There is a nationwide initiative mandated by President Bush and being overseen by the Department of Health and Human Services to computerize and make electronic those paper-based medical records that provide documentation of healthcare events. A single facility such as a hospital or physician’s office may have an electronic medical record, or EMR (think paperless record). However, combining multiple EMRs from multiple facilities (from multiple locations) will result in an Electronic Health Record (EHR) and ultimately a healthcare network where the data produced from each becomes integrated in a single source that is portable, easy to access and to navigate. It is the government’s belief that collectively interconnecting the health care data produced by the many health care facilities, doctor’s offices, care providers, nursing homes, pharmacies, etc., will streamline medical practice, reduce redundancy and duplication of effort and testing, save time, improve patient care and quality and ultimately reduce healthcare costs across the country.

For the medical transcriptionists and many healthcare professionals, AHDI’s EHR initiative is a daunting task with many considerations, many more obstacles and few known answers. It is our hope that by providing basic resources about this topic, better understanding of the future goals can be obtained in order to help transcriptionists protect their interests and better promote the integral part that transcriptionists provide in the documentation and data formulation process.

The EHR Team’s Vision, Mission and Goals

EHR Vision: To ensure transcription experts are knowledgeable and engaged as participants in the evolution towards a national electronic healthcare record.

EHR Mission: To create relevance for the transcription expert as a significant contributor to the electronic healthcare record and the quality of the documentation therein.

EHR Goals

1. Educate, motivate and activate all transcriptionists regarding the Electronic Health Record (EHR) and their respective roles.
2. Provide relevant case studies about the contribution that medical transcription lends to the development of an EHR.
3. Publish no less than 3 EHR-related articles and present no less than 3 times in 2006 about medical transcription and its impact on the EHR.
4. Develop website resources and a presence on the AHDI website in order to provide our members with information they need to better understand the EHR.
5. Research and report on trends and progress of national EHR initiatives linking with alliances and work groups and providing public comment and survey materials that demonstrate the value medical transcription can bring to quality information initiatives around the EHR.

Meet the EHR Team

Elisa Comer, CPEHR, CPHIT, CQA
National EHR Coordinator

Elisa Comer is President and CEO of Eagle’s Landing Transcription Service (ELTS) based in Johnson City, Tennessee. She has over 20 years of healthcare experience, including direct patient care, administrative and ancillary support, documentation solutions, and transcription. Elisa was appointed the AHDI National EHR Initiative Coordinator by Peter Preziosi, Phd, CAE. During 2005, Elisa was named US Small Business Administration's Small Business Person of the Year for Tennessee, for which she traveled to Washington, D.C., and represented the transcription industry at National Small Business Week.

ELTS partners with many community colleges, which send their transcription students to ELTS for completion of their internship. The ELTS staff works to bridge the gap between the classroom setting and real-world documentation processes through this internship requirement, which serves as college credit.

Elisa is a member of the Appalachian Regional Health Improvement Organization (RHIO), now called CareSpark, where she serves on the technology committee. In July 2005, Elisa addressed the Tennessee Association for Medical Transcription on EHRs. In October 2005, she chaired an AHDI webinar and spoke at the East Tennessee Chapter of AHDI Fall Symposium. Elisa is scheduled for multiple local, state, and national EHR conferences where she will continue her efforts as a quality advocate in the setting of an EHR. She is certified in electronic health records and health information technology and is a certified quality auditor.

Miriam Wilmoth, CMT, FAAMT

Miriam Wilmoth is currently serving as the first elected President of the Tennessee Association for Medical Transcription, Past President of the Greater Memphis Chapter of AHDI, and past Chair for the AHDI Membership Task Force. Miriam has been in the medical transcription industry for 28 years. Currently, Miriam is Supervisor of Metro Transcription for the Baptist Memorial Health Care Corporation in Memphis, Tennessee, providing support for 6 Memphis metro facilities. Memphis Baptist has recently undertaken a multi-year EHR implementation project.

