<s>
Federal	O
and	O
state	O
governments	O
,	O
insurance	O
companies	O
and	O
other	O
large	O
medical	O
institutions	O
are	O
heavily	O
promoting	O
the	O
adoption	O
of	O
electronic	B-Application
health	I-Application
records	I-Application
.	O
</s>
<s>
One	O
VA	O
study	O
estimates	O
its	O
electronic	B-Application
medical	I-Application
record	I-Application
system	O
may	O
improve	O
overall	O
efficiency	O
by	O
6%	O
per	O
year	O
,	O
and	O
the	O
monthly	O
cost	O
of	O
an	O
EMR	O
may	O
(	O
depending	O
on	O
the	O
cost	O
of	O
the	O
EMR	O
)	O
be	O
offset	O
by	O
the	O
cost	O
of	O
only	O
a	O
few	O
"	O
unnecessary	O
"	O
tests	O
or	O
admissions	O
.	O
</s>
<s>
of	O
4484	O
physicians	O
(	O
62%	O
response	O
rate	O
)	O
,	O
83%	O
of	O
all	O
physicians	O
,	O
80%	O
of	O
primary	O
care	O
physicians	O
,	O
and	O
86%	O
of	O
non-primary	O
care	O
physicians	O
had	O
no	O
EHRs	B-Application
.	O
</s>
<s>
"	O
Among	O
the	O
83%	O
of	O
respondents	O
who	O
did	O
not	O
have	O
electronic	B-Application
health	I-Application
records	I-Application
,	O
16%	O
"	O
had	O
bought	O
,	O
but	O
not	O
implemented	O
an	O
EHR	O
system	O
yet	O
.	O
</s>
<s>
This	O
is	O
an	O
increase	O
over	O
2008	O
when	O
only	O
38.4	O
%	O
of	O
office-based	O
physicians	O
reported	O
using	O
fully	O
or	O
partially	O
electronic	B-Application
medical	I-Application
record	I-Application
systems	O
(	O
EMR	O
)	O
in	O
2008	O
.	O
</s>
<s>
As	O
of	O
2013	O
,	O
78	O
percent	O
of	O
office	O
physicians	O
are	O
using	O
basic	O
electronic	B-Application
medical	I-Application
records	I-Application
.	O
</s>
<s>
Types	O
of	O
EHR	O
data	O
used	O
in	O
hospitals	O
include	O
structured	O
data	O
(	O
e.g.	O
,	O
medication	O
information	O
)	O
and	O
unstructured	B-Application
data	I-Application
(	O
e.g.	O
,	O
clinical	O
notes	O
)	O
.	O
</s>
<s>
The	O
usage	O
of	O
electronic	B-Application
medical	I-Application
records	I-Application
can	O
vary	O
depending	O
on	O
who	O
the	O
user	O
is	O
and	O
how	O
they	O
are	O
using	O
it	O
.	O
</s>
<s>
Electronic	B-Application
medical	I-Application
records	I-Application
can	O
help	O
improve	O
the	O
quality	O
of	O
medical	O
care	O
given	O
to	O
patients	O
.	O
</s>
<s>
Harvard	O
University	O
has	O
conducted	O
an	O
experiment	O
in	O
which	O
they	O
tested	O
how	O
doctors	O
and	O
nurses	O
use	O
electronic	B-Application
medical	I-Application
records	I-Application
to	O
keep	O
their	O
patients	O
 '	O
information	O
up	O
to	O
date	O
.	O
</s>
<s>
The	O
studies	O
found	O
that	O
electronic	B-Application
medical	I-Application
records	I-Application
were	O
very	O
useful	O
;	O
a	O
doctor	O
or	O
a	O
nurse	O
was	O
able	O
to	O
find	O
a	O
patient	O
's	O
information	O
fast	O
and	O
easy	O
just	O
by	O
typing	O
their	O
name	O
;	O
even	O
if	O
it	O
was	O
misspelled	O
.	O
</s>
<s>
The	O
usage	O
of	O
electronic	B-Application
medical	I-Application
records	I-Application
increases	O
in	O
some	O
workplaces	O
due	O
to	O
the	O
ease	O
of	O
use	O
of	O
the	O
system	O
;	O
whereas	O
the	O
president	O
of	O
the	O
Canadian	O
Family	O
Practice	O
Nurses	O
Association	O
says	O
that	O
using	O
electronic	B-Application
medical	I-Application
records	I-Application
can	O
be	O
time-consuming	O
,	O
and	O
it	O
is	O
n't	O
very	O
helpful	O
due	O
to	O
the	O
complexity	O
of	O
the	O
system	O
.	O
</s>
<s>
Electronic	B-Application
medical	I-Application
records	I-Application
,	O
like	O
other	O
medical	O
records	O
,	O
must	O
be	O
kept	O
in	O
unaltered	O
form	O
and	O
authenticated	O
