10/04/2018
NCEGR National Center of E-Governments’ Research
IRAQI E-HEALTH
Ali Al Ukaby
MPM, Ph.D. Candidate
Contents
1 Overview of Health Care in Iraq4
2Financing overview5
3Executive Summary6
4Burden of Disease6
5Public Health Informatics6
6Interoperability and Standards7
7ISO/TC 2157
8Health Level Seven (HL7)7
9ICD-9, 107
10Core Functions of an EHR8
10.1Result Management.8
10.2Electronic Communications and Connectivity.8
10.3Administrative Processes.8
11E-Health Capacity Building9
12Electronic Medical Records9
13Electronic Health Records9
14Digital health records9
15Core functions an EMR system10
15.1Health information and data:10
15.2Results management:10
15.3Order management:10
15.4Decision support:10
16Electronic communication and connectivity10
16.1Patient support:10
16.2Administrative processes:10
16.3Reporting:10
17Access to Information10
18Unlocking the Market for e-Health11
19National e-Health Policies11
20Conclusions11
21Iraqi E-Government12
22Health Provision13
23ECONOMIC AND SOCIAL COMMISSION FOR WESTERN ASIA (ESCWA) Iraqi E-HEALTH13
24Interoperability14
25Electronic Patient Flow14
26Summary15
26.1Predictions16
27EHR Vision16
28EHR Benefits17
29Technology17
30Purpose18
31Culture19
32Strategy20
33Objectives20
34Compatibility21
1 Overview of Health Care in Iraq
A formal health care system in Iraq began with British occupation following the end of the First World War in 1918. In 1921 the first directorate of public health services was formed which was upgraded to become a Ministry of Health in September of the same year. It was annexed in the following year to the Ministry of Interior as a Directorate. In 1952 the Ministry of Health was re-established and its organizational structure was formalized in 1959. The basic organization structure has changed little since then.
In 1978, Iraq signed the Alma-Ata Declaration on Primary Health Care and strengthened the Department of Preventive Medicine through the construction of health centers throughout the country.
In 1981, a Public Health Law was enacted. It stated that health is a right for each citizen and the responsibility of the state to provide all means to promote health prevent and treat diseases. The main functions of the Ministry of Health were described as:
• Establishment and management of health facilities.
• Control of communicable diseases.
• School health and maternal and child health services.
• Promotion of nutritional
• Provision of mental health services
• Supply of drugs, vaccines, sera and other medical goods
Referral systems, communications, and training to integrate health centers into a primary care strategy were planned for in the early 1980s. These plans were put on hold when war began.
Services are provided by 269 hospitals (public and private), 1570 health centers, 308 health insurance clinics, 254 chronic illness pharmacies and 32 special pharmacies for rare drugs.
Most health services are provided by MOH facilities. The private sector constitutes a rising minority of all beds and medical visits.
Hospitals are managed by the Directorate of Technical Affairs. Outpatient care is managed by Directorate of Public Clinics.
These afternoon clinics charge nominal fees and dispense drugs for patients registered in the chronic illnesses card system.
Preventive services and the management of health centers is the responsibility of the Directorate of Preventive Medicine’s Primary Health Care Department. “Health insurance clinics” are public clinics in rural areas where new graduates provide 2 years of social service.
2 Financing overview
M.O.H since its establishment at 1958 adopted the policy of central financing system & free medical services in all health facilities (PHC, hospital, preventive & curative activities).
In 1972 outpatient clinic examination fees of 25 fills were initiated at governmental hospitals for curative care while examination for PHC was free. In 1982 the examination fees increased to (100 fills) and in 1983 (100 fills) drug fees were added on with exemptions to different categories.
In the same year minister of health authorized charging from indoor patients in government hospitals private wards & nursing. In 1984 patient charges were instituted for public clinic & cardiovascular hospitals, in addition foreigners & non-resident Arab people were also included in the schedule of charges.
Due to sanctions in 1990, the health financing system was severely affected due to limited budget allocation, thus in 1997 a new financing policy was adopted as pilot in 7 specialized hospital called “self–financing” system in which the cost of care was shifted
To the patients. This system was extended to all hospitals in 1999 and PHC centers in 2001.
Psychiatric and Fever hospitals were excluded from the Auto-financing scheme in the pre-conflict period; Iraq’s budget framework was characterized by a dichotomy
Between public entities that are ‘on-budget’ (all Ministries and their agencies that perform a public function) and ‘off-budget’ entities (also known as ‘self-financing’ entities), which included almost all health provision facilities.
