Electronic health records in the United States

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University has conducted an experiment in which they tested how doctors and nurses use electronic medical records to keep their patients' information up to date. The studies found that electronic medical records were very useful; a doctor or a nurse was able to find a patient's information fast and easy just by typing their name; even if it was misspelled. The usage of electronic medical records increases in some workplaces due to the ease of use of the system; whereas the president of the Canadian Family Practice Nurses Association says that using electronic medical records can be time-consuming, and it isn't very helpful due to the complexity of the system. Beth Israel Deaconess Medical Center reported that doctors and nurses prefer to use a much more friendly user software due to the difficulty and time it takes for medical staff to input the information as well as to find a patient's information. A study was done and the amount of information that was recorded in the EMRs was recorded; about 44% of the patient's information was recorded in the EMRs. This shows that EMRs are not very efficient most of the time.

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health records, especially copy-and-paste, may enable fraudulent claims for reimbursement. The authorities are concerned that healthcare providers may easily use these systems to create documentation of medical care that did not actually occur. These concerns came to the forefront in 2012, in a joint letter from the U.S. Departments of Justice and Health and Human Services to the American hospital community. The American Hospital Association responded, focusing on the need for clear guidance from the government regarding permissible and prohibited conduct using electronic health records. In a December 2013 audit report, the U.S. HHS Office of the Inspector General (OIG) issued an audit report reiterating that vulnerabilities continue to exist in the operation of electronic health records. The OIG's 2014 Workplan indicates an enhanced focus on providers' use of electronic health records.

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estimates to be 12 million, will inevitably lead to breaches of privacy on a massive scale. Appel has written that while "hospitals keep careful tabs on who accesses the charts of VIP patients," they are powerless to act against "a meddlesome pharmacist in Alaska" who "looks up the urine toxicology on his daughter's fiance in Florida, to check if the fellow has a cocaine habit." This is a significant barrier for the adoption of an EHR. Accountability among all the parties that are involved in the processing of electronic transactions including the patient, physician office staff, and insurance companies, is the key to successful advancement of the EHR in the US Supporters of EHRs have argued that there needs to be a fundamental shift in "attitudes, awareness, habits, and capabilities in the areas of privacy and security" of individual's health records if adoption of an EHR is to occur.

751:(HIPAA) as well as many local laws. The HIPAA protects a patient's information; the information that is protected under this act are: information doctors and nurses input into the electronic medical record, conversations between a doctor and a patient that may have been recorded, as well as billing information. Under this act there is a limit as to how much information can be disclosed, and as well as who can see a patient's information. Patients also get to have a copy of their records if they desire, and get notified if their information is ever to be shared with third parties. Covered entities may disclose protected health information to law enforcement officials for law enforcement purposes as required by law (including court orders, court-ordered warrants, subpoenas) and administrative requests; or to identify or locate a suspect, fugitive, material witness, or missing person. 780:

effect for the federal government for years. This includes two ideas, standardized formatting of data electronically exchanged and federalization of security and privacy practices among the private sector. Private companies have promised to have "stringent privacy policies and procedures." If protection and security are not part of the systems developed, people will not trust the technology nor will they participate in it. There is also debate over ownership of data, where private companies tend to value and protect data rights, but the patients referenced in these records may not have knowledge that their information is being used for commercial purposes.

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software, failed to fix certain bugs, failed to ensure data portability, and failed to reliably record laboratory and diagnostic imaging orders. The government also alleged that eClinicalWorks paid kickbacks to influential customers who recommended its products. The case marks the first time the government applied the federal Anti-Kickback Statute law to the promotion and sale of an electronic health records system. The False Claims Act lawsuit was brought by a whistleblower who was a New York City employee implementing eClinicalWorks’ system at Rikers Island Correctional Facility when he became aware of the software flaws. His “

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found that only 20.4% of all physicians reported using a system described as minimally functional and including the following features: orders for prescriptions, orders for tests, viewing laboratory or imaging results, and clinical progress notes. As of 2013, 78 percent of office physicians are using basic electronic medical records. As of 2014, more than 80 percent of hospitals in the U.S.have adopted some type of EHR. Though within a hospital, the type of EHR data and mix varies significantly. Types of EHR data used in hospitals include structured data (e.g., medication information) and

761:. Former US president George W. Bush called for the creation of networks, but federal investigators report that there is no clear strategy to protect the privacy of patients as the promotions of the electronic medical records expands throughout the United States. In 2007, the Government Accountability Office reports that there is a "jumble of studies and vague policy statements but no overall strategy to ensure that privacy protections would be built into computer networks linking insurers, doctors, hospitals and other health care providers." 80:

asking "how such dramatic claims of cost-saving and quality improvement could be true". A 2014 survey of the American College of Physicians member sample, however, found that family practice physicians spent 48 minutes more per day when using EMRs. 90% reported that at least 1 data management function was slower after EMRs were adopted, and 64% reported that note writing took longer. A third (34%) reported that it took longer to find and review medical record data, and 32% reported that it was slower to read other clinicians' notes.

667: 722:(HHS) Office for Civil Rights. So far, from the first wall postings in September 2009 through the latest on 8 December 2012, there have been 18,059,831 "individuals affected," and even that massive number is an undercount of the breach problem. The civil rights office has not released all of the records of tens of thousands of breaches in the United States, it has received under a federal reporting mandate on breaches affecting fewer than 500 patients per incident. 61:. The US Congress included a formula of both incentives (up to $ 44,000 per physician under Medicare, or up to $ 65,000 over six years under Medicaid) and penalties (i.e. decreased Medicare and Medicaid reimbursements to doctors who fail to use EMRs by 2015, for covered patients) for EMR/EHR adoption versus continued use of paper records as part of the Health Information Technology for Economic and Clinical Health (HITECH) Act, enacted as part of the, 499:

office expenses or increase their revenue sufficiently to pay for it. For example. the use of health IT could reduce the number of duplicated diagnostic tests. However, that improvement in efficiency would be unlikely to increase the income of many physicians. ...Given the ease at which information can be exchanged between health IT systems, patients whose physicians use them may feel that their privacy is more at risk than if paper records were used.

732:, roughly 150 people (from doctors and nurses to technicians and billing clerks) have access to at least part of a patient's records during a hospitalization, and 600,000 payers, providers and other entities that handle providers' billing data have some access also. Recent revelations of "secure" data breaches at centralized data repositories, in banking and other financial institutions, in the retail industry, and from 675:

translating the various vocabularies of the information being transmitted, allowing all of the VA facilities to access and interpret the patient records. The Laboratory Data Sharing and Interoperability (LDSI) application is a new program being implemented to allow sharing at certain sites between the VA and DoD of "chemistry and hematology laboratory tests". Unlike the CHDR, the LDSI is currently limited in its scope.

776:. For example, Patricia Galvin, a lawyer in San Francisco, saw a psychologist at Stanford Hospital & Clinics after her fiance committed suicide. Her therapist had assured her that her records would be confidential. But after she applied for disability benefits, Stanford gave the insurer her therapy notes, and the insurer denied her benefits based on what Galvin claims was a misinterpretation of the notes. 142:

a health care practice or facility. This role has been said to require changes such that the sole medico-legal record should be held elsewhere. The physical medical records are the property of the medical provider (or facility) that prepares them. This includes films and tracings from diagnostic imaging procedures such as X-ray, CT, PET, MRI, ultrasound, etc. The patient, however, according to

579:, a very large U.S. health care IT industry trade group, observed that EMR adoption rates "have been slower than expected in the United States, especially in comparison to other industry sectors and other developed countries. A key reason, aside from initial costs and lost productivity during EMR implementation, is lack of efficiency and usability of EMRs currently available." The U.S. 772:, the DHHS takes no action on complaints under HIPAA, and medical records are disclosed under court orders in legal actions such as claims arising from automobile accidents. HIPAA has special restrictions on psychotherapy records, but psychotherapy records can also be disclosed without the client's knowledge or permission, according to the 551:

the budget but also workflow. Costs for upgrades and associated regression testing can be particularly high where the applications are governed by FDA regulations (e.g. Clinical Laboratory systems). Physicians desire modular upgrades and ability to continually customize, without large-scale reimplementation.

