A Brief History of Electronic Health Records (EHRs)

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A Brief History of Electronic Health Records (EHRs)

  • January 2004. In his state of the union address, President Bush launched an initiative to make electronic health records available to most Americans within the next 10 years. “By computerizing health records, we can avoid dangerous medical mistakes, reduce costs, and improve care.” [1]

  • 2004. HHS Secretary Tommy Thompson appointed David Brailer as the national health information technology coordinator to provide: "leadership for the development and nationwide implementation of an interoperable HIT infrastructure," with the goal of establishing electronic health records for all Americans within 10 years.[2]

  • 2006. CMS defined its role as providing: “support for development of Electronic Health Records.”[3]

  • January 2009. President Obama, in a speech at George Mason University said “[EHRs] will cut waste, eliminate red tape, and reduce the need to repeat expensive medical tests…it just won't save billions of dollars and thousands of jobs -- it will save lives by reducing the deadly but preventable medical errors that pervade our health care system.”[4]

  • February 2009.  President Obama in his State of the Union address continued the momentum. “Our recovery plan will invest in electronic health records and new technology that will reduce errors, bring down costs, ensure privacy, and save lives.”[5]

  • February 2009. The HITECH act is signed into law. Beginning in fiscal year 2012, CMS will rank hospitals based on 30-day readmission rate for heart attack, heart failure and pneumonia.  Those in bottom quartile nationally from the prior year will have a percent of total Medicare payments withheld up to 1% in 2013, up to 2% in 2014, and up to 3% in 2015.

  • March 2010. President Obama signed the Patient Protection & Affordable Care Act. Provisions in the Act strengthened the HITECH Act, and gave us “Meaningful Use” by 2014. Physicians and hospitals need to prove that they have met 25 different functional objectives with their use of an EHR product to be considered “meaningful users”. These objectives include computerized physician order entry (CPOE), the use of clinical decision alerts, incorporation of lab results into their EHR as discrete data, ePrescribing and electronic information distribution to patients. Penalties include cuts to Medicare payments for those not implementing EHR.

  • Public and Private Pilots of ACOs over the last decade. Testing of bundled payments show ~5% cost advantage to taxpayers. CMS pilot programs include:  1) The Engelberg Center for Healthcare Reform at Brooking 2) The Dartmouth Institute. Medicare pilot sites include:  1) Carillion Clinic, Roanoke, VA 2) Norton Healthcare, Louisville, KY  3) Tucson Medical Center, Tucson, AZ. Private payor pilot sites include: 1) Anthem Blue Cross Blue Shield 2)  Monarch Healthcare 3) Advocate Healthcare 4) Blue Cross Blue Shield of IL  5) Healthcare Partners, Torrence, CA .

  • October 2011.  Final Rules for ACOs.  The Final Rules for ACOs strengthen the need for robust EHRs, with more financial incentives for rural docs and hospitals; digital data collection of 33 performance measures; “double points” for EHR as a quality measure; and random audits.  Electronic records will be table stakes for all providers participating in an ACO, as “failure to report quality measure data accurately, completely and timely (or to timely correct such data) might subject the ACO to termination or other sanctions.”[6]

  • June 2012.  The Supreme Court upholds the Affordable Care Act (ACA) by a vote of 5-4.  Many items in the ACA warrant the rapid transition to electronic medical records for skilled providers:  1) hospitals will increasingly align with like-minded, data-driven partners who can prove successful outcomes like readmission prevention; 2) Corporate Compliance programs that will now be required for nursing homes to drive continuous improvement and prove it with data; 3) Accountable Care and it's incentives for participants who have electronic medical records.  Summary:  market forces more than ever before are driving the rapid transition to EMR in post-acute care.


[1] http://www.whitehouse.gov/infocus/healthcare/

[2] http://www.hhs.gov/healthit/onc/mission/

[3]http://www.cms.hhs.gov/MissionVisionGoals/Downloads/CMSStrategicActionPlan06-09_061023a.pdf

[4]http://www.cnbc.com/id/28559492/Text_of_Obama_Speech_on_the_Econom

[5] http://www.whitehouse.gov/the_press_office/Remarks-of-President-Barack-Obama-Address-to-Joint-Session-of-Congress/

[6] https://www.cms.gov/ACO/

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