inhibiting or delaying ovulation and possibly by inhibiting implantation of the fertilized egg. It is effective only before a pregnancy is established – in the 5 days between intercourse and implantation of the fertilized egg – and is ineffective after implantation. There are no known risks to an established pregnancy or harm to the developing embryo, nor any increased risk for a future ectopic pregnancy.

The most commonly used regimens are combined estrogen-progestin and progestin-only pills. Ulipristal acetate, a progesterone agonist/antagonist, was approved for emergency contraception in 2010.

The estrogen-progestin regimen uses various oral contraceptive products in doses that are equal to two doses of 100 mcg of ethinyl estradiol plus 0.5 mg of levonorgestrel, taken as soon as possible after intercourse, up to 72 hours, with a second dose 12 hours after the first dose.

The progestin-only regimen contains 1.5 mg levonorgestrel in single-dose or two-dose protocols and can be acquired over the counter for women age 17 years and older; patients younger than 17 years require a prescription. The manufacturers of the progestin-only regimen are phasing out the two-dose protocol, because studies have shown that taking 1.5 mg one time is equally as effective as two 0.75-mg pills 12 hours apart.

Recent studies have shown that emergency contraception is modestly effective up to 5 days after intercourse. The newest approved regimen contains 30 mg of ulipristal acetate in a single dose, and studies have shown effectiveness for up to 5 days after intercourse.

It is estimated that emergency contraception can prevent approximately 75% of pregnancies that would otherwise occur, and the levonorgestrel-only regimen is approximately 50% more effective than the combined regimen.

Side effects from emergency contraception are short term in nature, with no serious side effects. Nausea and vomiting are most common and are found more often with the estrogen-progestin regimen than with the levonorgestrel or ulipristal acetate regimens. It is recommended that an antiemetic be prescribed prophylactically if the combined regimen is given. Irregular bleeding can occur with all of the regimens during the month after treatment. Other side effects include breast tenderness, dizziness, headache, cramping, and fatigue.

There are also no health conditions that are contraindications for emergency contraception, even those that would otherwise be a contraindication for oral contraception. No clinical examination or pregnancy testing is necessary before dispensing a prescription of emergency contraception – unless the woman was a victim of assault, when further sexually transmitted disease testing and counseling are important.

Emergency contraception may be used more than once, even within the same menstrual cycle; but it is not intended and not recommended to be used as long-term contraception.

Use of a copper intrauterine device (IUD) for emergency contraception has been reported since 1976, and has pregnancy rates of 0%-0.2% if inserted within 5 days of intercourse. The advantage of insertion of the copper IUD is that it can be retained for long-term contraception. Women who meet the standard criteria for insertion of an IUD and do not have any medical indications that would prohibit them from using the copper device may choose this alternative to hormonal treatment, although the risks and costs must be considered.

Because emergency contraception delays ovulation, it is possible that a woman can become pregnant later in the menstrual cycle. Women should begin using barrier contraceptives immediately after using emergency contraception to prevent pregnancy until normal menses resumes. Long-term hormonal methods – IUD, oral, Depo-Provera, or implant – should be administered after the next menstrual period, once it is confirmed that the patient is not pregnant.

Clinical follow-up is not necessary after the administration of emergency contraception. The woman should be advised that if her menstrual period is delayed by a week or more, she should consider the possibility that she may be pregnant, and see her practitioner. Evaluation is also necessary should the woman experience signs of a spontaneous abortion or ectopic pregnancy. In addition, women should be offered sexually transmitted disease screening in a follow-up appointment or at the time of administration of the emergency contraception.

The Bottom Line

Emergency contraception is underused, and the most important barrier to use is a lack of information. The levonorgestrel-only regimen is more effective than the combined regimen, with less nausea associated with it and is therefore the preferred regimen. Emergency contraception can be made available for up to 5 days after intercourse.

 

It is recommended that when initiating family planning or contraception discussions, emergency contraception options should be discussed and prescribed.

A list of commonly prescribed oral contraceptives that can be used for emergency contraception in the United States can be found at the following two excellent Web sites: http://ec.princeton.edu/ and http://ec.princeton.edu/questions/dose.html#dose.

References

• Emergency Contraception. ACOG Practice Bulletin 112, May 2010.

• Ella product Web site.

Dr. Ward is a first-year ob.gyn. resident at Abington (Pa.) Memorial Hospital. Dr. Skolnik is an associate director of the family medicine residency program at Abington Memorial Hospital.

