HIM 200 Module 2 EHR Adoption Short Paper Example

Paid to Go Paperless: The HITECH Act and Brennan County Medical Center's Electronic Record

[Student Name]

Southern New Hampshire University

HIM 200: Introduction to Health Information Technology

Module Two Short Paper

[Instructor Name]

[Date]

The organization, setting and figures below are a composite written as a model document. No real employer, client, colleague or patient is described.

Paid to Go Paperless: The HITECH Act and Brennan County Medical Center's Electronic Record

Brennan County Medical Center switched from paper charts to an electronic health record in 2013. Staff who were there remember the go-live week as chaos, but few can explain why the hospital made the switch when it did. The answer is a 2009 federal law. This paper explains what the HITECH Act offered and required, what research shows about its effect, how Brennan County's transition unfolded for the health information management department and what the law left unfinished.

Before HITECH

In the mid-2000s, most American hospitals still relied mainly on paper. Electronic records were expensive to buy and install, disrupted work during the changeover and delivered many of their benefits, such as fewer duplicate tests, to payers and patients rather than to the hospital paying for them. Large academic centers and integrated systems led adoption, while smaller community hospitals like Brennan County lagged. Brennan County used electronic systems for billing, laboratory results and pharmacy, but physician notes, nursing documentation and orders remained on paper.

What the Law Did

Passed inside the 2009 economic stimulus package, the HITECH Act created incentive payments through Medicare and Medicaid for hospitals and clinicians that adopted certified electronic record technology and used it in specified ways. Beginning in 2015, Medicare payments were reduced for eligible hospitals that had not met the requirements. Federal certification of each product assured buyers that a product could perform required functions. The combination of rewards, later penalties and product standards addressed the cost and uncertainty that had held hospitals back.

Meaningful Use in Three Stages

Payments depended on meaningful use, not purchase alone. Stage one focused on capturing data electronically, such as problem lists, medication lists and computerized orders. Stage two raised thresholds and added requirements for exchanging summaries of care and giving patients online access. Stage three emphasized interoperability and outcomes. In 2018, the Medicare program was renamed Promoting Interoperability to reflect that shift. Each stage required hospitals to report measures, which meant HIM and information technology staff spent considerable time documenting compliance.

Did the Law Work?

Adler-Milstein and Jha (2017) tested whether HITECH itself, rather than a general trend, drove adoption. Their comparison group, hospitals the law left out such as psychiatric, long-term care and rehabilitation facilities, adopted far more slowly after 2009 than the hospitals offered payments. Their comparison group strengthens the conclusion, since ineligible hospitals experienced the same technology market but not the incentives. The finding explains Brennan County's timing: its board approved the purchase in 2011 specifically to capture incentive payments.

Brennan County's Go-Live

The hospital received about $2.1 million in incentive payments over several years, roughly half the cost of its system. Go-live came in phases: orders and nursing documentation first, physician notes three months later. Productivity dropped for weeks, physicians complained about extra clicks and the emergency department briefly returned to paper downtime forms when the system slowed. Within a year, however, the hospital met stage one requirements and began stage two work, including a patient portal.

The Hybrid Record Problem

For HIM staff, the hardest period was the hybrid record, when part of each patient's chart was electronic and part was paper. The department had to define the legal health record, deciding which documents in which format constituted the official record for release and legal purposes. Staff scanned years of paper charts that clinicians might need, indexed each document to the correct patient and encounter and cleaned duplicate entries in the master patient index. Release-of-information requests took longer because staff had to check two places, and every copy sent to an attorney or insurer had to be assembled from both halves of the chart and reviewed page by page for completeness.

Unintended Consequences

Rapid adoption brought problems the law did not anticipate. Copy-and-paste documentation made notes longer and sometimes inaccurate. Clinicians faced frequent alerts, many of which they overrode. Documentation time rose. Howe et al. (2018) later analyzed patient safety reports from three health systems and found that some described events potentially related to electronic record usability, including a subset where harm may have occurred. Speed of adoption meant many hospitals, including Brennan County, installed systems without redesigning the workflows around them.

Adoption Is Not Exchange

Meaningful use succeeded in putting records on computers but was less successful at getting computers to talk to each other. Holmgren et al. (2017) found that in 2015 fewer than a third of hospitals were engaged in all four interoperability activities of finding, sending, receiving and integrating outside data. At Brennan County, the record could send summaries to other hospitals using the same vendor, but most local clinics used different systems, so faxing continued.

From Meaningful Use to the Cures Act

Congress responded with the 21st Century Cures Act in 2016. The law, explained by Black et al. (2018), outlawed information blocking, meaning conduct by vendors, networks or providers that needlessly keeps electronic health data from patients or other clinicians, and federal rules issued in 2020 went on to require certified systems to support standardized application programming interfaces. The policy focus moved from whether hospitals had electronic records to whether patients and other providers could get information out of them.

What It Meant for HIM Work

The HITECH era changed HIM jobs profoundly. File clerks became scanning and indexing specialists, coders moved to computer-assisted coding and release-of-information staff began handling electronic requests and patient portal questions. New tasks appeared: auditing the electronic record for completeness, maintaining templates and managing downtime procedures. HIM professionals became the people who understood both the record's legal requirements and its electronic structure.

Table 1. HIM Tasks Before and After Brennan County's Electronic Record

Note. Based on the author's department records and interviews with long-serving staff.

Conclusion

The HITECH Act worked in its main goal: it moved hospitals like Brennan County from paper to electronic records far faster than the market would have. It also left an unfinished job, since records that cannot be shared still send HIM staff to the fax tray, and systems installed quickly produced usability problems. The next module examines interoperability, the challenge the Cures Act now targets.

References

Adler-Milstein, J., & Jha, A. K. (2017). HITECH Act drove large gains in hospital electronic health record adoption. Health Affairs, 36(8), 1416-1422. https://doi.org/10.1377/hlthaff.2016.1651

Black, J. R., Hulkower, R. L., & Ramanathan, T. (2018). Health information blocking: Responses under the 21st Century Cures Act. Public Health Reports, 133(5), 610-613. https://doi.org/10.1177/0033354918791544

Holmgren, A. J., Patel, V., & Adler-Milstein, J. (2017). Progress in interoperability: Measuring US hospitals' engagement in sharing patient data. Health Affairs, 36(10), 1820-1827. https://doi.org/10.1377/hlthaff.2017.0546

Howe, J. L., Adams, K. T., Hettinger, A. Z., & Ratwani, R. M. (2018). Electronic health record usability issues and potential contribution to patient harm. JAMA, 319(12), 1276-1278. https://doi.org/10.1001/jama.2018.1171