Electronic Health Records : Overview, Challenges and Legislation

Recent data breaches have highlighted the importance of ensuring the security of health information, including Medicare beneficiary data. The objectives of chapter 1 are to identify the major external entities that collect, store, and process Medicare fee-for-service beneficiary data; determine whether requirements for the protection of Medicare beneficiary data align with federal guidance; and assess CMS oversight of the implementation of those requirements. Health care providers are increasingly sharing patients health records electronically. When a patients records are shared with another provider, it is important to accurately match them to the correct patient. As reported in chapter 2 accurately matching patient health records is a barrier to health information exchange and that inaccurately matched records can adversely affect patient safety or privacy. VA provides health care services to approximately 9 million veterans and their families and relies on its health information system -- VistA -- to do so. However, the system is more than 30 years old. In June 2017, the department announced plans to acquire the same system -- the Cerner system -- that DOD is implementing. Chapter 3 and 4 review key aspects of VistA and VAs plans for the new acquisition of the Cerner system. The National Defense Authorization Act for Fiscal Year 2008 included provisions that VA and DOD jointly develop and implement electronic health record systems or capabilities and accelerate the exchange of health care information. The act also required that these systems be compliant with applicable interoperability standards. Further, the act established a joint Interagency Program Office to act as a single point of accountability. Chapter 5 discusses findings on the establishment and evolution of the Interagency Program Office over the last decade. Chapters 6 through 8 discuss recent legislation pertaining to electronic health records.