ADA News

The current model has been in place for more than a century.

A patient has a paper file in a physician's or dentist's office containing his or her medical records. If the patient were to leave that office for another practice or move out of state, one of several options is available.

The patient could start over and not transfer any medical records to the new practice. He could have his physician or dentist mail the records or even fax them. More sophisticated offices might have the capability to electronically scan the records and e-mail them to the new doctor’s office.

All that will start to change in the next couple of years as the federal government, state governments and private companies work to develop an interoperable electronic health record system for the country. Proponents say once it's in place it'll be a more streamlined system, but how all of the parties and models connect has many confused.

And for good reason. It's not a system ruled or developed by one body; it's one with many stakeholders who have different ideas and roles in the process.

Despite opponents who have yet to buy into the federal government's claim that electronic health records will provide more security, improve Americans' health and cost less, the U.S. Department of Health and Human Services is moving forward aggressively and expecting others to jump on board. As part of President Obama's American Recovery and Reinvestment Act of 2009, $27 billion will be spent over 10 years to develop an interoperable electronic health record system.

Although several stand-alone products are available for use within a practice or organization, the standards to achieve a useful information exchange among organizations and systems have not been finalized and are currently under development.

The American Dental Association is working to develop and implement the dental portion of the electronic health record. Following a request for proposal issued by HHS under the Bush administration, the ADA worked to position itself as the expert resource and advocate for dentistry's portion of the EHR.

The ADA Electronic Health Record Workgroup was established in 2007 and, under the leadership of Dr. Robert Faiella, 1st District trustee, has established advisory groups to develop standards for the EHR, provide education to membership and advocate for dentistry within the EHR process.

So how does everything fit together? Below are some topics highlighting key aspects of the EHR process:

• Federal vs. state vs. local: It’s the federal government's role to develop the national compliance standards as well as assure security and privacy for the exchange of information. It's up to each state's legislature to amend its laws to accommodate the protection of an electronic health record as opposed to a paper one. State Medicaid agencies must also plan and develop their own incentive program to reimburse doctors for complying. Regional Extension Centers are being created to support the providers in adopting EHRs.
  
  The charge is to establish the foundation and infrastructure to support the technology for an automated exchange of health information. The challenge will be to connect a number of distinct networks that use differing approaches in different states.

• Incentives: On July 13, the Department of HHS released final rules for the first "meaningful use" requirements, which determine how health care professional organizations must implement stipulated aspects of the EHR system in order to receive incentive payments. Eligible professionals who move to a certified electronic health record will be eligible to receive monetary reimbursements through Medicare or Medicaid.
  
  For example, the Health Information Technology for Economic and Clinical Health Act provides for reimbursing eligible Medicaid providers, such as dentists who voluntarily demonstrate compliance with a specified EHR implementation criteria, as much as $63,750 in incentives over six years. However, in order to qualify, the eligible professional must use a certified EHR to achieve "meaningful use" as that term is defined by the regulations and must have a patient population with at least 30 percent Medicaid beneficiaries. For Medicare, eligible professionals are individuals who are not hospital-based.
  
  Complying with the EHR system is voluntary but those who don't will not receive full reimbursement for services. Noncompliant Medicare providers' reimbursements for covered Medicare services will be reduced starting in 2015. There are no federal plans to reduce monies paid to Medicaid providers for Medicaid services, but the states have that option.
  
  This is just the first of three phases of meaningful use criteria and as subsequent phases are released, the criteria will become more stringent.

• Funding: The federal stimulus package has allotted money for incentives but not to sustain an EHR model indefinitely. Dr. Faiella said a sustainable business model has to be developed for an EHR system to exist and be successful in the long term. There are also grants available to states through the HITECH Act that will provide seed money to help get EHR programs up and running, Dr. Faiella said.

• Health Information Exchange models: Several private companies and nonprofit organizations have already developed systems to allow hospitals and physicians' and dentists' offices to share medical information electronically. For example, the Indiana Health Information Exchange is a coalition that includes five competing hospital systems, the nation's largest health insurer, employers, physicians and public health officials in addition to other economic development, community and business organizations.

Implementing an EHR system began to take shape under President Bush in 2006, when he issued an executive order encouraging the use of electronic health records in government health programs, including the Federal Employees Health Benefit Program, Medicare, dental and other health programs operated by the Indian Health Service, TRICARE for the Department of Defense, other uniformed services and the Department of Veterans Affairs health programs.

"We will make use of electronic records and other health information technology to help control costs and reduce dangerous medical errors," said the former president's mission statement.

Shortly after former HHS Secretary Michael Leavitt spoke to the ADA House of Delegates at the 2006 annual session, he launched a national initiative seeking support from the business community for EHRs.

Prior to the establishment of the ADA's EHR workgroup, there was the 14-member Association Task Force on the National Health Information Infrastructure, an earlier name for the overall national EHR system, formed in 2005. The group was charged with making sure that dentists would be prepared for the arrival of the electronic health record and that dentistry's voice would be heard in the federal government's plan.

The first EHR systems could roll out this fall. The ADA's EHR workgroup has established advisory groups dedicated to different areas to oversee the development of standards for the EHR, formulation of vocabularies needed to document clinical activity, the provision of education for members, advocacy for dentistry at the federal and state level, liaison activities with other standards development organizations globally and participation in the certification of compliant EHR systems for dentistry.

For more information on EHRs, visit http://healthit.hhs.gov.