Oral contraceptives are prescribed daily, yet emergency contraception options often are overlooked. Emergency contraception is used to prevent pregnancy after an unprotected or inadequately protected act of sexual intercourse. An open, informative conversation is an important way to increase awareness and knowledge to avoid unintended pregnancies.

Emergency contraception works by inhibiting or delaying ovulation and possibly by inhibiting implantation of the fertilized egg. It is effective only before a pregnancy is established – in the 5 days between intercourse and implantation of the fertilized egg – and is ineffective after implantation. There are no known risks to an established pregnancy or harm to the developing embryo, nor any increased risk for a future ectopic pregnancy.

The most commonly used regimens are combined estrogen-progestin and progestin-only pills. Ulipristal acetate, a progesterone agonist/antagonist, was approved for emergency contraception in 2010.

The estrogen-progestin regimen uses various oral contraceptive products in doses that are equal to two doses of 100 mcg of ethinyl estradiol plus 0.5 mg of levonorgestrel, taken as soon as possible after intercourse, up to 72 hours, with a second dose 12 hours after the first dose.

The progestin-only regimen contains 1.5 mg levonorgestrel in single-dose or two-dose protocols and can be acquired over the counter for women age 17 years and older; patients younger than 17 years require a prescription. The manufacturers of the progestin-only regimen are phasing out the two-dose protocol, because studies have shown that taking 1.5 mg one time is equally as effective as two 0.75-mg pills 12 hours apart.

Recent studies have shown that emergency contraception is modestly effective up to 5 days after intercourse. The newest approved regimen contains 30 mg of ulipristal acetate in a single dose, and studies have shown effectiveness for up to 5 days after intercourse.

It is estimated that emergency contraception can prevent approximately 75% of pregnancies that would otherwise occur, and the levonorgestrel-only regimen is approximately 50% more effective than the combined regimen.

Side effects from emergency contraception are short term in nature, with no serious side effects. Nausea and vomiting are most common and are found more often with the estrogen-progestin regimen than with the levonorgestrel or ulipristal acetate regimens. It is recommended that an antiemetic be prescribed prophylactically if the combined regimen is given. Irregular bleeding can occur with all of the regimens during the month after treatment. Other side effects include breast tenderness, dizziness, headache, cramping, and fatigue.

There are also no health conditions that are contraindications for emergency contraception, even those that would otherwise be a contraindication for oral contraception. No clinical examination or pregnancy testing is necessary before dispensing a prescription of emergency contraception – unless the woman was a victim of assault, when further sexually transmitted disease testing and counseling are important.

Emergency contraception may be used more than once, even within the same menstrual cycle; but it is not intended and not recommended to be used as long-term contraception.

Use of a copper intrauterine device (IUD) for emergency contraception has been reported since 1976, and has pregnancy rates of 0%-0.2% if inserted within 5 days of intercourse. The advantage of insertion of the copper IUD is that it can be retained for long-term contraception. Women who meet the standard criteria for insertion of an IUD and do not have any medical indications that would prohibit them from using the copper device may choose this alternative to hormonal treatment, although the risks and costs must be considered.

Because emergency contraception delays ovulation, it is possible that a woman can become pregnant later in the menstrual cycle. Women should begin using barrier contraceptives immediately after using emergency contraception to prevent pregnancy until normal menses resumes. Long-term hormonal methods – IUD, oral, Depo-Provera, or implant – should be administered after the next menstrual period, once it is confirmed that the patient is not pregnant.

Clinical follow-up is not necessary after the administration of emergency contraception. The woman should be advised that if her menstrual period is delayed by a week or more, she should consider the possibility that she may be pregnant, and see her practitioner. Evaluation is also necessary should the woman experience signs of a spontaneous abortion or ectopic pregnancy. In addition, women should be offered sexually transmitted disease screening in a follow-up appointment or at the time of administration of the emergency contraception.

The Bottom Line

Emergency contraception is underused, and the most important barrier to use is a lack of information. The levonorgestrel-only regimen is more effective than the combined regimen, with less nausea associated with it and is therefore the preferred regimen. Emergency contraception can be made available for up to 5 days after intercourse.

 

It is recommended that when initiating family planning or contraception discussions, emergency contraception options should be discussed and prescribed.

A list of commonly prescribed oral contraceptives that can be used for emergency contraception in the United States can be found at the following two excellent Web sites: http://ec.princeton.edu/ and http://ec.princeton.edu/questions/dose.html#dose.