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requires safeguards to limit the number of people who have access to personal information. However, given the number of people who may have access to your information as part of the operations and business of the health care provider or plan, there is no realistic way to estimate the number of people

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was passed in the US in 1996 to establish rules for access, authentications, storage and auditing, and transmittal of electronic medical records. This standard made restrictions for electronic records more stringent than those for paper records. However, there are concerns as to the adequacy of these

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The 2003 National Defense Authorization Act (NDAA) ensured that the VA and DoD would work together to establish a bidirectional exchange of reference quality medical images. Initially, demonstrations were only worked in El Paso, Texas, but capabilities have been expanded to six different locations of

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While Stage 2 focuses more on information exchange and patient engagement, many large EHR systems have this type of functionality built into their software, making it easier to achieve compliance. Also, for those eligible providers who have successfully attested to Stage 1, meeting Stage 2 should not

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to those who adopt and use "certified EHRs" of $ 63,750 over 6 years beginning in 2011. Eligible professionals must begin receiving payments by 2016 to qualify for the program. For Medicare the maximum payments are $ 44,000 over 5 years. Doctors who do not adopt an EHR by 2015 will be penalized 1% of

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The cost of implementing an EMR system for smaller practices has also been criticized; data produced by the Robert Wood Johnson Foundation demonstrates that the first-year investment for an average five-person practice is $ 162,000 followed by about $ 85,000 in maintenance fees. Despite this, tighter

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In a 2008 survey by DesRoches et al. of 4484 physicians (62% response rate), 83% of all physicians, 80% of primary care physicians, and 86% of non-primary care physicians had no EHRs. "Among the 83% of respondents who did not have electronic health records, 16%" had bought, but not implemented an EHR

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Within the private sector, many companies are moving forward in the development, establishment, and implementation of medical record banks and health information exchange. By law, companies are required to follow all HIPAA standards and adopt the same information-handling practices that have been in

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centers in Tampa and Richmond, Denver, North Chicago, Biloxi, and the National Capitol Area medical facilities. Radiological images such as CT scans, MRIs, and x-rays are being shared using the BHIE. Goals of the VA and DoD in the near future are to use several image sharing solutions (VistA Imaging

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Office-based physicians in particular may see no benefit if they purchase such a product—and may even suffer financial harm. Even though the use of health IT could generate cost savings for the health system at large that might offset the EMR's cost, many physicians might not be able to reduce their

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The government released its final ruling on achieving Stage 2 of meaningful use in August 2012. Eligible providers will need to meet 17 of 20 core objectives in Stage 2, and fulfill three out of six menu objectives. The required percentage of patient encounters that meet each objective has generally

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The first steps in achieving meaningful use are to have a certified electronic health record (EHR) and to be able to demonstrate that it is being used to meet the requirements. Stage 1 contains 25 objectives/measures for Eligible Providers (EPs) and 24 objectives/measures for eligible hospitals. The

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Electronic medical records, like other medical records, must be kept in unaltered form and authenticated by the creator. Under data protection legislation, the responsibility for patient records (irrespective of the form they are kept in) is always on the creator and custodian of the record, usually

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In the United States, the CDC reported that the EMR adoption rate had steadily risen to 48.3 percent at the end of 2009. This is an increase over 2008 when only 38.4% of office-based physicians reported using fully or partially electronic medical record systems (EMR) in 2008. However, the same study

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Federal law and regulations now provide rights to notice of a breach of health information. The Health Information Technology for Economic and Clinical Health (HITECH) Act requires HHS and the Federal Trade Commission (FTC) to jointly study and report on privacy and data security of personal health

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In the United States, reimbursement for many healthcare services is based upon the extent to which specific work by healthcare providers is documented in the patient's medical record. Enforcement authorities in the United States have become concerned that functionality available in many electronic

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The US Indian Health Service uses an EHR similar to Vista called RPMS. VistA Imaging is also being used to integrate images and co-ordinate PACS into the EHR system. In Alaska, use of the EHR by the Kodiak Area Native Association has improved screening services and helped the organization reach all

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Clinical Data Repository/Health Data Repository (CDHR) is a database that allows for the sharing of patient records, especially allergy and pharmaceutical information, between the Department of Veteran Affairs (VA) and the Department of Defense (DoD) in the United States. The program shares data by

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Furthermore, software technology advances at a rapid pace. Most software systems require frequent updates, sometimes even server upgrades, and often at a significant ongoing cost. Some types of software and operating systems require full-scale re-implementation periodically, which disrupts not only

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Studies call into question whether, in real life, EMRs improve the quality of care. 2009 produced several articles raising doubts about EMR benefits. A major concern is the reduction of physician-patient interaction due to formatting constraints. For example, some doctors have reported that the use

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standards and governance to make sure that health information exchanges are compatible with other exchanges being set up throughout the country. CONNECT is an open-source software solution that supports electronic health information exchange. The CONNECT initiative is a Federal Health Architecture

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In a survey by DesRoches et al. (2008), 66% of physicians without EHRs cited capital costs as a barrier to adoption, while 50% were uncertain about the investment. Around 56% of physicians without EHRs stated that financial incentives to purchase and/or use EHRs would facilitate adoption. In 2002,

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settlement with an electronic health records vendor for misrepresenting its ability to meet “meaningful use” standards and therefore receive incentive payments. eClinicalWorks paid $ 155 million to settle charges that it had failed to meet all government requirements, failed to adequately test its

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Brigham and Women's Hospital in Boston, Massachusetts, estimated it achieved net savings of $ 5 million to $ 10 million per year following installation of a computerized physician order entry system that reduced serious medication errors by 55 percent. Another large hospital generated about $ 8.6

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Shabo, Amnon (2014): "It's Time for Health Record Banking!" editorial to special issue of Methods of Information in Medicine, Vol. 53, No. 2, pp. 63–65 "change in current legislation so that the copy of a legally-authenticated medical record stored in an IHRB is the sole medico-legal record and

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The privacy threat posed by the interoperability of a national network is a key concern. One of the most vocal critics of EMRs, New York University Professor Jacob M. Appel, has claimed that the number of people who will need to have access to such a truly interoperable national system, which he

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known as the Computerized Patient Record System (CPRS) allows health care providers to review and update a patient's electronic medical record at any of the VA's over 1,000 healthcare facilities. CPRS includes the ability for Licensed Practitioners to place orders, including medications, special

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One VA study estimates its electronic medical record system may improve overall efficiency by 6% per year, and the monthly cost of an EMR may (depending on the cost of the EMR) be offset by the cost of only a few "unnecessary" tests or admissions. Jerome Groopman disputed these results, publicly

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The Security Rule that was adopted in 2005 did not require breach notification. However, notice might be required by state laws that apply to a variety of industries, including health care providers. In California, a law has been in place since 2003 requiring that a HIPAA covered organization's

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The price of EMR and provider uncertainty regarding the value they will derive from adoption in the form of return on investment have a significant influence on EMR adoption. In a project initiated by the Office of the National Coordinator for Health Information, surveyors found that hospital

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To receive federal incentive money, CMS requires participants in the Medicare EHR Incentive Program to "attest" that during a 90-day reporting period, they used a certified EHR and met Stage 1 criteria for meaningful use objectives and clinical quality measures. For the Medicaid EHR Incentive

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objectives/measures have been divided into a core set and menu set. EPs and eligible hospitals must meet all objectives/measures in the core set (15 for EPs and 14 for eligible hospitals). EPs must meet 5 of the 10 menu-set items during Stage 1, one of which must be a public health objective.

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The usage of electronic medical records can vary depending on who the user is and how they are using it. Electronic medical records can help improve the quality of medical care given to patients. Many doctors and office-based physicians refuse to get rid of traditional paper records. Harvard

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The Security Rule, according to Health and Human Services (HHS), establishes a security framework for small practices as well as large institutions. All covered entities must have a written security plan. The HHS identifies three components as necessary for the security plan: administrative

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initial costs were estimated to be $ 50,000–70,000 per physician in a 3-physician practice. Since then, costs have decreased with increasing adoption. A 2011 survey estimated a cost of $ 32,000 per physician in a 5-physician practice during the first 60 days of implementation.

567:) electronic health record system at all VA facilities, fewer recently-trained medical professionals will be inexperienced in electronic health record systems. Older practitioners who are less experienced in the use of electronic health record systems will retire over time. 176:) set meaningful use of interoperable EHR adoption in the health care system as a critical national goal and incentivized EHR adoption. The "goal is not adoption alone but 'meaningful use' of EHRs—that is, their use by providers to achieve significant improvements in care." 527:

One case study by Miller et al. (2005) of 14 small primary-care practices found that the average practice paid for the initial and ongoing costs within 2.5 years. A 2003 cost-benefit analysis found that using EMRs for 5 years created a net benefit of $ 86,000 per provider.