All revenues of ‘on-budget’ entities are required to be put into consolidated revenue, controlled by the Ministry of Finance.
Expenses of ‘on-budget’ entities are made against Budget appropriation lines.
Further, the vast bulk of public expenditure under the previous regime was ‘off-budget’,
Reflecting goods received under the Oil-for-Food program. In 2003 the system reverted to the old method of charging for curative care and medicines with free diagnostics and free examinations for PHC services.
3 Executive Summary
Iraq is country of 30 million people, 46 % of whom live in rural areas. It is divided into 18 Provinces and there are 2 official languages. It is rich in natural resources and has one of the largest and most oil reserved, with a GDP per capita (PPP): $3,800 (2010 est.). GDP - real growth rate: 0.8% (2010 est.). Despite this, it has an official unemployment rate of 15.3% (2009 est.), approximately 25% of its people live below the poverty datum line and 10.7% live on less than US$1 (purchasing power parity) per day.
4 Burden of Disease
Its people carry a disproportionate burden of disease, people with respiratory diseases and percentage of the population admitted to and treated with antibiotics and the rate of life with pneumonia of the population 727, 87 for each 1000 population. Hepatitis incidence of the total types of viral hepatitis in 2010 up from (6.13) in 2009 to (8.81) per 10,000 inhabitants. Immune Deficiency (AIDS) The rate of injuries (0.02) per 10,000 population rose in 2010 to (12) cases was the number of casualties recorded for the Iraqis in 2009 And average form of (0.03) per 10,000 population.
5 Public Health Informatics
Health care is provided by the Government, through the Ministry of Health through the Provincial Departments of Health. State healthcare is provided to 100% of the population (nearly 30 million people). The number of doctor’s jurisdiction and jurisdiction by the provinces to the whole of Iraq for the year (2010) is (24 750) and average (7.5) doctor per 10,000 inhabitants. There is no wide range of health information systems with little standardization and interoperability.
6 Interoperability and Standards
Interoperability is an important consideration, as the eighteen Provinces used old systems. Iraq has no member of ISO/TC 215 Health Informatics. Several standards are in use to promote interoperability and data interchange. Iraq has not adopted ICD-10 as the national diagnosis coding standard, and (HL7 version 2.5) as the national messaging standard in the public sector.
7 ISO/TC 215
Was established during 1998 with the following scope: Standardization in the field of information for health, and Health Information and Communications Technology (ICT) to achieve compatibility and interoperability between independent systems. Also, to ensure compatibility of data for comparative statistical purposes (eg, classifications), and to reduce duplication of effort and redundancies.
8 Health Level Seven (HL7)
Is the standard for electronic data exchange in all healthcare environments, with special emphasis on inpatient acute care facilities (i.e., hospitals)? It summarizes the work of a committee of healthcare providers (i.e., users), vendors and consultants established in March 1987 when a conference hosted by Dr. Sam Schultz at the Hospital of the University of Pennsylvania. HL7 sanctioned national groups also exist in many other countries outside of the United States including Australia, Canada, China, Finland, Germany, India, Japan, Korea, New Zealand, Southern Africa, Switzerland, Taiwan, The Netherlands, and The United Kingdom. The term "Level 7" refers to the highest level of the Open System Interconnection (OSI) model of the International Organization for Standardization (ISO). In broader terms HL7 refers to Health Level 7.
9 ICD-9, 10
The ICD is the international standard diagnostic classification for all general epidemiological, many health management purposes and clinical use. These include the analysis of the general health situation of population groups and monitoring of the incidence and prevalence of diseases and other health problems in relation to other variables such as the characteristics and circumstances of the individuals affected, reimbursement, resource allocation, quality and guidelines. The ICD-10-CM revision includes more than 155,000 diagnostic codes, compared to 13,000 in ICD-9-CM. In addition, ICD-10-CM includes twice as many categories and introduces alphanumeric category classifications.
10 Core Functions of an EHR
The functionality of a personal electronic health record (EHR) may vary from a simple web-based interface for interactive data entry and data review up to a much more powerful system, additionally supporting electronic data/document communication between clinical information systems of primary care practitioners or hospitals, and even reminder-based support for the empowered citizen to actively take care of his/her health, based on relevant disease management programs. It is a means of supporting patient empowerment. Since storage and communication of data in an EHR involves sensitive personal health data, it is necessary to implement specific security and access management requirements for each of these functions.