References

• Emergency Contraception. ACOG Practice Bulletin 112, May 2010.

• Ella product Web site.

Dr. Ward is a first-year ob.gyn. resident at Abington (Pa.) Memorial Hospital. Dr. Skolnik is an associate director of the family medicine residency program at Abington Memorial Hospital.

As medical practices grow, so does the number of charts occupying space on their shelves. Most physicians look forward to the day when they can dispense with paper charts completely and reclaim precious office space. Unfortunately, the goal of a paperless office is a very difficult one to achieve. It can take years to get there and, even with the best EHR software, the process of adding old data into the system can be arduous.

There are two basic methods to input old paper records. Historical information such as diagnoses, medication lists, and allergies can be manually entered by the physician or staff. More detailed information, such as reports of procedures or correspondence from other physicians, will need to be scanned into the record. Either way, it will take a significant amount of work to enter even a small number of charts. This can be both time consuming and costly. There are many pitfalls that may not be obvious initially, so it can be helpful to consider the following tips:

Begin by Looking Forward

Typically, it is most beneficial to work forward from the point of installation and insure that all new patient information is immediately entered into the EHR to avoid creating a paper chart entirely. One way to do this is to “scan forward” – that is, to scan documents received only after the EHR is in place. Such scanned documents can immediately be digitized and attached to the patient’s electronic chart. The original can then be shredded instead of adding it to the paper record. By doing so, there will be a single date marking the end of information available on paper. After that date, all staff members will know to look in the EHR to find the data they need.

Take it One Day at A Time

One way to feasibly address the problem of entering old information into the EHR is to do a limited but consistent amount every day. But where to start? Many practices select charts to scan by reviewing the following day’s patient schedule. By “preloading” charts, important data are available at the time of an appointment, and the charts of so-called “frequent flyer" patients are usually among the first to be entered. Once the chart has been inputted, it can be archived off-site or properly disposed of.

To Scan or Not to Scan

Commonly, patient charts are filled with a tremendous amount of irrelevant information. Amidst the reports, notes, and letters are likely dozens of sticky notes, blank pages, fax cover sheets, and antiquated data. For a couple of reasons, it behooves a practice to spend time prepping charts before scanning them.

First, every page that is scanned will need to be indexed for the EHR to properly file it. It would be extremely cumbersome, when searching for an old lab result, to have to wade through dozens of papers at random. Indexing allows all documents to be sorted by type and date, but this process is extremely time-consuming. Each page scanned needs to be individually addressed. To minimize the amount of indexing, a practice may decide to only sort information of a certain age or type. Everything else can be then placed into a general, unsorted electronic file. In this way, the most important data are easy to find, yet even less valuable documents can be located with a bit of effort if necessary.

The second compelling reason is cost, both in staff hours and in storage. Many offices choose EHR solutions that are hosted off site. All data exist on an external server and, depending on the nature of the storage agreement, every page scanned into the system may incur an additional charge. In most cases the rate is about a penny a page. One need not take a very long look at the chart rack to realize how quickly the price will add up. Choosing to electronically archive only the most important items can help minimize the economic impact and make the overall process much more efficient.

When to Say Goodbye to Paper

There are a few commonly cited reasons why practices hesitate to finally eliminate paper charts. First is the fear of unintentionally losing critical patient data. This is reasonable, and data security should be a primary consideration when designing an electronic storage solution. All EHR vendors have set specifications for storage focused on security and reliability. If the data are to be maintained on site, one way to insure safety is through continuous backup. Higher standards are typically maintained at off-site storage facilities with multiple levels of redundancy. A well-chosen storage method should alleviate any fears of data loss.

 

The second reason practices hold onto paper records is concern about the need to produce the chart for possible malpractice proceedings. This represents a misunderstanding about the legality of electronic media. Regardless of where the chart is stored – on paper or in cyberspace – it is acceptable in a court of law.

The length of time the data must be maintained varies from state to state, but is typically about 7 years for adults or 7 years after turning age 18 for minors. Fortunately, once all the charts are archived, they can be safely and securely maintained indefinitely without the ever-growing need for a bigger office to store them.