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information. HITECH also requires the agencies to issue breach notification rules that apply to HIPAA covered entities and Web-based vendors that store health information electronically. The FTC has adopted rules regarding breach notification for internet-based vendors.

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Beyond financial concerns there are a number of legal and ethical dilemmas created by increasing EMR use, including the risk of medical malpractice due to user error, server glitches that result in the EMR not being accessible, and increased vulnerability to hackers.

206:(HIE) has emerged as a core capability for hospitals and physicians to achieve "meaningful use" and receive stimulus funding. Healthcare vendors are pushing HIE as a way to allow EHR systems to pull disparate data and function on a more interoperable level. 3823: 487:

administrators and physicians who had adopted EMR noted that any gains in efficiency were offset by reduced productivity as the technology was implemented, as well as the need to increase information technology staff to maintain the system.

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were rated highly for interoperability. Interoperability has been lacking, but is enhanced by certain compatibility features (e.g., Epic interoperates with itself via CareEverywhere) or in some cases regional or national networks, such as

2158: 72:, passed in 2016, prohibited information blocking, which had slowed interoperability. In 2018, the Trump administration announced the MyHealthEData initiative to further allow for patients to receive their health records. The federal 113:

regulations regarding meaningful use criteria and national laws (Health Information Technology for Economic and Clinical Health Act and the Affordable Care Act) have resulted in more physicians and facilities adopting EMR systems:

736:, have caused concern about storing electronic medical records in a central location. Records that are exchanged over the Internet are subject to the same security concerns as any other type of data transaction over the Internet. 2452:

Wang SJ, Middleton B, Prosser LA, Bardon CG, Spurr CD, Carchidi PJ, Kittler AF, Goldszer RC, Fairchild DG, Sussman AJ, Kuperman GJ, Bates DW (April 2003). "A cost-benefit analysis of electronic medical records in primary care".

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Li, Qian; Yang, Xi; Xu, Jie; Guo, Yi; He, Xing; Hu, Hui; Lyu, Tianchen; Marra, David; Miller, Amber; Smith, Glenn; DeKosky, Steven; Boyce, Richard D.; Schliep, Karen; Shenkman, Elizabeth; Maraganore, Demetrius (2023-02-23).

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In the United States, there are no standards for semantic interoperability of health care data; there are only syntactic standards. This means that while data may be packaged in a standard format (using the pipe notation of

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project that was conceived in 2007 and initially built by 20 various federal agencies and now comprises more than 500 organizations including federal agencies, states, healthcare providers, insurers, and health IT vendors.

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published the scientific evidence of 173,398,820 (over 173 million) individuals affected in USA from October 2008 (when the data were collected) to September 2017 (when the data was uploaded for the statistical analysis).

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In the United States, a substantial majority of healthcare providers train at a VA facility sometime during their career. With the widespread adoption of the Veterans Health Information Systems and Technology Architecture

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Cohen GR, Grossman JM, O'Malley AS (2010). "Electronic Medical Records and Communication with Patients and Other Clinicians: Are We Talking Less?". Center for Studying Health System Change, Issue Brief No. 131

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breach could have triggered a notice even though notice was not required by the HIPAA Security Rule. Since 1 January 2009, California residents are required to receive notice of a health information breach.

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U.S. Department of Health and Human Services Centers for Medicare & Medicaid Services 42 CFR Parts 412, 413, 422 et al. Medicare and Medicaid Programs; Electronic Health Record Incentive Program; Final

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The healthcare industry spends only 2% of gross revenues on Health Information Technology (HIT), which is low compared to other information intensive industries such as finance, which spend upwards of 10%.

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Training of employees to use an EHR system is costly, just as for training in the use of any other hospital system. New employees, permanent or temporary, will also require training as they are hired.

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However, medical and healthcare providers have experienced 767 security breaches resulting in the compromised confidential health information of 23,625,933 patients during the period of 2006–2012.

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The U.S. Congressional Budget Office concluded that the cost savings may occur only in large integrated institutions like Kaiser Permanente, and not in small physician offices. They challenged the

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studied usability in 2011 and lists a number of specific issues that have been reported by health care workers. The U.S. military's EMR "AHLTA" was reported to have significant usability issues.

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which is a work in progress and still being developed. This started with the North Carolina Healthcare Information and Communication Alliance founded in 1994 and who received funding from

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million in annual savings by replacing paper medical charts with EHRs for outpatients and about $ 2.8 million annually by establishing electronic access to laboratory results and reports.

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who may come across your records. Additionally, law enforcement access is authorized under the act. In some cases, medical information may be disclosed without a warrant or court order.

3849: 641:(VA) has the largest enterprise-wide health information system that includes an electronic medical record, known as the Veterans Health Information Systems and Technology Architecture ( 604:), it lacks definition, or linkage to a common shared dictionary. The addition of layers of complex information models (such as the HL7 v3 RIM) does not resolve this fundamental issue. 754:

Medical and health care providers experienced 767 security breaches resulting in the compromised confidential health information of 23,625,933 patients during the period of 2006–2012.

886:, and CSPI (Evident Thrive) had the top market share at 28%, 26%, 9%, and 6% in 2018. For large hospitals with over 500 beds, Epic and Cerner had over 85% market share in 2019. In 2684: 2265: 1467:

Roukema J, Los RK, Bleeker SE, van Ginneken AM, van der Lei J, Moll HA (January 2006). "Paper versus computer: feasibility of an electronic medical record in general pediatrics".

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Evans DC, Nichol WP, Perlin JB (April 2006). "Effect of the implementation of an enterprise-wide Electronic Health Record on productivity in the Veterans Health Administration".

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announced Share Everywhere, which lets providers access medical information through a portal; their platform was described as "closed" in 2014, with competitors sponsoring the

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The detailed definition of "meaningful use" is to be rolled out in 3 stages over a period of time until 2017. Details of each stage are hotly debated by various groups.

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Vendors may use anonymized data for their own business or research purposes; for example, as of 2019 Cerner and AWS partnered using data for a machine learning tool.

3578: 2946:"Rural Practice Redesigns Care Processes To Allow Multidisciplinary Teams To Leverage Electronic Health Record, Leading to Better Screening of Medically Underserved" 3929: 4099: 2945: 580: 173: 62: 3967: 3884: 2601: 200:” case was later joined by the government. Notably, CMS has said it will not punish eClinicalWorks clients that "in good faith" attested to using the software. 747:

In the United States, information in electronic medical records is referred to as Protected Health Information (PHI) and its management is addressed under the

2235: 2212: 3710: 638: 2111:"Developing and evaluating a machine learning based algorithm to predict the need of pediatric intensive care unit transfer for newly hospitalized children" 1561: 1109: 3874: 1637: 3879: 3863: 2577: 2049: 1700: 608: 466: 1819: 306:

In other words, providers need to show they're using certified EHR technology in ways that can be measured significantly in quality and in quantity.

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Some physicians are skeptical of the positive claims and believe the data is skewed by vendors and others with an interest in EHR implementation.

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Starting in 2015, hospitals and doctors will be subject to financial penalties under Medicare if they are not using electronic health records.

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Provide patients with timely electronic access to their health information (including lab results, problem list, medication lists, allergies)

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Koczkodaj WW, Mazurek M, Strzałka D, Wolny-Dominiak A, Woodbury-Smith M (2018). "Electronic Health Record Breaches as Social Indicators".

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In the United States in 2011 there were 380 major data breaches involving 500 or more patients' records listed on the website kept by the

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The economics of sharing have been blamed for the lack of interoperability, as limited data sharing can help providers retain customers.

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DesRoches CM, Campbell EG, Rao SR, Donelan K, Ferris TG, Jha A, Kaushal R, Levy DE, Rosenbaum S, Shields AE, Blumenthal D (July 2008).

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One major issue that has risen on the privacy of the US network for electronic health records is the strategy to secure the privacy of

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The Obama Administration's Health IT program intends to use federal investments to stimulate the market of electronic health records:

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Bleich HL, Slack WV (January 2010). "Reflections on electronic medical records: when doctors will use them and when they will not".

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released its proposed rule for Stage 3 meaningful use. These new rules focus on some of the tougher aspects of Stage 2 and require

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Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, and outreach.