Susan Lucci, CMT, RHIT, FAAMT - Board Liaison

Susan Lucci has been in health information management since 1985, has a degree in Business Administration as well as HIM. Susan was elected to the Board of Directors for AHDI for the term 2006-2008 and serves on the Editorial Advisory Council for AHDI, the Resolutions Committee and as board liaison for the Managers and Supervisors Group and the EHR initiative. Susan currently works as Director of Transcription Operations for Transcription Relief Services, LLC. She is an active member of AHIMA, and currently serves as Facilitator of the Communities of Practice for the Medical Transcription Community for AHIMA.

Common Terms

RHIO: Regional Health Improvement Organization. These groups are organized teams who come together lending their expertise to connect medical records in a particular region. The purpose of an RHIO is improved healthcare as demonstrated through improved patient outcomes and controlled costs of medical care. To date, 4 RHIOs have been charged by the Office of the National Coordinator for Health Information Technology (ONCHIT), with the task of developing a prototype EHR over the next 24 months. It is from these prototypes that a national process will be selected for the Electronic Health Record. These teams promote interconnectivity of information, not one method of documentation over another.

ONCHIT: Office of the National Coordinator for Health Information Technology.

EHR: Electronic Health Record. A computerized medical record where information from multiple electronic (and often different) sources is interconnected to a single source for data storage and electronic access on demand.

EMR: Electronic Medical Record. A computerized medical record that enables electronic documentation of health visits through user-defined fields where data is stored in a database. This data may be received from several different electronic sources.

A single facility, such as a hospital or physician’s office, may have an electronic medical record (EMR). [Think paperless record.] Combining multiple EMRs from multiple facilities, however, will result in an Electronic Health Record (EHR), where the data produced from each becomes easily integrated in a single source that is easy to access and to navigate. It is the government’s belief that collectively interconnecting the health care data produced by the many health care facilities, doctor’s offices, care providers, nursing homes, pharmacies, etc., will streamline medical practice, reduce redundancy and duplication of effort and testing, save time, and ultimately reduce healthcare costs across the country.

EHR FAQs

What is the EHR Initiative for AHDI?

The EHR Initiative is an organized effort led by a team of transcription/EHR professionals to outline and assist with the movement and support of the transcription processes into the Electronic Health Record environment. This initiative will provide MTs with education about the EHR, what it is, what it is not, and what it means for the transcriptionist’s future as a professional. The EHR Team will provide educational tools and other resources to allow transcriptionists to become actively involved in the EHR movement. It is our belief that MTs possess a highly unique skill set, a blend of medical terminology and a detailed knowledge of documentation practices that can be leveraged in the EHR environment. Early adaptation of these goals will help to position the MT as an expert in health data analysis for the future.

What is an electronic health record?

An electronic health record, or EHR, is a record of patient care that is computerized, or electronic, and is interconnected amongst a wide variety of providers and facilities. It is the interconnectivity of data and ultimately information that drives President Bush’s vision for every American to have an EHR. Further, it is well documented that experts anticipate improvements in America’s healthcare by improving patient outcomes, disease management and prevention, and controlling the runaway cost of medical care by streamlining the information process, saving time, preventing duplication of treatment and better patient followup, for example.

Who are the major players in the EHR movement?

The major players in this movement are government entities, such as the ONCHIT office, physicians and hospitals, EMR vendors, and other ancillary healthcare providers, such as the medical transcriptionist and other HIM professionals like HIM Directors, IT Application analyst, system specialist, etc.

How will the EHR affect transcription?

There are many predictions of how transcription will change in an EHR setting, but for the most part the general consensus is that tapes and paper transcription will indeed succumb to digital methods of dictation/transcription. Other changes, such as voice recognition editing, are and will cause changes in the way medical language specialists perform their jobs. While EMR companies use elimination of transcription to sell their products, many physicians find EMRs cumbersome and prefer to dictate their notes. The percentage of doctors’ offices that have totally eliminated transcription and implemented EMR/template-based systems remains low. No studies evaluating the possible sacrifices of document quality in cases where transcription is eliminated have been documented to date. This is a task that is being researched by the EHR Team.