by	O
the	O
creator	O
.	O
</s>
<s>
The	O
"	O
goal	O
is	O
not	O
adoption	O
alone	O
but	O
'	O
meaningful	O
use	O
 '	O
of	O
EHRs	B-Application
—	O
that	O
is	O
,	O
their	O
use	O
by	O
providers	O
to	O
achieve	O
significant	O
improvements	O
in	O
care.	O
"	O
</s>
<s>
Title	O
IV	O
of	O
the	O
act	O
promises	O
maximum	O
incentive	O
payments	O
for	O
Medicaid	O
to	O
those	O
who	O
adopt	O
and	O
use	O
"	O
certified	O
EHRs	B-Application
"	O
of	O
$	O
63,750	O
over	O
6	O
years	O
beginning	O
in	O
2011	O
.	O
</s>
<s>
In	O
2017	O
the	O
government	O
announced	O
its	O
first	O
False	O
Claims	O
Act	O
settlement	O
with	O
an	O
electronic	B-Application
health	I-Application
records	I-Application
vendor	O
for	O
misrepresenting	O
its	O
ability	O
to	O
meet	O
“	O
meaningful	O
use	O
”	O
standards	O
and	O
therefore	O
receive	O
incentive	O
payments	O
.	O
</s>
<s>
The	O
case	O
marks	O
the	O
first	O
time	O
the	O
government	O
applied	O
the	O
federal	O
Anti-Kickback	O
Statute	O
law	O
to	O
the	O
promotion	O
and	O
sale	O
of	O
an	O
electronic	B-Application
health	I-Application
records	I-Application
system	O
.	O
</s>
<s>
Starting	O
in	O
2015	O
,	O
hospitals	O
and	O
doctors	O
will	O
be	O
subject	O
to	O
financial	O
penalties	O
under	O
Medicare	O
if	O
they	O
are	O
not	O
using	O
electronic	B-Application
health	I-Application
records	I-Application
.	O
</s>
<s>
The	O
meaningful	O
use	O
of	O
EHRs	B-Application
intended	O
by	O
the	O
US	O
government	O
incentives	O
is	O
categorized	O
as	O
follows	O
:	O
</s>
<s>
The	O
Obama	O
Administration	O
's	O
Health	O
IT	O
program	O
intends	O
to	O
use	O
federal	O
investments	O
to	O
stimulate	O
the	O
market	O
of	O
electronic	B-Application
health	I-Application
records	I-Application
:	O
</s>
<s>
The	O
first	O
steps	O
in	O
achieving	O
meaningful	O
use	O
are	O
to	O
have	O
a	O
certified	O
electronic	B-Application
health	I-Application
record	I-Application
(	O
EHR	O
)	O
and	O
to	O
be	O
able	O
to	O
demonstrate	O
that	O
it	O
is	O
being	O
used	O
to	O
meet	O
the	O
requirements	O
.	O
</s>
<s>
(	O
2008	O
)	O
,	O
66%	O
of	O
physicians	O
without	O
EHRs	B-Application
cited	O
capital	O
costs	O
as	O
a	O
barrier	O
to	O
adoption	O
,	O
while	O
50%	O
were	O
uncertain	O
about	O
the	O
investment	O
.	O
</s>
<s>
Around	O
56%	O
of	O
physicians	O
without	O
EHRs	B-Application
stated	O
that	O
financial	O
incentives	O
to	O
purchase	O
and/or	O
use	O
EHRs	B-Application
would	O
facilitate	O
adoption	O
.	O
</s>
<s>
Another	O
large	O
hospital	O
generated	O
about	O
$8.6	O
million	O
in	O
annual	O
savings	O
by	O
replacing	O
paper	O
medical	O
charts	O
with	O
EHRs	B-Application
for	O
outpatients	O
and	O
about	O
$2.8	O
million	O
annually	O
by	O
establishing	O
electronic	O
access	O
to	O
laboratory	O
results	O
and	O
reports	O
.	O
</s>
<s>
With	O
the	O
widespread	O
adoption	O
of	O
the	O
Veterans	B-Application
Health	I-Application
Information	I-Application
Systems	I-Application
and	I-Application
Technology	I-Application
Architecture	I-Application
(	O
VistA	B-Application
)	O
electronic	B-Application
health	I-Application
record	I-Application
system	O
at	O
all	O
VA	O
facilities	O
,	O
fewer	O
recently-trained	O
medical	O
professionals	O
will	O
be	O
inexperienced	O
in	O
electronic	B-Application
health	I-Application
record	I-Application
systems	O
.	O
</s>
<s>
Older	O
practitioners	O
who	O
are	O
less	O
experienced	O
in	O
the	O
use	O
of	O
electronic	B-Application
health	I-Application
record	I-Application
systems	O
will	O