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System which provides a comprehensive multimedia data from many specialties, including cardiology, radiology, and orthopedics. A

4069: 1960: 4127: 3017:"At risk of exposure: In the push for electronic medical records, concern is growing about how well privacy can be safeguarded" 2916: 2971: 1984:"Tensions and paradoxes in electronic patient record research: a systematic literature review using the meta-narrative method" 57:

Federal and state governments, insurance companies and other large medical institutions are heavily promoting the adoption of

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The use of certified EHR technology for the electronic exchange of health information to improve the quality of health care.

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requires doctors to show "meaningful use" of an EHR system. As of June 2010, there were no penalty provisions for Medicaid.

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Software, hardware and other services for EMR system implementation are provided for cost by various companies including

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Certification of software: To provide assurance that the EHRs meet basic quality, safety, and efficiency standards

4176: 3813: 3785: 3464:"HIPAA Basics: Medical Privacy in the Electronic Age from the Privacy Rights Clearinghouse www.privacyrights.org" 1565: 1116: 623: 4132: 4036: 3905: 938: 788: 650: 439:

Capability to provide electronic syndromic surveillance data to public health agencies and actual transmission.

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Capability to exchange key clinical information electronically among providers and patient authorized entities.

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Wafa T (2010). "How the Lack of Prescriptive Technical Granularity in HIPAA Has Compromised Patient Privacy".

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Use certified EHR to identify patient-specific education resources and provide to the patient if appropriate.

3995: 3733: 924:(CPOE) had existed for more than 30 years, but by 2006 only 10% of hospitals had a fully integrated system. 791:

had succeeded in breaking the encryption codes protecting electronic health records, among other databases.

3112: 2498: 2081:"Mining a large-scale EHR with machine learning methods to predict all-cause 30-day unplanned readmissions" 1983: 1342:

Simon SR, Kaushal R, Cleary PD, Jenter CA, Volk LA, Poon EG, Orav EJ, Lo HG, Williams DH, Bates DW (2007).

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system yet. The 2009 National Ambulatory Medical Care Survey of 5200 physicians (70% response rate) by the

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Blumenthal D, Tavenner M (August 2010). "The "meaningful use" regulation for electronic health records".

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Maintenance costs can be high. Miller et al. found the average estimated maintenance cost was $ 8500 per

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Department of Health and Human Services Breach Notification for Unsecured Protected Health Information

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healthcare providers are no longer required by the law to hold archives of medical records." page 65,

612: 4262: 3753: 2993: 1680: 544: 2467: 3737: 3439:"Privacy Rights Clearinghouse's Chronology of Data Security Breaches involving Medical Information" 795: 733: 512: 184:

Medicare payments, increasing to 3% over 3 years. In order to receive the EHR stimulus money, the

4236: 3990: 3924: 3915: 3719: 3347: 3183: 1798: 1755: 1492: 1245: 1091: 504: 219: 2053: 166: 3517: 1512:"Electronic health records were supposed to be everywhere this year. They're not—but it's okay" 309:

The meaningful use of EHRs intended by the US government incentives is categorized as follows:

4211: 4186: 4031: 4003: 3231: 3178: 3085: 3081: 2865: 2838: 2529: 2480: 2434: 2390: 2349: 2140: 2013: 1937: 1919: 1820:"Electronic Health Records Vendor to Pay $ 155 Million to Settle False Claims Act Allegations" 1790: 1747: 1618: 1484: 1449: 1414: 1373: 1270: 1226: 1179: 1083: 999: 694: 690: 98: 2706: 4084: 3747: 3402: 3364: 3339: 3204: 2830: 2521: 2472: 2424: 2380: 2339: 2329: 2130: 2122: 2003: 1995: 1927: 1909: 1782: 1739: 1608: 1600: 1476: 1441: 1404: 1363: 1355: 1216: 1169: 1075: 989: 981: 906: 897: 491: 192: 1316: 4267: 4196: 2581: 2239: 2216: 2159:"What is Meaningful Use? | Policy Researchers & Implementers | HealthIT.gov" 1845:"EHR vendor eClinicalWorks reaches ground-breaking $ 155 million whistleblower settlement" 1687: 891: 887: 868: 725: 2890: 2739: 1704: 1344:"Correlates of electronic health record adoption in office practices: a statewide survey" 706:

21 clinical performance measures defined by the Indian Health Service as required by the

678:

One attribute for the start of implementing EHRs in the States is the development of the

336:

Strict and open standards: To ensure users and sellers of EHRs work towards the same goal

3046: 2799: 2769: 2126: 1932: 1897: 894:

had the highest satisfaction, while in acute hospital care Epic scored relatively well.

4226: 4181: 4171: 4166: 4142: 4021: 4013: 3910: 3403:"Not all Recommended Fraud Safeguards have been Implemented in Hospital EHR Technology" 2344: 2317: 2135: 2110: 2008: 1613: 1588: 1368: 1343: 994: 969: 815: 784: 3272: 2476: 1156:

McDonald CJ, Callaghan FM, Weissman A, Goodwin RM, Mundkur M, Kuhn T (November 2014).

436:

Capability to submit electronic data to immunization registries and actual submission.

4282: 4231: 4216: 4191: 4064: 3351: 1999: 1802: 1759: 1589:"Legal, ethical, and financial dilemmas in electronic health record adoption and use" 646: 457:

be as difficult, as it builds incrementally on the requirements for the first stage.

3365:

U.S.Department of Health & Human Services and U.S. Departments of Justice Letter

3250: 2266:"Medicare and Medicaid Programs; Electronic Health Record Incentive Program-Stage 3" 1536: 1496: 1174: 1157: 1134: 1095: 444:

Program, providers follow a similar process using their state's attestation system.

4221: 4153: 3780: 3632:"KLAS report shows a lot is riding on upcoming Carequality, CommonWell partnership" 3530:"In EMR Market Share Wars, Epic and Cerner Triumph Yet Again | HealthLeaders Media" 2821:

Traynor K (November 2008). "National health information network passes live test".

1445: 1282:

National Center for Health : United States, 2008]. Retrieved 15 December 2009.

1158:"Use of internist's free time by ambulatory care Electronic Medical Record systems" 901: 875: 863:

Vendors often focus on software for specific healthcare providers, including acute

619: 3467: 395:

Provide patients with an electronic copy of their health information upon request.

302:

The use of certified EHR technology to submit clinical quality and other measures.

4206: 4026: 3442: 3153: 2499:"A State Policy Approach: Promoting Health Information Technology in California" 421:

Send reminders to patients per patient preference for preventive/ follow-up care

1859:"CMS won't punish eClinicalWorks customers for meaningful use EHR attestations" 1042:"Achieving the Interoperability Promise of 21st Century Cures - Health IT Buzz" 4079: 3976: 3945: 3343: 2429: 2412: 2385: 2368: 1669: 1205:"Electronic health records in ambulatory care—a national survey of physicians" 1079: 659: 654:

procedures, X-rays, patient care nursing orders, diets, and laboratory tests.

470: 185: 2869: 2547: 1923: 985: 355:

Full list of the Core Requirements and a full list of the Menu Requirements.

93:

showed that 51.7% of office-based physicians did not use any EMR/EHR system.

4074: 3828: 3098:

US Code of Federal Regulations, Title45, Volume 1 (Revised 1 October 2005):

2525: 2088: 693:

has a pilot program to share health records between their systems VistA and

415:

Incorporate clinical lab-test results into certified EHR as structured data.

3235: 2842: 2533: 2484: 2438: 2394: 2353: 2144: 2109:

Zhai H, Brady P, Li Q, Lingren T, Ni Y, Wheeler DS, Solti I (August 2014).

2017: 1941: 1794: 1751: 1622: 1604: 1488: 1480: 1453: 1418: 1409: 1392: 1377: 1230: 1183: 1087: 1003: 21:

EHR adoption of all physicians in the US. Source: DesRoches et al. (2008).

1221: 1204: 1018:"Trump Administration Announces MyHealthEData Initiative at HIMSS18 | CMS" 473:

providers to vastly improve their EHR adoption and care delivery by 2018.

3489: 2413:"The value of electronic health records in solo or small group practices" 1786: 1743: 970:"Health Information Blocking: Responses Under the 21st Century Cures Act" 933: 883: 864: 758: 663:

and DoD Picture Archiving & Communications System (PACS) solutions).

296:

The use of a certified EHR in a meaningful manner, such as e-prescribing.

180: 3554:"Epic, Cerner Continue to Dominate U.S. Hospital EHR Market, KLAS Finds" 2334: 2301: 1982:

Greenhalgh T, Potts HW, Wong G, Bark P, Swinglehurst D (December 2009).