How can I find out about how the EHR will directly affect my job?

If employed in a hospital, HIM management should serve as a ready resource to answer questions regarding the facility's plans for implementation of the EHR and how it will impact transcription. For those who work in physician offices, information regarding plans for the EHR should be sought first through the practice manager or administrator, or secondarily from the physicians themselves. For those who are employed as ICs, who work for MTSOs, or ancillary healthcare employers, it would be beneficial to begin as soon as possible to open dialogue with those who provide the flow of outsourced work regarding their plans to transition into the EHR environment with their customers. A transcriptionist should be fully educated about the EHR before initiating such conversations in order to provide input regarding technologies, standards and protocols, and, above all, quality, to help insure that a positive contribution is made by the MT to the decision-making process.

How can I get involved?

Become educated by learning what an EHR is and what it is not. Understand that traditional transcription will probably, at some point, go away. This does not mean transcriptionists are no longer needed or will no longer have a job. This does mean that the transcriptionist may have to perform the task of providing document quality in a different manner. Know when it is best to pay attention to the claims of "eliminating transcription" versus dismissal of these claims as simple “feature bloat” sales techniques. Learn how to carry on a conversation with an EMR vendor who says transcription will go away. Refuse to be intimidated; instead, be motivated to action.

What is a RHIO?

Regional Health Improvement Organization. These groups are organized teams who come together and lend their expertise to connect medical records in a particular region. The purpose of a RHIO is improved healthcare as demonstrated through improved patient outcomes and controlled costs of medical care. To date, 4 RHIOs have been charged by Dr. David Brailer’s office with the task of developing a prototype EHR over the next 24 months. It is from these prototypes that a national process will be selected for the Electronic Health Record. These teams promote interconnectivity of information, not one method of documentation over another.

Is an EHR a good thing?

The EHR Team believes that yes, an EHR is a good thing for the American healthcare system. A simple look at the victims of Hurricane Katrina shows that computerized, interconnected patient medical records do indeed make a difference in treating the patient. Real-time, up-to-date information from all providers in a patient setting promotes enhanced communication and thereby, patient care is improved. While not the primary goal of EHRs, controlling the cost of healthcare by preventing duplication of tests and other treatment modalities is an added benefit that is anticipated to occur.

Helpful Websites

www.hhs.gov/healthit.org (Office of the National Coordinator for Health Information Technology)
www.ehealthinitiative.org (eHealth Initiative and the Foundation for eHealth Initiative are independent, non-profit affiliated organizations whose missions are the same: to drive improvement in the quality, safety, and efficiency of healthcare through information and information technology)
www.ahima.org (American Health Information Management Association)
www.himss.org (Healthcare Information and Management Systems Society)
www.ehrva.org (HIMSS Electronic Health Record Vendors Association)
www.carespark.com (Appalachian RHIO)
www.aaos.org/wordhtml/bulletine/aug04/computer.htm (Using SRT and comparison to MT accuracy)
www.aaos.org/wordhtml/anmt2005/poster/p224.htm (Study of SRT)
www.aaos.org/wordhtml/bulletin/dec04/computer.htm
www.psqh.com/current.html (September/October 2005 Columns: Technology and Quality and Interoperability: More Knowledge or Just More Data?)
www.healthmgttech.com/archives/1104/1104beyond_clinical.htm (Article Beyond Clinical Documentation: Using the EMR as a Quality Tool)
www.jamia/cgi/content/abstract/11/4/300 (Abstract of Article Impacts of Computerized Physician Documentation in a Teaching Hospital: Perceptions of Faculty and Resident Physicians)
www.centerforhit.org (AAFP’s Center for Health Information Technology, Physician’s Electronic Health Record Coalition (PEHRC))
www.nhinwatch.com (Your Comprehensive Guide to the National Health Information Network)
www.asq.org (American Society for Quality)
www.healthtransformation.net (Center for Health Transformation)
ccbh.ehealthinitiative.org (Connecting Communities for Better Health Resource Center)
www.ahrq.gov (Agency for Healthcare Research and Quality)

