PerspectivesAre you interested in submitting a Perspective Article? Be sure to read The Science Advisory Board's Editorial Guides for Perspective Articles. Click here. Managing Records On-Line by Beth Friedman, RHIT Executive Summary The World Wide Web…what started as a way to send information electronically has become the catalyst for change in virtually every aspect of our lives. From banking to shopping, our lives are transformed by the power of the Internet. And with the latest advances in technical security tools, the future continues to be bright. Among the 143 million Americans using the Internet, 35 percent are searching for health services or using on-line health information resources. That’s one out of every three! Certainly the next step for these 50 million Americans is to use the Internet to access, manage and store their own personal health records. To provide this type of on-line information access, health care providers must implement new technologies, and the sooner, the better. This white paper discusses the three key factors driving medical records to the web. Three common technologies being used to achieve remote, on-line record access are described and specific hospital case studies mentioned. Finally, this white paper explores how record management will change in an on-line environment and identifies areas for specific focus within Health Information Management (HIM) Departments that pursue on-line record solutions. The Case for On-Line Medical Records Until recent advances in security technology, on-line records and patient access to these records was a distant dream. However, today savvy health care providers are using security tools coupled with the Internet to move toward on-line medical records as a competitive differentiator, a way to improve care delivery and reduce costs. To attract new patients, physicians and employers, hospitals are making information available on-line. Just as patients can store and access their personal banking information, they want to be able to view health information and access their records easily, conveniently and securely via the Internet. Individual consumers and employers who contract for health care services will be most attracted to physicians or hospitals that can meet this need. In addition, on-line records help improve care delivery by facilitating information sharing by nurses, physicians and other health care professionals. The ability for a nurse, physician and consultant to view the same chart simultaneously simply is not feasible with a paper record. The benefits of record sharing grow exponentially when an organization has multiple locations. In fact, 76 percent of health care professionals mentioned the need to share comparable patient data among different sites within a multi-entity health care delivery system as the major factor driving their organization toward electronic records.[1] And sharing this information via Web technology is the top priority for 35 percent of this group. Finally, on-line records can help organizations reduce costs. Many organizations have achieved documented savings in reduced paper costs, improved workflow, faster billing cycles and time savings for staff. Twenty years ago, banking organizations began reinventing their services. ATM machines now replace long teller lines and on-line banking has replaced paper checks and the need to balance your checkbook. Many providers are already making strides toward electronic records within their organizations. The next step is to use the Internet to take records “on-line” and transform health information management (HIM) from a paper-based, labor intensive process to a streamlined, secure, patient self-service function. The Internet is providing the technology to make this transformation. Today’s Options for On-Line Medical Records Web-based Solutions One way to provide on-line access to information is through Internet, or Web-based solutions. With this technology, the medical record information—scanned images or discrete data—is stored at a secure host computer site. To populate the host computer, information is sent or entered via the Internet. Access and viewing of the records is also performed via the Internet and a Web browser. High levels of technical security including digital certificates, passwords, firewalls, virtual private networks and biometrics ensure that only authorized users can enter or view information. In keeping with our focus on the Internet, we’ll look at direct access to a Web-based application—document imaging—as it is being used to view records on-line. Case Study: A Web-Based Document Imaging System[2] McNairy Hospital, Selmer, TN, needed a way to give Emergency Room physicians easier access to patient records. The hospital decided to contract with a vendor to scan records, encrypt the images and send them via the Internet to a secure remote site where they are stored, and with proper authorization, available for on-line viewing by physicians or other hospital personnel. Today, all patient records are stored electronically at the vendor’s host site. A physician working in the middle of the night can quickly and easily view the last admission or outpatient records for an emergency patient. McNairy has been using this solution since July 2001 to give physicians Internet access to historical medical records. Tips for Record Management With this type of solution, record access must be tightly controlled with passwords, digital certificates, one-time ciphers and a complete audit log. The director of medical records is responsible for granting access, assigning digital certificates and reviewing the log. To further guard security, physicians can only view patient records at designed PC workstations within the hospital. Another Option: The Web Portal Another option for Internet-based patient information is use of Web-portal technology. Web portals were one of the first Web-services solutions and have been used throughout a variety of industries. Providers use Web portals to give clinicians and other staff access to internal hospital systems. In basic terms, a portal is a “gateway” into an existing computer system. It allows remote users (clinicians, patients and others) secure access to information stored within the hospital’s computer. Case Study: Access to Patient Information