1359: 4161: 4094: 3934: 2834: 2367:

Fleming NS, Culler SD, McCorkle R, Becker ER, Ballard DJ (March 2011).

2210:

Torrieri, Marisa "Dealing with Meaningful Use Attestation Aggravation"

2036: 197: 124:

Open source EMR systems exist but have not seen widespread adoption of

1914: 503:

Doubts have been raised about cost saving from EMRs by researchers at

4137: 3688: 3150:"Privacy Rights Clearinghouse's Chronology of Data Security Breaches" 879: 254:

Electronic laboratory reporting for reportable conditions (hospitals)

146:, has a right to view the originals, and to obtain copies under law. 3378:"Letter addressed to Secretary Sebelius and Attorney General Holder" 2302:

Evidence on the costs and benefits of health information technology.

374:

Maintain an up-to-date problem list of current and active diagnoses.

74:

Office of the National Coordinator for Health Information Technology

1110:"VistA:Winner of the 2006 Innovations in American Government Award" 433:

Provide a summary care record for transitions in care or referrals.

3833: 3818: 2021: 665: 642: 564: 234:

Patient registries (e.g., "a directory of patients with diabetes")

151:

Health Information Technology for Economic and Clinical Health Act

3605:"Epic, athenahealth Most Effectively Enable EHR Interoperability" 2707:"Moving Past the EHR Interoperability Blame Game - NEJM Catalyst" 2185:"HealthIT.gov | the official site for Health IT information" 2572:

Healthcare Information and Management Systems Society, June 2009

118: 3949: 3692: 2285:"Breaking Down the Health IT Impacts of Stage 3 Meaningful Use" 368:

Generate and transmit permissible prescriptions electronically.

3100:

of Individually Identifiable Health Information (45CFR164.501)

2264:

Centers for Medicare & Medicaid Services (30 March 2015).

601: 597: 404:

Protect electronic health information (privacy & security)

728:

apply to both paper and electronic records. According to the

398:

Provide clinical summaries to patients for each office visit.

2318:"Benefits and drawbacks of electronic health record systems" 179:

Title IV of the act promises maximum incentive payments for

831:

safeguards, physical safeguards, and technical safeguards.

741:

Health Insurance Portability and Accountability Act (HIPAA)

3296:"NSA Code Cracking Puts Google, Yahoo Security Under Fire" 1293:"Office-based Physician Electronic Health Record Adoption" 231:

Clinical decision support (automated advice) for providers

2548:"What is EHR or EMR? | EHR VS EMR | Explained Everything" 1391:

Menachemi N, Perkins RM, van Durme DJ, Brooks RG (2006).

386:

Record smoking status for patients 13 years old or older.

3850:

American Association for Medical Systems and Informatics

2948:. Agency for Healthcare Research and Quality. 2013-05-22 2858:"VA, Kaiser Permanente launch e-health records exchange" 2596:

U.S. Medicine – The Voice of Federal Medicine, May 2009.

2512:

Parish C (2006). "Edging towards a brave new IT world".

392:

Report ambulatory quality measures to CMS or the States.

154: 2501:. California Legislative Analyst Office. February 2007. 2411:

Miller RH, West C, Brown TM, Sim I, Ganchoff C (2005).

1638:"5 Legal Issues Surrounding Electronic Medical Records" 1348:

Journal of the American Medical Informatics Association

3317:"UCLA Health Says 4.5M May Be Affected In Data Breach" 1847:, Phillips & Cohen LLP Press Release, May 31, 2017 615:

is a privately sponsored interoperability initiative.

284:

of check-boxes has led to fewer open-ended questions.

2254:

Marisa Torrieri, Physicians Practice, September 2012.

1654:

National Archives and Records Administration (NARA):

720:

United States Department of Health and Human Services

577:

Healthcare Information and Management Systems Society

218:

Improve care quality, safety, efficiency, and reduce

697:, respectively. This software called 'CONNECT' uses 4245: 4151: 4118: 4055: 4042:

Health Insurance Portability and Accountability Act

4012: 3983: 3898: 3842: 3804: 3726: 3680:

The Executive's Guide to Electronic Health Records.

3200:"Why shared medical database is wrong prescription" 3047:"FBI seeks stolen personal data on 26 million vets" 794:In 2015, 4.5 million health records were hacked at 749:

Health Insurance Portability and Accountability Act

658:VA and DoD facilities. These facilities include VA 362:

Use computerized order entry for medication orders.