retire	O
over	O
time	O
.	O
</s>
<s>
This	O
means	O
that	O
while	O
data	O
may	O
be	O
packaged	O
in	O
a	O
standard	O
format	O
(	O
using	O
the	O
pipe	O
notation	O
of	O
HL7	O
,	O
or	O
the	O
bracket	O
notation	O
of	O
XML	B-Protocol
)	O
,	O
it	O
lacks	O
definition	O
,	O
or	O
linkage	O
to	O
a	O
common	O
shared	O
dictionary	O
.	O
</s>
<s>
In	O
the	O
United	O
States	O
,	O
the	O
Department	O
of	O
Veterans	O
Affairs	O
(	O
VA	O
)	O
has	O
the	O
largest	O
enterprise-wide	O
health	O
information	O
system	O
that	O
includes	O
an	O
electronic	B-Application
medical	I-Application
record	I-Application
,	O
known	O
as	O
the	O
Veterans	B-Application
Health	I-Application
Information	I-Application
Systems	I-Application
and	I-Application
Technology	I-Application
Architecture	I-Application
(	O
VistA	B-Application
)	O
.	O
</s>
<s>
A	O
key	O
component	O
in	O
VistA	B-Application
is	O
their	O
VistA	B-Algorithm
imaging	I-Algorithm
System	O
which	O
provides	O
a	O
comprehensive	O
multimedia	O
data	O
from	O
many	O
specialties	O
,	O
including	O
cardiology	O
,	O
radiology	O
,	O
and	O
orthopedics	O
.	O
</s>
<s>
A	O
graphical	B-Application
user	I-Application
interface	I-Application
known	O
as	O
the	O
Computerized	B-Application
Patient	I-Application
Record	I-Application
System	O
(	O
CPRS	O
)	O
allows	O
health	O
care	O
providers	O
to	O
review	O
and	O
update	O
a	O
patient	O
's	O
electronic	B-Application
medical	I-Application
record	I-Application
at	O
any	O
of	O
the	O
VA	O
's	O
over	O
1,000	O
healthcare	O
facilities	O
.	O
</s>
<s>
Goals	O
of	O
the	O
VA	O
and	O
DoD	O
in	O
the	O
near	O
future	O
are	O
to	O
use	O
several	O
image	O
sharing	O
solutions	O
(	O
VistA	B-Algorithm
Imaging	I-Algorithm
and	O
DoD	O
Picture	O
Archiving	O
&	O
Communications	O
System	O
(	O
PACS	O
)	O
solutions	O
)	O
.	O
</s>
<s>
One	O
attribute	O
for	O
the	O
start	O
of	O
implementing	O
EHRs	B-Application
in	O
the	O
States	O
is	O
the	O
development	O
of	O
the	O
Nationwide	O
Health	O
Information	O
Network	O
which	O
is	O
a	O
work	O
in	O
progress	O
and	O
still	O
being	O
developed	O
.	O
</s>
<s>
The	O
Department	O
of	O
Veterans	O
Affairs	O
and	O
Kaiser	O
Permanente	O
has	O
a	O
pilot	O
program	O
to	O
share	O
health	O
records	O
between	O
their	O
systems	O
VistA	B-Application
and	O
HealthConnect	O
,	O
respectively	O
.	O
</s>
<s>
The	O
US	O
Indian	O
Health	O
Service	O
uses	O
an	O
EHR	O
similar	O
to	O
Vista	B-Application
called	O
RPMS	B-Application
.	O
</s>
<s>
VistA	B-Algorithm
Imaging	I-Algorithm
is	O
also	O
being	O
used	O
to	O
integrate	O
images	O
and	O
co-ordinate	O
PACS	O
into	O
the	O
EHR	O
system	O
.	O
</s>
<s>
Recent	O
revelations	O
of	O
"	O
secure	O
"	O
data	O
breaches	O
at	O
centralized	O
data	O
repositories	O
,	O
in	O
banking	O
and	O
other	O
financial	O
institutions	O
,	O
in	O
the	O
retail	O
industry	O
,	O
and	O
from	O
government	O
databases	O
,	O
have	O
caused	O
concern	O
about	O
storing	O
electronic	B-Application
medical	I-Application
records	I-Application
in	O
a	O
central	O
location	O
.	O
</s>
<s>
The	O
Health	O
Insurance	O
Portability	O
and	O
Accountability	O
Act	O
(	O
HIPAA	O
)	O
was	O
passed	O
in	O
the	O
US	O
in	O
1996	O
to	O
establish	O
rules	O
for	O
access	O
,	O
authentications	O
,	O
storage	O
and	O
auditing	O
,	O
and	O
transmittal	O
of	O
electronic	B-Application
medical	I-Application
records	I-Application
.	O
</s>
<s>
In	O
the	O
United	O
States	O
,	O
information	O
in	O
electronic	B-Application
medical	I-Application
