In the world of mountain climbing, it is well-known that those that race to the top as quickly as possible without taking the necessary steps are doomed to fail. Thinning oxygen levels coupled with harsh conditions at high altitude compel successful climbers to take the right gear and acclimate at base camp. Similary, it can be overwhelming to try to throw yourself headfirst into the world of EMRs without taking stock and adjusting to the new system. Preperation minimizes the risks involved in the ascent toward the ultimate goal, as it has for generations of mountain climbers.

In 2009, Congress enacted the Health Information Technology for Economic and Clinical Health Act (HITECH) as part of the American Recovery and Reinvestment Act (ARRA) to expand upon HIPAA regulations pertaining to electronic transmission of health information. Given the significant increase in EMR/EHR adoption, it is important to proactively manage the transition from manual to electronic logging when distributing protected health information (medical records with patient identification). In fact, both HIPAA and the HITECH Act mandate that all providers implement a consistent and compliant logging of all health information releases.

Currently, HIPAA reqires the accounting to include the items below for each disclosure (164.528(b)(2)

• The date of the disclosure
• The name of the entity or person who received the protected health information and, if known, the address of such entity or person;
• A brief description of the protected health information disclosed; and
• A brief statement of the purpose of the disclosure that reasonably informs the individual of the basis for the disclosure.
• A copy of the request for health information or a brief statement of the purpose of the disclosure

A few summary areas of how the HITECH Act changed the HIPAA regulations:

• They closed HIPAA's exemption of privacy rules for electronically transmitted medical records
• There are new breach of information notification requirements in the transmission of EMRs
• Breaches affecting a number of individuals must be made public and reported to the Department of Health and Human Services
• Of special note: Healthcare providers must now manage all aspects of tracking electronic disclosure, including information pertaining to carrying out treatment, payment and health care operations, and provide them to individuals requesting an accounting of disclosures for a period of three years prior to the date on which the accouting is requested

I will be covering these issues in more detail in discussions to come. For a complete list of modifications to HIPAA under the HITECH Act, click here. A few suggested steps for your journey up the EMR compliance mountain:

• Implement an automated release of information system, logging both electronic and paper records disclosed
• Incorporate all faxing of health information into a centralized release of information process
• Maintain electronic images of the request for health information as part of your automated logging system

I was recently asked what I would relate our current healthcare industry to and, after some thought, I said the banking industry of 1982. Walking into a bank branch brought the sounds of shuffling papers and passbook stamps into one's ears. Healthcare Information Technology - it's time to leadExchanges at the bank were neither quick nor efficient, and if their numbers didn't add up with one's personal calculations, hours could easily be spent trying to figure out where that one dollar went.

To me, this sounds like trying to figure out healthcare paperwork today. In fact, according to a 2008-2009 CDC survey, nearly 66 percent of physicians (where efficiency should begin) reported not using any sort of health information technology. If it doesn't begin electronically, then we're all playing catch up and the fact is: much of today's healthcare industry remains inefficient and paper-based.

In order to transform the healthcare industry, we must tear down the thick walls of the outdated incentive systems and one-way communication methods between health care providers, payers and patients.

For this to occur, the systems must integrate and engage with each other. Systems that allow convergence of data, automation of administrative processes and real-time collaboration can offer substantial improvements to the healthcare industry. At CH Mack, we see many forward-thinking organizations that are looking for these advantages.

Fast forward to today's banking industry. Electronic banking has empowered both consumers and banking industry services to today's achievements. Consumers can quickly pay bills, and research financial health online thanks to the introduction of technology that has been implemented into our banking system.

Fortunately, I now lead an organization that empowers healthcare stakeholders to realize a better system — one that leads to improved healthcare for everyone. Could healthcare technologies advance and even lead the banking industry in a decade?

As technology is advancing and becoming implemented, it is significantly changing our daily lives. I have seen 'real world' interconnected technology changing the way in which healthcare and people interact on all sides of the board. Our processes are becoming more effective and our information more accessible.

When I say 'real world' interconnected technology, I mean the ability to connect disparate sources of health information that can be executed with current technology. As this applied technology continues to adapt and grow, we will see even more evolution within health information technology and its solutions.