3251:"Spread of records stirs fears of privacy erosion" 3222:Nulan C (2001). "HIPAA—a real world perspective". 1730:Blumenthal D (February 2010). "Launching HITECH". 968:Black JR, Hulkower RL, Ramanathan T (2018-08-22). 839:Health Insurance Portability and Accessibility Act 158: 3217: 3215: 3172: 3170: 611:was a leading interoperability standard, and the 257:Immunization reporting to immunization registries 3656:"Amazon, Cerner team up on AI, machine learning" 3421:"OIG's 2014 work plan steps up scrutiny of EHRs" 2311: 2309: 1878:"U.S. Issues Rules on Electronic Health Records" 783:In 2013, reports based on documents released by 509:Wharton School of the University of Pennsylvania 267:Ensure adequate privacy and security protections 3930:List of medical and health informatics journals 3383:. American Hospital Association. Archived from 1198: 1196: 909:, CommonWell Health Alliance, and Carequality. 260:Syndromic surveillance (health event awareness) 4100:Participative decision-making in organizations 3271:. Post-gazette.com. 1969-12-31. Archived from 3179:"Warnings Over Privacy of U.S. Health Network" 3117:U.S. Department of Health & Human Services 2897:. U.S. Department of Health and Human Services 2233:"Meaningful Use: Stage 2 Regulations Overview" 581:National Institute of Standards and Technology 63:American Recovery and Reinvestment Act of 2009 3961: 3704: 2406: 2404: 2060:. Center for Medicare & Medicaid Services 430:Perform medication reconciliation as relevant 389:Implement one clinical decision support rule. 8: 2968:"Breaches Affecting 500 or More Individuals" 2796:United States Department of Veterans Affairs 2766:United States Department of Veterans Affairs 2736:United States Department of Veterans Affairs 2050:Centers for Medicare & Medicaid Services 1681:Medical Records – Frequently Asked Questions 1562:"EMR – Electronic Medical Records Solutions" 1434:International Journal of Medical Informatics 2623:"Interoperability in EHR: the medical mine" 1252:. CDC/National Center for Health Statistics 571:Software quality and usability deficiencies 292:The main components of meaningful use are: 191:In 2017 the government announced its first 45: EHR purchase planned in 2 years (22%) 3968: 3954: 3946: 3711: 3697: 3689: 2823:American Journal of Health-System Pharmacy 2252:"EHR Incentive Program: A Progress Report" 900:is a focus for systems; in 2018, Epic and 609:Fast Healthcare Interoperability Resources 244:Engage patients and families in their care 39: Bought but not implemented yet (13%) 2466: 2428: 2384: 2343: 2333: 2134: 2007: 1931: 1913: 1814: 1812: 1612: 1408: 1367: 1220: 1173: 1133:Groopman J, Hartzband P (12 March 2009). 993: 365:Implement drug-drug, drug-allergy checks. 270:Predict future health conditions through 3855:American Medical Informatics Association 3682:(2007, Health Administration Press) p.03 3490:"Data Security Breach Notification Laws" 3419:Hirsch, Marla Durben (1 February 2014). 383:Record and chart changes in vital signs. 380:Maintain active medication allergy list. 3890:American College of Medical Informatics 3074:Northern Illinois University Law Review 2085:ASE@360 Open Scientific Digital Library 950: 689:The Department of Veterans Affairs and 684:Department of Health and Human Services 453:increased over the Stage 1 objectives. 3015:Health & Medicine (26 June 2006). 2687:from the original on September 7, 2017 708:Government Performance and Results Act 27: Fully functional EHR system (4%) 3743:Artificial intelligence in healthcare 3626: 3624: 2322:Risk Management and Healthcare Policy 1959:. Physicians Practice. Archived from 1244:Hsiao CJ, et al. (Dec 8, 2010). 699:Nationwide Health Information Network 680:Nationwide Health Information Network 645:). A key component in VistA is their 91:National Center for Health Statistics 7: 2570:Defining and Testing EMR Usability. 2242:Robert Anthony, CMS, 30 August 2012. 1656:Long-Term Usability of Optical Media 670:Electronic health records flow chart 325:Ensure adequate privacy and security 322:Improve population and public health 247:Improve population and public health 172:,§2.A.III & B.4) (a part of the 2656:from the original on March 22, 2016 2127:10.1016/j.resuscitation.2014.04.009 1957:"Do EMRs Make You a Better Doctor?" 1775:The New England Journal of Medicine 1732:The New England Journal of Medicine 1209:The New England Journal of Medicine 1135:"Obama's $ 80 Billion Exaggeration" 333:Incentives: to providers who use IT 4120:Health information on the Internet 2996:. Modernhealthcare.com. 2011-12-22 2675:Caldwell, Patrick (October 2015). 2187:. Healthit.hhs.gov. Archived from 2161:. Healthit.hhs.gov. Archived from 319:Engage patients and their families 163:Tooltip Public Law (United States) 14: 3497:Federation of American Scientists 3138:Summary of the HIPAA Privacy Rule 2054:"CMS EHR Meaningful Use Overview" 1587:Sittig DF, Singh H (April 2011). 922:computerized provider order entry 591:Lack of semantic interoperability 2455:The American Journal of Medicine 2000:10.1111/j.1468-0009.2009.00578.x 1068:Health Economics, Policy and Law 412:Implement drug-formulary checks. 377:Maintain active medication list. 4289:Healthcare in the United States 4253:Open-source healthcare software 4128:Health information on Knowledge 3678:Smaltz, Detlev and Eta Berner. 2316:Menachemi N, Collum TH (2011). 1271:Are More Doctors Adopting EHRs? 1175:10.1001/jamainternmed.2014.4506 547:health-care provider per year. 126:open-source EMR system software 3603:EHRIntelligence (2018-03-02). 3249:Francis T (28 December 2006). 2798:. 3 March 2009. Archived from 2768:. 3 March 2009. Archived from 2738:. 3 March 2009. Archived from 1446:10.1016/j.ijmedinf.2009.10.002 726:Privacy concerns in healthcare 639:Department of Veterans Affairs 228:Quality and safety measurement 1: 3791:Health information management 3776:health information technology 3401:Levinson DR (December 2013). 3294:Holmes A (6 September 2013). 3198:Appel JM (30 December 2008). 2917:"Federal Health Architecture" 2477:10.1016/S0002-9343(03)00057-3 2079:Zhai H, Iyer S, Ni Y (2014). 1679:Medical Board of California: 600:, or the bracket notation of 316:Reduce healthcare disparities 3766:Translational bioinformatics 3113:"Health Information Privacy" 2856:Mearian L (6 January 2010). 2283:Bresnick J (23 March 2015). 33: Basic EHR system (13%) 4070:Doctor–patient relationship 3977:Telemedicine and telehealth 3796:Consumer health informatics 3177:Pear R (18 February 2007). 2924:Federal Health Architecture 1857:Sullivan T (July 6, 2017). 1397:Informatics in Primary Care 920:As of 2006, systems with a 714:Privacy and confidentiality 204:Health information exchange 4310: 4105:Patient Activation Measure 3843:Professional organizations 3534:www.healthleadersmedia.com 3332:Social Indicators Research 1902:Alzheimer's & Dementia 1824:U.S. Department of Justice 803:Social Indicators Research 637:In the United States, the 624:CommonWell Health Alliance 4294:Electronic health records 4177:Remote patient monitoring 3885:International Association 3814:Continuity of Care Record 3786:Public health informatics 3344:10.1007/s11205-018-1837-z 3269:"Pittsburgh Post-Gazette" 3102:. Retrieved 30 July 2006. 2970:. Hhs.gov. Archived from 2643:Electronic Health Records 2640:Kobb E, Sauser K (2014). 