EHR-Specific Acronyms

ADE - Adverse Drug Event
AHIMA - American Health Information and Management Association
AHRQ - Agencies for Health Care Research and Quality
AMIA - American Medical Informatics Association
ANSI - American National Standards Institute
AOA - American Osteopathic Association
ASC - Accredited Standards Committee (from ANSI)
BC-MAR - Bar-coded medication administration systems
CCR - Continuum of Care Record
CDA - Clinical Document Architecture
CDR - Clinical Data Repository or Central Data Repository
CDS - Clinical Decision Support
CDW - Clinical Data Warehouse
CMS - Centers for Medicare and Medicaid Services (Formerly HCFA - Healthcare Finance Administration)
COLD - Computer output to laser disk
COWs - Computer on Wheels
CoP - Conditions of Participation
CPI - Consumer Price Index
CPOE - Computerized provider order entry
CPT - Current Procedural Terminology (from AMA)
DICOM - Digital Imaging and Communications in Medicine
DM - Disease Management
DSA - Digital Signature Algorithm
DSL - Digital Subscriber Lines
DSS - Digital Signature Standard
EBM - Evidence-Based Medicine
EDMS - Electronic Document Management System
EHR - Electronic Health Record
EMPI - Enterprise Master Patient Index
EMR - Electronic Medical Record
ePHI - electronic protected health information
ESIGN - Electronic Signatures in Global and National Commerce Act
GUI - Graphical User Interface
HCPCS - Health Care Financing Administration Common Procedure Coding System
HEDIS - Health Plan Employer Data and Information Set
HHS - US Department of Health and Human Services
HIE - Health Information Exchange
HIPAA - Health Insurance Portability and Accountability Act
HIT - Health Information Technology
HL7 - Health Level Seven (HL7 is a protocol for formatting, transmitting and receiving data in a healthcare environment)
ICD - International Classification of Diseases
IHE - Integrating the Healthcare Enterprise (IHE is an initiative by healthcare professionals and industry to improve the way computer systems in healthcare share information. HIE promotes the coordinated use of established standards such as DICOM and HL7 to address specific clinical needs in support of optimal patient care. Systems developed in accordance with IHE communicate with one another better, are easier to implement, and enable care providers to use information more effectively)
IOM - Institute of Medicine
IP - Internet Protocol
ISDN - Integrated Services Digital network
ISO - International Standards Organization
JCAHO - Joint Commission on Accreditation of Healthcare Organizations
LAN - Local area network
MMA - Medicare Prescription Drug Improvement, and Modernization Act
MPI - Master Patient Index
MRN - Medical Record Number
NCQA - National Committee for Quality Assurance
NCVHS - National Committee on Vital and Health Statistics
NDC - National Drug Codes
NHIN - National Health Information Network
NIST - National Institute of Standards and Technology
NLM - The National Library of Medicine
NLP - Natural Language Processing
ONCHIT - Office of National Coordinator for Health Information Technology
O/S - Operating System (for a computer)
P4P - Pay for Performance
PACS - Picture archiving and communications systems
PCP - Primary Care Physician
PHI - Protected Health Information
PHR - Patient Health Record
PMPY - Per Member Per Year
PMS - Practice Management System
POTS - Plain old telephone service
QIO - Quality Information Organization (Formerly called PRO - Peer Review Organization)
RAID - Redundant Arrays of Independent Storage
RAM - Random Access Memory
RFI - Request for Information
RFP - Request for Proposal
RHIO - Regional Health Information Organization
ROI - Return on Investment
ROM - Read only memory
SAN - Storage Area Network
SDO - Standards Development Organizations
SQL - Structured Query Language
SSL - Secure Socket Layer (transmission protocol)
SSP - Storage Service Provider
TCP/IP - Transmission Control Protocol/Internet Protocol
TPO - treatment, payment and healthcare operation
UMLS - Unified Medical Language System (developed by NLM)
USB - Universal Serial Bus
VOIP - Voice over the internet protocol
VPN - Virtual Private Network
WAN - Wide Area Network
XML - Extensible mark-up language