• In recent times, technology has enabled case managers to access information from many different sources in an interconnected way. This has allowed them to not only have a more complete picture of an individual, but has also allowed their work processes to become more efficient – which also allows them to work more cases without increasing their work schedules.
• The proliferation of interconnected technology has forced case managers to become more computer literate. Five years ago, it was not uncommon for a case manager to have limited computer experience. Today it is a job expectation that a case manager is computer proficient. As they have seen online systems make their jobs easier, case managers have also begun to embrace the value of interconnected technologies.

• Interconnected technologies have allowed an organization's information from disparate systems to be linked and stored in a single data warehouse. This has allowed for enhanced reporting capabilities – whether it be for internal case management program evaluation and development, or for external reporting to stake holders/licensing and accreditation bodies. The integrated data has also helped in identifying quality issues and ongoing evaluation of interventions implemented. These types of activities help case management organizations, as well as the practice of case management overall, to focus on those activities that will bring the biggest value to the quality of care members receive.
• Through interconnected technologies, case managers now have access to biometric tools – that allow them to monitor vital signs, weight, etc. – of members in their caseloads right on their desktop. The interconnected systems alert the case manager when things such as vital signs are changing, allowing for immediate intervention before an issue escalates. This allows proactive case management, without daily contact with the actual member.
• Trusted resources for evidence-based guidelines and standards are at the case managers fingertips. Interconnected technologies can allow case managers to automatically capture care plan problems from an HRA or assessment done on an individual in another system; when the two have been set-up to interconnect.

Adopting technologies that allow our healthcare systems to interconnect should and must be one of our top priorities in allowing healthcare professionals to manage and coach patients and members on optimizing health. These tools will have far reaching possibilities, including a renewed focus on telemedicine, a drastic increase in communication between provider and patient, as well as improving patient and members abilities to best manage their own healthcare situations.

"If you don't know where you're going, any road will take you there," is a famous line from The Wizard of Oz.

It's true that the best road isn't always the most obvious one. Let's consider this in the context of the healthcare industry. Does the industry really know where its going—or is it speeding ahead without a roadmap?

With our electronic medical record push in the United States, we have a fundamental question to ask the health care community: Why are we going electronic?

I've led health information technology companies for a number of years and fully believe it's time to take our health information, workflows, and tools from the stone age to the new age. I just think we should know where we're going and take the road that leads to progress.

Jumping too Quickly

When it comes to implementing new medical technology, it's tempting to jump too quickly to the how before understanding the why. You may be questioning how to qualify for stimulus money, for example. Or wondering how to comply with the upcoming "meaningful use" definition.

While these are fine questions to ask in the short run, we need to be careful not to lose site of the larger goals—increasing quality healthcare while decreasing cost—as we strive to reach electronic healthcare panacea by 2014.

Health Data Management recently reported that 75% of people agree that systems relying on document imaging and management technology will drastically decrease given their lack of ability to crest the "meaningful use" requirement. This is a discouraging sign at best.

Having witnessed the evolution from paper to electronic automation, I can honestly say that health care's use of document imaging has made a huge difference to providers moving from paper to full and integrated EMR systems. To disregard this necessary step for many providers ignores the reality of managing paper-based systems already in place such as those for quality assurance, risk management, and ERs. And there's the complication of transitioning from paper forms—that have defined processes more than most want to admit—to electronic input by clinicians.

Focus on the Road Ahead

A recent report on the Colorado healthcare transition to an EHR system highlights this and indicates both the format and the presentation of information made a substantial difference when providers were converting to an electronic system.

Skipping over imaging systems and going straight from paper to fully integrated EMRs is like going from horse and buggy to this year's turbo Porsche. If not handled properly, the transition from paper to electronic can bring about losses in productivity and quality. It's important to keep the end goal in mind and stay on the road of progress while implementing the necessary healthcare IT. We need to have good guideposts along the road to ensure we're on the right path.

Finally, consider this telling report from For the Record: 77% of healthcare workers continue to be frustrated when looking for healthcare information to simply do their job. We can do better. Let's provide healthcare workers with the tools they need to do their jobs well and stay focused on the road ahead.