2430:10.1377/hlthaff.24.5.1127 2386:10.1377/hlthaff.2010.0768 1690:. Retrieved 30 July 2006. 1658:. Retrieved 30 July 2006. 1317:"Big Data in Health Care" 1080:10.1017/S1744133105001210 494:'s estimates of savings. 313:Improve care coordination 241:Improve care coordination 59:electronic health records 51: No EHR system (48%) 4133:Online patient education 4037:Electronic health record 3906:Electronic health record 3230:(2): 29–37, quiz 38–40. 2895:CONNECT Community Portal 1642:Becker's Hospital Review 1273:Retrieved 31 March 2011. 986:10.1177/0033354918791544 939:Electronic health record 874:In the hospital market, 651:graphical user interface 101:(e.g., clinical notes). 3734:Medical image computing 3255:The Wall Street Journal 2526:10.7748/ns.20.27.15.s22 1876:Pear R (13 July 2010). 1537:"The Future of Nursing" 1321:The National Law Review 1189:(subscription required) 770:The Wall Street Journal 4258:Patient opinion leader 4110:Shared decision-making 4047:Personal health record 3806:Medical classification 3771:Translational medicine 2215:8 January 2012 at the 2058:EHR Incentive Programs 1644:. Becker's Healthcare. 1605:10.1542/peds.2010-2184 1564:. Dell. Archived from 1481:10.1542/peds.2004-2741 1410:10.14236/jhi.v14i1.609 1297:dashboard.healthit.gov 1162:JAMA Internal Medicine 671: 585:Department of Commerce 501: 461:Meaningful use Stage 3 448:Meaningful use Stage 2 347:Meaningful use Stage 1 70:21st Century Cures Act 4090:Knowledge translation 4057:Patient participation 3921:Personalized medicine 3760:Computational biology 3558:Healthcare Innovation 2732:"NDAA Image Exchange" 1988:The Milbank Quarterly 1222:10.1056/NEJMsa0802005 1137:. Wall Street Journal 974:Public Health Reports 810:Regulatory compliance 669: 496: 174:2009 stimulus package 76:leads these efforts. 4263:Research participant 3866:(to merge from 2020) 3864:Australasian College 3754:Behavior informatics 3224:Radiology Management 2270:The Federal Register 1787:10.1056/NEJMp1006114 1744:10.1056/NEJMp0912825 734:government databases 477:Barriers to adoption 371:Record demographics. 213:Goals and objectives 3984:Background concepts 3875:European Federation 3738:imaging informatics 2335:10.2147/RMHP.S12985 2221:Physicians Practice 2165:on 26 February 2012 1516:The Washington Post 1360:10.1197/jamia.M2187 1323:. 17 September 2014 1122:on 14 January 2009. 846:Breach notification 826:Medical data breach 796:UCLA Medical Center 513:Stanford University 408:Menu Requirements: 358:Core Requirements: 4237:Telerehabilitation 3991:Health informatics 3925:precision medicine 3916:Remote manipulator 3880:Indian Association 3860:Australian Society 3720:Health informatics 3583:Healthcare IT News 3488:Stevens G (2012). 3425:Fierce Health Care 3275:on 19 January 2012 3184:The New York Times 2891:"What is CONNECT?" 2835:10.2146/news080090 2802:on 24 October 2009 2772:on 24 October 2009 2742:on 24 October 2009 2580:2012-03-22 at the 2238:2012-09-29 at the 1955:Gabriel B (2008). 1882:The New York Times 1863:Healthcare IT News 1686:2011-08-09 at the 1541:Norwich University 1250:NCHS Health E-Stat 787:revealed that the 672: 505:Harvard University 465:On March 20, 2015 220:health disparities 4276: 4275: 4212:Teleophthalmology 4202:Telemental health 4187:Tele-epidemiology 4032:De-identification 4004:Telecommunication 3943: 3942: 3870:Brazilian Society 3390:on 12 March 2016. 3021:Los Angeles Times 2974:on 29 August 2013 2627:Medical Economics 1915:10.1002/alz.12967 730:Los Angeles Times 691:Kaiser Permanente 539:Maintenance costs 99:unstructured data 4301: 4085:Health education 3970: 3963: 3956: 3947: 3748:Neuroinformatics 3713: 3706: 3699: 3690: 3683: 3676: 3670: 3669: 3667: 3666: 3652: 3646: 3645: 3643: 3642: 3636:FierceHealthcare 3628: 3619: 3618: 3616: 3615: 3600: 3594: 3593: 3591: 3590: 3575: 3569: 3568: 3566: 3565: 3550: 3544: 3543: 3541: 3540: 3526: 3520: 3515: 3509: 3508: 3506: 3504: 3494: 3485: 3479: 3478: 3476: 3475: 3466:. Archived from 3460: 3454: 3453: 3451: 3450: 3441:. Archived from 3435: 3429: 3428: 3416: 3410: 3409: 3407: 3398: 3392: 3391: 3389: 3382: 3373: 3367: 3362: 3356: 3355: 3327: 3321: 3320: 3313: 3307: 3306: 3304: 3302: 3291: 3285: 3284: 3282: 3280: 3265: 3259: 3258: 3246: 3240: 3239: 3219: 3210: 3209: 3205:Orlando Sentinel 3195: 3189: 3188: 3174: 3165: 3164: 3162: 3161: 3152:. Archived from 3146: 3140: 3135: 3129: 3128: 3126: 3124: 3109: 3103: 3096: 3090: 3089: 3069: 3063: 3062: 3060: 3058: 3043: 3037: 3036: 3034: 3032: 3023:. Archived from 3012: 3006: 3005: 3003: 3001: 2990: 2984: 2983: 2981: 2979: 2964: 2958: 2957: 2955: 2953: 2942: 2936: 2935: 2933: 2931: 2921: 2913: 2907: 2906: 2904: 2902: 2887: 2881: 2880: 2878: 2876: 2853: 2847: 2846: 2818: 2812: 2811: 2809: 2807: 2788: 2782: 2781: 2779: 2777: 2758: 2752: 2751: 2749: 2747: 2728: 2722: 2721: 2719: 2718: 2703: 2697: 2696: 2694: 2692: 2672: 2666: 2665: 2663: 2661: 2655: 2648: 2637: 2631: 2630: 2619: 2613: 2612: 2610: 2609: 2600:. Archived from 2590: 2584: 2568: 2562: 2561: 2559: 2558: 2544: 2538: 2537: 2514:Nursing Standard 2509: 2503: 2502: 2495: 2489: 2488: 2470: 2449: 2443: 2442: 2432: 2408: 2399: 2398: 2388: 2364: 2358: 2357: 2347: 2337: 2313: 2304: 2299: 2293: 2292: 2289:EHR Intelligence 2280: 2274: 2273: 2261: 2255: 2249: 2243: 2230: 2224: 2223:. January 2012. 2207: 2201: 2200: 2198: 2196: 2191:on 11 March 2012 2181: 2175: 2174: 2172: 2170: 2155: 2149: 2148: 2138: 2106: 2100: 2099: 2097: 2096: 2087:. Archived from 2076: 2070: 2069: 2067: 2065: 2052:(Oct 12, 2011). 2046: 2040: 2032: 2026: 2025: 2020:. Archived from 2011: 1979: 1973: 1972: 1970: 1968: 1952: 1946: 1945: 1935: 1917: 1908:(8): 3506–3518. 1892: 1886: 1885: 1873: 1867: 1866: 1854: 1848: 1842: 1836: 1835: 1833: 1831: 1816: 1807: 1806: 1770: 1764: 1763: 1727: 1721: 1720: 1718: 1716: 1697: 1691: 1677: 1671: 1665: 1659: 1652: 1646: 1645: 1633: 1627: 1626: 1616: 1584: 1578: 1577: 1575: 1573: 1558: 1552: 1551: 1549: 1547: 1533: 1527: 1526: 1524: 1522: 1507: 1501: 1500: 1464: 1458: 1457: 1429: 1423: 1422: 1412: 1388: 1382: 1381: 1371: 1339: 1333: 1332: 1330: 1328: 1313: 1307: 1306: 1304: 1303: 1289: 1283: 1280: 1274: 1268: 1262: 1261: 1259: 1257: 1241: 1235: 1234: 1224: 1200: 1191: 1190: 1187: 1177: 1153: 1147: 1146: 1144: 1142: 1130: 1124: 1123: 1121: 1114: 1106: 1100: 1099: 1063: 1057: 1056: 1054: 1053: 1038: 1032: 1031: 1029: 1028: 1014: 1008: 1007: 997: 965: 959: 955: 907:EHealth Exchange 898:Interoperability 613:Argonaut Project 492:Rand Corporation 274:before diagnoses 272:machine learning 193:False Claims Act 164: 160: 50: 44: 38: 32: 26: 4309: 4308: 4304: 4303: 4302: 4300: 4299: 4298: 4279: 4278: 4277: 4272: 4268:Virtual patient 4241: 4197:Teledermatology 4147: 4114: 4051: 4008: 3979: 3974: 3944: 3939: 3894: 3838: 3800: 3722: 3717: 3687: 3686: 3677: 3673: 3664: 3662: 3660:Healthcare Dive 3654: 3653: 3649: 3640: 3638: 3630: 3629: 3622: 3613: 3611: 3609:EHRIntelligence 3602: 3601: 3597: 3588: 3586: 3577: 3576: 3572: 3563: 3561: 3552: 3551: 3547: 3538: 3536: 3528: 3527: 3523: 3516: 3512: 3502: 3500: 3492: 3487: 3486: 3482: 3473: 3471: 3462: 3461: 3457: 3448: 3446: 3437: 3436: 3432: 3418: 3417: 3413: 3405: 3400: 3399: 3395: 3387: 3380: 3376:Umbdenstock R. 3375: 3374: 3370: 3363: 3359: 3329: 3328: 3324: 3315: 3314: 3310: 3300: 3298: 3293: 3292: 3288: 3278: 3276: 3267: 3266: 3262: 3248: 3247: 3243: 3221: 3220: 3213: 3197: 3196: 3192: 3176: 3175: 3168: 3159: 3157: 3148: 3147: 3143: 3136: 3132: 3122: 3120: 3111: 3110: 3106: 3097: 3093: 3071: 3070: 3066: 3056: 3054: 3045: 3044: 3040: 3030: 3028: 3014: 3013: 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1889: 1875: 1874: 1870: 1856: 1855: 1851: 1843: 1839: 1829: 1827: 1818: 1817: 1810: 1772: 1771: 1767: 1729: 1728: 1724: 1714: 1712: 1703:(Jun 3, 2011). 