Health Information and Data. The electronic chart must hold everything that is currently included within a paper chart. All information within the electronic chart must be information/data that would be used to make critical decisions
10.1 Result Management.
The ability to manage all test results (from labs, radiology reports).
Order Management. All prescriptions are to be written electronically to reduce medical errors due to illegible handwriting. Orders are also automatically generated.
Decision Support. Warnings/reminders to enhance clinical performance. Decision support can aid in: drug interactions/prescriptions/prevention, detection of disease outbreaks, evidence-based guidelines, etc. Overall, it will assist providers in making the best decision possible for the patient.
10.2 Electronic Communications and Connectivity.
An interoperable system that is able to connect with multiple providers, the patient, labs, and hospitals in a secure manner. Patient Support. The ability to provide patients with educational material as well as the ability to enter data themselves concerning home monitoring devices.
10.3 Administrative Processes.
This is referred to as the Practice Management. The administrative process is to improve the efficiency in scheduling appointments, eliminate confusions, determine insurance eligibility, etc. reporting. A standardized system to produce reports that are demanded by state, federal, and local levels.
11 E-Health Capacity Building
There is an urgent need for capacity development in e-Health at all levels. Many health workers do not have any computer training during their basic training and those from rural schools may never have used a computer. Postgraduate qualifications are offered at Universities.
12 Electronic Medical Records
Most of Iraqi physicians have lack in information technology during the period of 1990-2010, because of corruption in the Iraqi medical system, between the lab doctor and the doctor, and the doctor takes a cut. That corruption influences the treatment or medicines prescribed. There is a lack of supervision due to shortage of senior physicians.
13 Electronic Health Records
There is no of all Provincial Hospitals have some form of functioning electronic medical record system. There are several systems in place and they are not necessarily lack interoperable. The MOH recently have no experience for the development of an e-Health Record which will include the requirement to provide interoperability with legacy systems. Multiple systems also not exist in the private sector. The National project does not look to link with any of the private sector systems.
14 Digital health records
The center of health information system is centrally managed digital health record including important medical information and forwarding information to the different parties. It also contains the links permitting the information search from different parts of health information. Health record system must guarantee the necessary information exchange for the registry and to create the environment for exchanging data about health information. It is not only technological but also organizational project. The precondition for the digital health record is the e-health act or the set of rules defining the rights of doctors and patients for the use of data. This law is not yet promulgated in Iraq. Favor the use of digital health record. The improvement of exchange of information between doctors and the rise of the quality treatment are seen as the most important benefits. People wish to have access to their medical record by internet and medical stuff has the digital overview of their health.
15 Core functions an EMR system
15.1 Health information and data:
Immediate access to key information that would improve the ability of clinicians to make sound decisions in a timely manner. Those data include patients' diagnoses, allergies and laboratory test results.
15.2 Results management:
Quick access of new and past test results by all clinicians involved in treating a patient.
15.3 Order management:
Computerized entry and storage of data on all medications, tests and other services.
15.4 Decision support:
Electronic alerts and reminders to improve compliance with best practices ensure regular screenings and other preventive practices, identify possible drug interactions, and facilitate diagnoses and treatments.
16 Electronic communication and connectivity
Secure and readily accessible communication among clinicians and patients.
16.1 Patient support:
Tools offering patients access to their medical records, interactive education and the ability to do home monitoring and self-testing.
16.2 Administrative processes:
Tools, including scheduling systems, which improve administrative efficiencies and patient service.
16.3 Reporting:
Electronic data storage that uses uniform data standards to enable physician offices and health care organizations to comply with federal, state and private reporting requirements in a timely manner.
17 Access to Information
That the overall literacy rate in Iraq is approximately 80%, with illiteracy at 18-20%. Illiteracy among women is estimated at 26.4% as compared to 11.6% among men. There are 2 official languages and many people who are literate in one will not be literate in the others. Internet usage is low, 2.8 % of population.
18 Unlocking the Market for e-Health
The needs of developing countries are different to those of the developed world in some areas. International companies have come to Iraq, in some instances as global competitors, and in other as partners or benefactors. There is a shortage of people experienced in e-Health in Iraq. Local research and development in e-Health not funded by government and undertaken by government bodies or universities. There is no example of successful innovations developed in Iraq and taken to the market place.