records	I-Application
is	O
referred	O
to	O
as	O
Protected	O
Health	O
Information	O
(	O
PHI	O
)	O
and	O
its	O
management	O
is	O
addressed	O
under	O
the	O
Health	O
Insurance	O
Portability	O
and	O
Accountability	O
Act	O
(	O
HIPAA	O
)	O
as	O
well	O
as	O
many	O
local	O
laws	O
.	O
</s>
<s>
The	O
HIPAA	O
protects	O
a	O
patient	O
's	O
information	O
;	O
the	O
information	O
that	O
is	O
protected	O
under	O
this	O
act	O
are	O
:	O
information	O
doctors	O
and	O
nurses	O
input	O
into	O
the	O
electronic	B-Application
medical	I-Application
record	I-Application
,	O
conversations	O
between	O
a	O
doctor	O
and	O
a	O
patient	O
that	O
may	O
have	O
been	O
recorded	O
,	O
as	O
well	O
as	O
billing	O
information	O
.	O
</s>
<s>
One	O
major	O
issue	O
that	O
has	O
risen	O
on	O
the	O
privacy	O
of	O
the	O
US	O
network	O
for	O
electronic	B-Application
health	I-Application
records	I-Application
is	O
the	O
strategy	O
to	O
secure	O
the	O
privacy	O
of	O
patients	O
.	O
</s>
<s>
Former	O
US	O
president	O
George	O
W	O
.	O
Bush	O
called	O
for	O
the	O
creation	O
of	O
networks	O
,	O
but	O
federal	O
investigators	O
report	O
that	O
there	O
is	O
no	O
clear	O
strategy	O
to	O
protect	O
the	O
privacy	O
of	O
patients	O
as	O
the	O
promotions	O
of	O
the	O
electronic	B-Application
medical	I-Application
records	I-Application
expands	O
throughout	O
the	O
United	O
States	O
.	O
</s>
<s>
Accountability	O
among	O
all	O
the	O
parties	O
that	O
are	O
involved	O
in	O
the	O
processing	O
of	O
electronic	O
transactions	O
including	O
the	O
patient	O
,	O
physician	O
office	O
staff	O
,	O
and	O
insurance	O
companies	O
,	O
is	O
the	O
key	O
to	O
successful	O
advancement	O
of	O
the	O
EHR	O
in	O
the	O
US	O
Supporters	O
of	O
EHRs	B-Application
have	O
argued	O
that	O
there	O
needs	O
to	O
be	O
a	O
fundamental	O
shift	O
in	O
"	O
attitudes	O
,	O
awareness	O
,	O
habits	O
,	O
and	O
capabilities	O
in	O
the	O
areas	O
of	O
privacy	O
and	O
security	O
"	O
of	O
individual	O
's	O
health	O
records	O
if	O
adoption	O
of	O
an	O
EHR	O
is	O
to	O
occur	O
.	O
</s>
<s>
In	O
2013	O
,	O
reports	O
based	O
on	O
documents	O
released	O
by	O
Edward	O
Snowden	O
revealed	O
that	O
the	O
NSA	O
had	O
succeeded	O
in	O
breaking	O
the	O
encryption	O
codes	O
protecting	O
electronic	B-Application
health	I-Application
records	I-Application
,	O
among	O
other	O
databases	O
.	O
</s>
<s>
Enforcement	O
authorities	O
in	O
the	O
United	O
States	O
have	O
become	O
concerned	O
that	O
functionality	O
available	O
in	O
many	O
electronic	B-Application
health	I-Application
records	I-Application
,	O
especially	O
copy-and-paste	O
,	O
may	O
enable	O
fraudulent	O
claims	O
for	O
reimbursement	O
.	O
</s>
<s>
The	O
American	O
Hospital	O
Association	O
responded	O
,	O
focusing	O
on	O
the	O
need	O
for	O
clear	O
guidance	O
from	O
the	O
government	O
regarding	O
permissible	O
and	O
prohibited	O
conduct	O
using	O
electronic	B-Application
health	I-Application
records	I-Application
.	O
</s>
<s>
In	O
a	O
December	O
2013	O
audit	O
report	O
,	O
the	O
U.S.	O
HHS	O
Office	O
of	O
the	O
Inspector	O
General	O
(	O
OIG	O
)	O
issued	O
an	O
audit	O
report	O
reiterating	O
that	O
vulnerabilities	O
continue	O
to	O
exist	O
in	O
the	O
operation	O
of	O
electronic	B-Application
health	I-Application
records	I-Application
.	O
</s>
<s>
The	O
OIG	O
's	O
2014	O
Workplan	O
indicates	O
an	O
enhanced	O
focus	O
on	O
providers	O
 '	O
use	O
of	O
electronic	B-Application
health	I-Application
records	I-Application
.	O
</s>