Dr. Skolnik and Dr. Notte write the column, “EHR Report,” which regularly appears in Family Practice News, an Elsevier publication. Dr. Skolnik is associate director of the family medicine residency program at Abington (Pa.) Memorial Hospital and professor of family and community medicine at Temple University, Philadelphia. Dr. Notte is in private practice in Chalfont, Pa. They are partners in EHR Practice Consultants (www.ehrpc.com), helping practices move to EHR systems. Contact them at [email protected].

As medical practices grow, so does the number of charts occupying space on their shelves. Most physicians look forward to the day when they can dispense with paper charts completely and reclaim precious office space. Unfortunately, the goal of a paperless office is a very difficult one to achieve. It can take years to get there and, even with the best EHR software, the process of adding old data into the system can be arduous.

There are two basic methods to input old paper records. Historical information such as diagnoses, medication lists, and allergies can be manually entered by the physician or staff. More detailed information, such as reports of procedures or correspondence from other physicians, will need to be scanned into the record. Either way, it will take a significant amount of work to enter even a small number of charts. This can be both time consuming and costly. There are many pitfalls that may not be obvious initially, so it can be helpful to consider the following tips:

Begin by Looking Forward

Typically, it is most beneficial to work forward from the point of installation and insure that all new patient information is immediately entered into the EHR to avoid creating a paper chart entirely. One way to do this is to “scan forward” – that is, to scan documents received only after the EHR is in place. Such scanned documents can immediately be digitized and attached to the patient’s electronic chart. The original can then be shredded instead of adding it to the paper record. By doing so, there will be a single date marking the end of information available on paper. After that date, all staff members will know to look in the EHR to find the data they need.

Take it One Day at A Time

One way to feasibly address the problem of entering old information into the EHR is to do a limited but consistent amount every day. But where to start? Many practices select charts to scan by reviewing the following day’s patient schedule. By “preloading” charts, important data are available at the time of an appointment, and the charts of so-called “frequent flyer" patients are usually among the first to be entered. Once the chart has been inputted, it can be archived off-site or properly disposed of.

To Scan or Not to Scan

Commonly, patient charts are filled with a tremendous amount of irrelevant information. Amidst the reports, notes, and letters are likely dozens of sticky notes, blank pages, fax cover sheets, and antiquated data. For a couple of reasons, it behooves a practice to spend time prepping charts before scanning them.

First, every page that is scanned will need to be indexed for the EHR to properly file it. It would be extremely cumbersome, when searching for an old lab result, to have to wade through dozens of papers at random. Indexing allows all documents to be sorted by type and date, but this process is extremely time-consuming. Each page scanned needs to be individually addressed. To minimize the amount of indexing, a practice may decide to only sort information of a certain age or type. Everything else can be then placed into a general, unsorted electronic file. In this way, the most important data are easy to find, yet even less valuable documents can be located with a bit of effort if necessary.

The second compelling reason is cost, both in staff hours and in storage. Many offices choose EHR solutions that are hosted off site. All data exist on an external server and, depending on the nature of the storage agreement, every page scanned into the system may incur an additional charge. In most cases the rate is about a penny a page. One need not take a very long look at the chart rack to realize how quickly the price will add up. Choosing to electronically archive only the most important items can help minimize the economic impact and make the overall process much more efficient.

When to Say Goodbye to Paper

There are a few commonly cited reasons why practices hesitate to finally eliminate paper charts. First is the fear of unintentionally losing critical patient data. This is reasonable, and data security should be a primary consideration when designing an electronic storage solution. All EHR vendors have set specifications for storage focused on security and reliability. If the data are to be maintained on site, one way to insure safety is through continuous backup. Higher standards are typically maintained at off-site storage facilities with multiple levels of redundancy. A well-chosen storage method should alleviate any fears of data loss.

 

The second reason practices hold onto paper records is concern about the need to produce the chart for possible malpractice proceedings. This represents a misunderstanding about the legality of electronic media. Regardless of where the chart is stored – on paper or in cyberspace – it is acceptable in a court of law.

The length of time the data must be maintained varies from state to state, but is typically about 7 years for adults or 7 years after turning age 18 for minors. Fortunately, once all the charts are archived, they can be safely and securely maintained indefinitely without the ever-growing need for a bigger office to store them.

Dr. Skolnik and Dr. Notte write the column, “EHR Report,” which regularly appears in Family Practice News, an Elsevier publication. Dr. Skolnik is associate director of the family medicine residency program at Abington (Pa.) Memorial Hospital and professor of family and community medicine at Temple University, Philadelphia. Dr. Notte is in private practice in Chalfont, Pa. They are partners in EHR Practice Consultants (www.ehrpc.com), helping practices move to EHR systems. Contact them at [email protected].