19 National e-Health Policies
Several e-Governance projects have been implemented in neighbor countries. A Draft e-Health White Paper Discussion Document has been developed. There is the potential that the proposed e-Health Policy may not achieve the goal of a policy, which is to be enabling of the activities that government would like to see flourish. There is also the chance that the goals of the policy will not be achieved, not because of lack of political will, but because to the limited human capacity and skills in the state health care sector.
20 Conclusions
Iraq has not the potential to build on its experience in e-Health and successfully move further into the field, to the benefit of its people. There is no political will to achieve this. Basic enabling policy is in place for the use of ICT in e-Governance. An e-Health policy is not under discussion. There are, however, major challenges: broadband pe*******on is low, bandwidth is expensive, many health-workers are computer illiterate, there is not a culture of data acquisition and analysis, there are too few informaticians and medical practitioners with e-health experience, insufficient people across all levels are not being trained in the field, current plans do not appear to incorporate the private sector, and there is the danger that a top down approach to implementation will be taken.
Information management constitutes a major activity of the health care professional. Currently a few forces are together focusing attention on this function. Medical informatics is the field that concerns itself with the cognitive, information
processing, and communication tasks of medical practice, education, and research, including the information science and the technology to support these tasks.
It is an intrinsically interdisciplinary field, with a highly-applied focus, but it also addresses several fundamental research problems as well as planning and policy issues. After many years of development of information systems to support the infrastructure of medicine, a new generation of systems and tools are aimed at physicians and other health care managers and professionals - to support education, decision making, communication, and may other aspects of professional activity.
Health care institutions are beginning to make large-scale commitments to information systems and to services that will affect every aspect of their organization's function. Academic units of medical informatics are being established at several medical schools, medical informatics professionals are being sought to serve on faculties and hospital staffs, and medical informatics is emerging as a distinct academic entity.
21 Iraqi E-Government
The technological revolution has brought ICTs to much of the world. Considerable progress has been made in recent years. Between 1991 and 2003 telephone lines doubled and the availability of personal computers grew fivefold. However, as costs became affordable, the most revolutionizing progress was in the newer technologies such as the mobile technology and the Internet. Cellular subscribers increased by 83 times in the last 12 years while the increase in world Internet users was a whopping 151 times!
Developing regions also speeded up their use of modern information technology recently. In the last few years there was phenomenal growth in the use of the Internet among all regions of the world and especially in the developing regions.
Most of the governments has no resources on online. There is no awareness of online Government and all dealings between government and citizens or Businesses are in person or paper based. There is limited information Available by phone. No governmentshave any ICT infrastructure and any environments. A few governmental websites exist, providing basic information.
Directed at parties outside of the community. This information is static and infrequently updated. Some limited interaction with the government is possible by telephone or fax. The government distributes some information about services, procedures, rights and responsibilities in hard copy. Some governmental agencies post key information on websites, including directories of services, hours of operation, and downloadable forms. Information is often not kept current and relevant. Transactions take place primarily in person, by fax or by telephone, though electronic mail may expedite the process. The government manages relationships with some contractors and suppliers online or with other electronic mediation.
All governmental agencies post key information on websites and some have incorporated the Web into their strategy for interaction with the public. Interactive government websites allow the public to conduct transactions (e.g. apply for permits) online. Much government procurement and many interactions with suppliers take place online or with other electronic mediation. Meeting the citizen’s requirements is at the core of all quality improvement efforts. In E-Government, discovering the true citizen requirements is often the most difficult part of the job.
Continuous improvement of processes is essential to achieving quality. Most E-Government’s does not even have defined processes. A minimum set of stable and repeatable processes must be defined, implemented, standardized, measured and controlled for quality improvement to be sustainable.
22 Health Provision
Public health services and budgets are devolved from the Ministry of Health (MOH) and the nine Provincial Departments of Health with some primary healthcare services provided by municipalities. The annual healthcare spend by Government is US$182 per capita per annum. There is a major inequality in healthcare funding, with 60% of the total health-spend in Iraq consumed by 18% of the population who have medical insurance and who access the private medical sector, Iraq is relatively well supplied with doctors, with 77 doctors per 100,000 people, but again the distribution of doctors is skewed with the Provincial Hospital sector served by 24.4 doctors per 100,000 people and 9.9 specialists per 100,000 people. On average, 34.1% of the medical posts in the public health sector are vacant.