via a Web Portal[3] At Saint Alphonsus Regional Medical Center, Boise, ID, a physician portal was created in 1997 to provide secure, password-protected access to vital data. Originally designed using dial-up technology, the portal is now a Web-service that allows physicians 24-hour access to virtually every component of the patient record. With the help of an advanced patient identification system, patient information from 12 locations can be cross-referenced with physician and health information. Currently, more than 250 physicians use the portal. Requests for information, previously printed and faxed, are now handled via the physician portal saving time and money in the medical record department. Tips for Record Management in HIM: With this solution, a programmer was dedicated to maintaining the portal and monitoring all access activity. The electronic master patient index software helps to control physician access to patient information and ensure the “right physician” is viewing the “right patient.” The Next Frontier: Giving Patients Access to Records on the Web In both of the case studies, the focus is on access to patient information by employees within the health care organization. What happens in HIM when this type of access is extended to the patient? One medical group, the Michigan Electronic Medical Record Initiative, is advocating a statewide project that would save approximately $350 million per year.[4] With the system, Michigan residents would have their own private, secure and complete electronic medical record. Implications for HIM: When considering giving patients access to this type of Web-based record, strict security measures need to be in place. The technology should support similar log-on capabilities provided by on-line banking and on-line shopping via secure socket layer, digital certificates and other technical safeguards. Similar to on-line banking and using your credit card to shop on-line, the onus will be on the patient to maintain his or her own passwords and grant or deny access to health care providers. Records must only be accessed with the approval of the patient. Eventually, standards in e-health and electronic record technology will greatly enhance our ability to give patients Web-based access to their medical record information, whether scanned or computerized. The Future of HIM: On-line Personal Health Records Much talked about in the mid 1990s, on-line personal health records are positioned for success in the next decade. Not to be confused with the e-health content companies who floundered, personal health record Web sites are just beginning to attract attention in the marketplace, specifically in the United Kingdom and Australia. According to Manhattan Research, the 55 years and older segment is predicted to have the highest rates of on-line adoption over the next two to five years.[5] Given this statistic and the target market for health care products, the outlook for on-line health Web sites is extremely positive. A pioneer in on-line personal health records is MyLife (www.doctorglobal.com). At this Australian Web site, visitors can enter personal medical information including history, allergies, insurance information, next of kin and other health data. The member decides exactly who can view the information and who can update it. Once entered by the member and given proper authorization, the member’s caregiver can view all information entered and even update the record. Personal health records on the Internet are still several years away. But considering how quickly the Internet transformed banking, shopping and investing, managing our own medical record information is no longer a distant dream. HIM’s Role in e-Health The evidence for on-line medical records is compelling. Our population is aging and more citizens will demand on-line access to health information. The Internet has delivered conveniences in many areas of our lives and tomorrow’s patients will expect the same technology when receiving health care services. This transformation is driving HIM professionals into a new era of record management. Our responsibility is to lend experience and knowledge to the development and management of systems and standards to support on-line records. According to the American Health Information Management Association’s (AHIMA) e-Health Task Force,[6] HIM professionals are responsible for managing two basic objectives related to health information: data collection and facilitating information use. Specifically, the role of the HIM professional according to the Task Force is to bring record management expertise to the table in the e-health era. The same principles that we use to manage paper records pertain to electronic health information regardless of where or how it is stored. Finally, HIM professionals will be needed to educate the 50 million Americans who want to manage their own health information. From answering questions about medical records to helping consumers ensure the highest level of privacy for their on-line information, our skills and training will be in high demand. Conclusion There is no doubt about it…health care is joining the information highway. And with today’s new technologies and security tools, HIM professionals can make sure that our medical records go along for the ride! References: 1. Fourth Annual MRI Survey of Electronic Health Record Trends and Usage (2002) . Medical Record Institute: www.medrecinst.com/resources/survey2002/overview.pdf. 2. Turning Paper Records into Secure Record Sharing (September 2002). eWebCoding Case Study: www.eWebCoding.com/press_releases.htm. 3. Hall, Leslie Kelly (November 2002). Doctors Wired for Access to Patient Records. ADVANCE for Health Information Executives: www.advanceforhie.com. 4. The Michigan Electronic Medical Record Initiative (2002). Home page: www.memri.us. 5. Heard on the Street (Dec. 3, 2002). Today in E-Health Business. Atlantic Information Services: www.AISHealth.com/Products/211mdESC1102.html. 6. Job in the e-Health Era (June 2002). Journal of the American Health Information Management Association, pp. 32-35. Copyright 2004 eWebHealth. Beth Friedman is director of marketing for eWebHealth (formally eWebCoding). ### << Previous Next >> [ View All Perspectives ] |
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