As medical practices grow, so does the number of charts occupying space on their shelves. Most physicians look forward to the day when they can dispense with paper charts completely and reclaim precious office space. Unfortunately, the goal of a paperless office is a very difficult one to achieve. It can take years to get there and, even with the best EHR software, the process of adding old data into the system can be arduous.

There are two basic methods to input old paper records. Historical information such as diagnoses, medication lists, and allergies can be manually entered by the physician or staff. More detailed information, such as reports of procedures or correspondence from other physicians, will need to be scanned into the record. Either way, it will take a significant amount of work to enter even a small number of charts. This can be both time consuming and costly. There are many pitfalls that may not be obvious initially, so it can be helpful to consider the following tips:

Begin by Looking Forward

Typically, it is most beneficial to work forward from the point of installation and insure that all new patient information is immediately entered into the EHR to avoid creating a paper chart entirely. One way to do this is to “scan forward” – that is, to scan documents received only after the EHR is in place. Such scanned documents can immediately be digitized and attached to the patient’s electronic chart. The original can then be shredded instead of adding it to the paper record. By doing so, there will be a single date marking the end of information available on paper. After that date, all staff members will know to look in the EHR to find the data they need.

Take it One Day at A Time

One way to feasibly address the problem of entering old information into the EHR is to do a limited but consistent amount every day. But where to start? Many practices select charts to scan by reviewing the following day’s patient schedule. By “preloading” charts, important data are available at the time of an appointment, and the charts of so-called “frequent flyer" patients are usually among the first to be entered. Once the chart has been inputted, it can be archived off-site or properly disposed of.

To Scan or Not to Scan

Commonly, patient charts are filled with a tremendous amount of irrelevant information. Amidst the reports, notes, and letters are likely dozens of sticky notes, blank pages, fax cover sheets, and antiquated data. For a couple of reasons, it behooves a practice to spend time prepping charts before scanning them.

First, every page that is scanned will need to be indexed for the EHR to properly file it. It would be extremely cumbersome, when searching for an old lab result, to have to wade through dozens of papers at random. Indexing allows all documents to be sorted by type and date, but this process is extremely time-consuming. Each page scanned needs to be individually addressed. To minimize the amount of indexing, a practice may decide to only sort information of a certain age or type. Everything else can be then placed into a general, unsorted electronic file. In this way, the most important data are easy to find, yet even less valuable documents can be located with a bit of effort if necessary.

The second compelling reason is cost, both in staff hours and in storage. Many offices choose EHR solutions that are hosted off site. All data exist on an external server and, depending on the nature of the storage agreement, every page scanned into the system may incur an additional charge. In most cases the rate is about a penny a page. One need not take a very long look at the chart rack to realize how quickly the price will add up. Choosing to electronically archive only the most important items can help minimize the economic impact and make the overall process much more efficient.

When to Say Goodbye to Paper

There are a few commonly cited reasons why practices hesitate to finally eliminate paper charts. First is the fear of unintentionally losing critical patient data. This is reasonable, and data security should be a primary consideration when designing an electronic storage solution. All EHR vendors have set specifications for storage focused on security and reliability. If the data are to be maintained on site, one way to insure safety is through continuous backup. Higher standards are typically maintained at off-site storage facilities with multiple levels of redundancy. A well-chosen storage method should alleviate any fears of data loss.

 

The second reason practices hold onto paper records is concern about the need to produce the chart for possible malpractice proceedings. This represents a misunderstanding about the legality of electronic media. Regardless of where the chart is stored – on paper or in cyberspace – it is acceptable in a court of law.

The length of time the data must be maintained varies from state to state, but is typically about 7 years for adults or 7 years after turning age 18 for minors. Fortunately, once all the charts are archived, they can be safely and securely maintained indefinitely without the ever-growing need for a bigger office to store them.

Dr. Skolnik and Dr. Notte write the column, “EHR Report,” which regularly appears in Family Practice News, an Elsevier publication. Dr. Skolnik is associate director of the family medicine residency program at Abington (Pa.) Memorial Hospital and professor of family and community medicine at Temple University, Philadelphia. Dr. Notte is in private practice in Chalfont, Pa. They are partners in EHR Practice Consultants (www.ehrpc.com), helping practices move to EHR systems. Contact them at [email protected].