23 ECONOMIC AND SOCIAL COMMISSION FOR WESTERN ASIA (ESCWA) Iraqi E-HEALTH
Several health programs and projects are developed and implemented through the Ministry of Health in collaboration with the WHO, UNICEF, USAID and other organizations. As part of the bilateral programs with the WHO, a project linking the Ministry with health departments in all governorates was completed to work on the health information system HIS. Cooperation with the USAID has also been going on to implement within the electronic infrastructure of the Ministry's headquarters the project of the internal network. The Center for IT in the Ministry prepared some programs, such as the program for the treatment records of in-patients; and the program for statistical health indicators.
24 Interoperability
Considering the fragmented nature of the health information system in Iraq, interoperability is an important consideration, that Iraq missed the development over 30 years in health information system. The issue and promote the concept of interoperability between health information systems. Several issues were discussed and three working systems formed dealing with: Laboratory Systems Working, Evaluation of the Health Information Systems Working, and the Electronic Patient record systems working.
1. Lack of test facilities;
2. Lack of awareness of international standards and
3. Lack of national standards
4. As the main culprits.
25 Electronic Patient Flow
Is designed to communication and management solution for support service, operations and facilities managers, and this proven workflow automation tool provides:
• Real-time communication with staff
• Automatic dispatch for regular maintenance tasks
• Real-time job and employee tracking
• Time saving by eliminating returns to dispatch
• Pre-scheduling of preventive maintenance
Emergency Department had become so congested that patients were regularly overflowing into the nearby recovery area of the operating theatre suite, disrupting the work of both the Emergency Department and the Division of Surgery. Cancellations of elective work were pervasive, surgical training schemes were under scrutiny, the safety of care in the Emergency Department was becoming compromised, and high levels of staff turnover were undermining the viability of key clinical services. These difficulties had not arisen suddenly; nor were they a consequence of unusual levels of demand.
The clinical staffs at the Baghdad Medical City are energetic and well-motivated but there is no work standard to diminish congestion, without sustained benefit. What was needed was to do something that the staff did not yet know how to do.
26 Summary
Although several standards adopted, interoperability remains a challenge for most systems and applications.
Concerns
• There is no e-health policy yet. It is worrying that the national electronic patient record system project is proceeding in the absence of policy. It is this same lack of policy which is said to be inhibiting telemedicine uptake in the private sector, the very sector that will likely be called upon to provide telemedicine services to the under-resourced State hospitals.
• There is no a Draft White Paper to discuss. This too raises the concern that National Policy is reactive and not pro-active. Reactive policy may be both parochial and meet the demands of one jurisdiction, while placing impossible obstacles in another jurisdiction.
• Control of e-health is being centralized and there is the danger that it will be driven with a top down approach.
• There is an extreme shortage of expertise in medical informatics and telemedicine in Iraq and successful implementation will need buy-in and support from all sectors. Policy planning and management decisions about e- Health or telemedicine are often made by people who are not well versed in the field.
• Future sustainability of e-health initiatives will be dependent on a growing number of well-trained informaticians and telemedicine practitioners.
• Currently, too many health-workers are computer illiterate and those who have had basic training may return to work environments where they do not use computers.
• The business potential of e-health for local business and scientists is not being reached.
• Deregulation of the telecommunications sector is occurring too slowly and lack of broadband pe*******on and the high cost of bandwidth is stifling development.
• The restrictions imposed by the government intranet will impair development of any national information system or telemedicine initiative.
• There is a general lack of change management skills in the e-health sector in Iraq. Most Pressing Needs.
26.1 Predictions
• The implementation of the National Health Information Systems in Iraq will be a slow process. Health workers, especially in all areas will find that the process involves extra work and they will become frustrated by power and technical failures and slow response times of technical support teams.
• Training of healthcare professionals and workers in e-health will increase but the lack of adequate ICT infrastructure and access to the infrastructure will continue to be a problem...
• The divide between the private and public sectors will grow.
• The health divide between the developed and developing world will increase until it is an international problem at which stage, ICT’s will be used expediently in an international model to solve specific problems in distinct areas of need.
27 EHR Vision
Using electronic health records to improve the access and quality of health services; to reduce inefficiencies and avoidable costs; and to optimize the health outcomes of Iraq.
28 EHR Benefits
Advances patient care Allows immediate data entry at the patient’s bedside improving the management of information essential to patient care
Decreases errors Standardizes processes and centralizes clinical and administrative information improving workflow between all departments.
Reduces liability -Provides alerts and standards that help staff prevent medical errors.
Maximizes revenue Enables facilities to increase efficiency, optimize staff resources, and reduce costs. Provides a significant return on investment and improves efficiency and quality. One of the most important benefits of electronic health records is the ability to quickly transmit a patient’s medical history to other doctors. For example, if a patient is admitted to the emergency room, the ability to access the patient’s EHR in an instant allows doctors to make smarter decisions based on the patient’s medical history.
29 Technology
Technology in healthcare has made great progress in diagnostic and therapeutic applications. Using computers to assist in imaging, surgery and critical life support has meant lives are being saved that as recently as five years ago, were being lost.
However, the application of health information technology to clinical records has been dreadfully slow. The ability for different providers and organizations to electronically store and then exchange health-related information anywhere that a patient needs care does not exist, and looks likely not to exist, unless significant coordinated efforts are undertaken by all parties in the health industry.
Rewards for implementing electronic health records (EHRs) have proven elusive, and the expense is considerable. Confounding the progress of even this small amount of EHR implementation is the distressing fact that none of the disparate EHR systems currently in the market can communicate with each other (or in most cases even themselves) in any but the most rudimentary ways, if at all.
30 Purpose
Paper-based records have been in existence for centuries and their gradual replacement by computer-based records has been slowly underway for over twenty years in western healthcare systems. Computerized information systems have not achieved the same degree of pe*******on in healthcare as that seen in other sectors such as finance, transport and the manufacturing and retail industries. Further, deployment has varied greatly from country to country and from specialty to specialty and in many cases, has revolved around local systems designed for local use. National pe*******on of EMRs may have reached over 90% in primary care practices in Norway, Sweden and Denmark (2003), but has been limited to 17% of physician office practices in the USA (2001-2003) [HHS, 2005]. Those EMR systemsthat have been implemented however have been used mainly for administrative rather than clinical purposes.
Electronic medical record systems lie at the center of any computerized health information system. Without them other modern technologies such as decision support systems cannot be effectively integrated into routine clinical workflow. The paperless, interoperable, multi-provider, multi-specialty, multi-discipline computerized medical record, which has been a goal for many researchers, healthcare professionals, administrators and politicians for the past 20+ years, is however about to become reality in many western countries.
31 Culture
Are there common cultural characteristics that are present in practices that have achieved success in the adoption and use of EHRs as well as other health information technologies?
The following should be considered:
• Mission, Vision and Values: Articulate your clinic vision and ensure that all members of the practice team (clinicians, administrative, and support staff) buy into the vision and practice goals. This will become your foundational reference when difficult decisions have to be made, particularly if they involve the firing or hiring of staff.
• Communication: Regular formal and informal communication is necessary to keep all practice members informed about progress, challenges, successes, and failures — and what is going to be done in the event of a setback. Communication should involve scheduled face-to-face meetings and written or email updates. Knowing the status of the practice will reduce anxiety and will allow individuals to adjust their readiness for specific tasks.
• Rewards and Recognition: Do you have a practice culture that recognizes personal performance? This can be a strong motivator and will allow motivated staff to strive towards achievement of personal objectives. Rewards do not have to be financial, but can include recognition in intra-practice communications, being selected to lead specific aspects of the EHR adoption process, or offers to attend seminars or conferences on behalf of the practice.
• Training and Continuous Learning: It is important to establish a culture of continuous learning. EHR implementation is a commitment that will impact everyone indefinitely from that point forwards. Continuous learning can be achieved through external education — attending user group meetings and advanced vendor training sessions. It can also take place internally through advanced or “super users” taking time to train colleagues and office staff on more advanced EHR functionality.
32 Strategy
• National Network
• Clinic Consortia
• Multi-site expansion
• Hospital-based regional extension
33 Objectives
The four elements of objectives:
1. Improving quality, safety, and efficiency & reducing health disparities.
2. Engage patients & families in their healthcare.
3. Improve care coordination.
4. Ensure adequate privacy & security protections for personal health information.
The objectives in the final rule are designed to allow program participants to establish their own path to meaningful use. Further, the bar for measurements associated with several objectives was lowered. In the proposed rule for meaningful use 27 objectives had been defined in Stage 1 of the program. In the final rule, the objectives were organized into two tracks: Core Set and Menu Set. Program participants must achieve each of the objectives in the core set, while the menu set provides for greater flexibility in Stage 1
34 Compatibility
EHR Interoperability enables better workflows and reduced ambiguity, and allows data transfer among EHR systems and health care stakeholders. Ultimately, an interoperable environment improves the delivery of health care by making the right data available at the right time to the right people.
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