1699: 1698: 1694: 1688:Wayback Machine 1678: 1674: 1666: 1662: 1653: 1649: 1635: 1634: 1630: 1586: 1585: 1581: 1571: 1569: 1568:on 3 April 2012 1560: 1559: 1555: 1545: 1543: 1535: 1534: 1530: 1520: 1518: 1509: 1508: 1504: 1466: 1465: 1461: 1431: 1430: 1426: 1390: 1389: 1385: 1341: 1340: 1336: 1326: 1324: 1315: 1314: 1310: 1301: 1299: 1291: 1290: 1286: 1281: 1277: 1269: 1265: 1255: 1253: 1243: 1242: 1238: 1202: 1201: 1194: 1188: 1155: 1154: 1150: 1140: 1138: 1132: 1131: 1127: 1119: 1112: 1108: 1107: 1103: 1074:(Pt 2): 163–9. 1065: 1064: 1060: 1051: 1049: 1040: 1039: 1035: 1026: 1024: 1016: 1015: 1011: 967: 966: 962: 956: 952: 947: 930: 918: 892:Practice Fusion 888:ambulatory care 869:ambulatory care 861: 848: 828: 812: 716: 635: 633:Implementations 593: 573: 557: 541: 521: 484: 479: 463: 450: 349: 290: 281: 215: 162: 139: 86: 55: 54: 53: 52: 48: 46: 42: 40: 36: 34: 30: 28: 24: 12: 11: 5: 4307: 4305: 4297: 4296: 4291: 4281: 4280: 4274: 4273: 4271: 4270: 4265: 4260: 4255: 4249: 4247: 4243: 4242: 4240: 4239: 4234: 4229: 4227:Telepsychiatry 4224: 4219: 4214: 4209: 4204: 4199: 4194: 4189: 4184: 4182:Tele-audiology 4179: 4174: 4172:Remote therapy 4169: 4167:Remote surgery 4164: 4158: 4156: 4154:subspecialties 4149: 4148: 4146: 4145: 4143:PubMed Central 4140: 4135: 4130: 4124: 4122: 4116: 4115: 4113: 4112: 4107: 4102: 4097: 4092: 4087: 4082: 4077: 4072: 4067: 4061: 4059: 4053: 4052: 4050: 4049: 4044: 4039: 4034: 4029: 4024: 4022:Admission note 4018: 4016: 4014:Medical record 4010: 4009: 4007: 4006: 4001: 3993: 3987: 3985: 3981: 3980: 3975: 3973: 3972: 3965: 3958: 3950: 3941: 3940: 3938: 3937: 3932: 3927: 3918: 3913: 3911:Health Level 7 3908: 3902: 3900: 3899:Other concepts 3896: 3895: 3893: 3892: 3887: 3882: 3877: 3872: 3867: 3857: 3852: 3846: 3844: 3840: 3839: 3837: 3836: 3831: 3826: 3821: 3816: 3810: 3808: 3802: 3801: 3799: 3798: 3793: 3788: 3783: 3778: 3773: 3768: 3763: 3757: 3751: 3745: 3740: 3730: 3728: 3727:Subdisciplines 3724: 3723: 3718: 3716: 3715: 3708: 3701: 3693: 3685: 3684: 3671: 3647: 3620: 3595: 3570: 3545: 3521: 3510: 3480: 3455: 3430: 3411: 3393: 3368: 3357: 3338:(2): 861–871. 3322: 3308: 3286: 3260: 3241: 3211: 3190: 3166: 3141: 3130: 3104: 3091: 3064: 3038: 3027:on 16 May 2008 3007: 2985: 2959: 2937: 2926:. healthit.gov 2908: 2882: 2848: 2829:(22): 2086–7. 2813: 2783: 2753: 2723: 2698: 2667: 2632: 2614: 2585: 2563: 2552:www.curemd.com 2539: 2504: 2490: 2461:(5): 397–403. 2444: 2423:(5): 1127–37. 2417:Health Affairs 2400: 2373:Health Affairs 2359: 2305: 2294: 2275: 2256: 2244: 2225: 2202: 2176: 2150: 2121:(8): 1065–71. 2101: 2071: 2041: 2027: 1974: 1963:on 8 June 2010 1947: 1887: 1868: 1849: 1837: 1808: 1765: 1722: 1709:Meaningful Use 1705:"Introduction" 1692: 1672: 1660: 1647: 1628: 1599:(4): e1042–7. 1579: 1553: 1528: 1502: 1459: 1424: 1383: 1334: 1308: 1284: 1275: 1263: 1236: 1192: 1168:(11): 1860–3. 1148: 1125: 1101: 1058: 1046:Health IT Buzz 1033: 1009: 980:(5): 610–613. 960: 949: 948: 946: 943: 942: 941: 936: 929: 926: 917: 914: 860: 857: 847: 844: 827: 824: 819: 818: 816:Health Level 7 811: 808: 785:Edward Snowden 715: 712: 634: 631: 592: 589: 572: 569: 556: 555:Training costs 553: 540: 537: 520: 519:Start-up costs 517: 515:, and others. 483: 480: 478: 475: 462: 459: 449: 446: 441: 440: 437: 434: 431: 428: 425: 422: 419: 416: 413: 406: 405: 402: 399: 396: 393: 390: 387: 384: 381: 378: 375: 372: 369: 366: 363: 348: 345: 341: 340: 337: 334: 327: 326: 323: 320: 317: 314: 304: 303: 300: 297: 289: 288:Meaningful use 286: 280: 277: 276: 275: 268: 264: 263: 262: 261: 258: 255: 249: 248: 245: 242: 238: 237: 236: 235: 232: 229: 223: 222: 214: 211: 138: 135: 130: 129: 122: 85: 82: 47: 41: 35: 29: 23: 19: 18: 17: 13: 10: 9: 6: 4: 3: 2: 4306: 4295: 4292: 4290: 4287: 4286: 4284: 4269: 4266: 4264: 4261: 4259: 4256: 4254: 4251: 4250: 4248: 4246:Roles to play 4244: 4238: 4235: 4233: 4232:Teleradiology 4230: 4228: 4225: 4223: 4220: 4218: 4217:Telepathology 4215: 4213: 4210: 4208: 4205: 4203: 4200: 4198: 4195: 4193: 4192:Teledentistry 4190: 4188: 4185: 4183: 4180: 4178: 4175: 4173: 4170: 4168: 4165: 4163: 4160: 4159: 4157: 4155: 4152:Telemedicine 4150: 4144: 4141: 4139: 4136: 4134: 4131: 4129: 4126: 4125: 4123: 4121: 4117: 4111: 4108: 4106: 4103: 4101: 4098: 4096: 4093: 4091: 4088: 4086: 4083: 4081: 4078: 4076: 4073: 4071: 4068: 4066: 4065:Decision aids 4063: 4062: 4060: 4058: 4054: 4048: 4045: 4043: 4040: 4038: 4035: 4033: 4030: 4028: 4025: 4023: 4020: 4019: 4017: 4015: 4011: 4005: 4002: 4000: 3998: 3994: 3992: 3989: 3988: 3986: 3982: 3978: 3971: 3966: 3964: 3959: 3957: 3952: 3951: 3948: 3936: 3933: 3931: 3928: 3926: 3922: 3919: 3917: 3914: 3912: 3909: 3907: 3904: 3903: 3901: 3897: 3891: 3888: 3886: 3883: 3881: 3878: 3876: 3873: 3871: 3868: 3865: 3861: 3858: 3856: 3853: 3851: 3848: 3847: 3845: 3841: 3835: 3832: 3830: 3827: 3825: 3822: 3820: 3817: 3815: 3812: 3811: 3809: 3807: 3803: 3797: 3794: 3792: 3789: 3787: 3784: 3782: 3779: 3777: 3774: 3772: 3769: 3767: 3764: 3762:in healthcare 3761: 3758: 3756:in healthcare 3755: 3752: 3750:in healthcare 3749: 3746: 3744: 3741: 3739: 3735: 3732: 3731: 3729: 3725: 3721: 3714: 3709: 3707: 3702: 3700: 3695: 3694: 3691: 3681: 3675: 3672: 3661: 3657: 3651: 3648: 3637: 3633: 3627: 3625: 3621: 3610: 3606: 3599: 3596: 3584: 3580: 3574: 3571: 3559: 3555: 3549: 3546: 3535: 3531: 3525: 3522: 3519: 3514: 3511: 3498: 3491: 3484: 3481: 3470:on 2012-10-27 3469: 3465: 3459: 3456: 3445:on 2016-09-13 3444: 3440: 3434: 3431: 3426: 3422: 3415: 3412: 3404: 3397: 3394: 3386: 3379: 3372: 3369: 3366: 3361: 3358: 3353: 3349: 3345: 3341: 3337: 3333: 3326: 3323: 3318: 3312: 3309: 3297: 3290: 3287: 3274: 3270: 3264: 3261: 3256: 3252: 3245: 3242: 3237: 3233: 3229: 3225: 3218: 3216: 3212: 3207: 3206: 3201: 3194: 3191: 3186: 3185: 3180: 3173: 3171: 3167: 3156:on 2016-09-13 3155: 3151: 3145: 3142: 3139: 3134: 3131: 3118: 3114: 3108: 3105: 3101: 3095: 3092: 3087: 3083: 3079: 3075: 3068: 3065: 3053:. 23 May 2006 3052: 3048: 3042: 3039: 3026: 3022: 3018: 3011: 3008: 2995: 2989: 2986: 2973: 2969: 2963: 2960: 2947: 2941: 2938: 2925: 2918: 2912: 2909: 2896: 2892: 2886: 2883: 2871: 2867: 2863: 2862:Computerworld 2859: 2852: 2849: 2844: 2840: 2836: 2832: 2828: 2824: 2817: 2814: 2801: 2797: 2793: 2787: 2784: 2771: 2767: 2763: 2757: 2754: 2741: 2737: 2733: 2727: 2724: 2712: 2711:NEJM Catalyst 2708: 2702: 2699: 2686: 2682: 2678: 2671: 2668: 2652: 2645: 2644: 2636: 2633: 2628: 2624: 2618: 2615: 2604:on 2011-10-07 2603: 2599: 2597: 2589: 2586: 2583: 2579: 2576: 2573: 2567: 2564: 2553: 2549: 2543: 2540: 2535: 2531: 2527: 2523: 2519: 2515: 2508: 2505: 2500: 2494: 2491: 2486: 2482: 2478: 2474: 2469: 2464: 2460: 2456: 2448: 2445: 2440: 2436: 2431: 2426: 2422: 2418: 2414: 2407: 2405: 2401: 2396: 2392: 2387: 2382: 2378: 2374: 2370: 2363: 2360: 2355: 2351: 2346: 2341: 2336: 2331: 2327: 2323: 2319: 2312: 2310: 2306: 2303: 2298: 2295: 2290: 2286: 2279: 2276: 2271: 2267: 2260: 2257: 2253: 2248: 2245: 2241: 2237: 2234: 2229: 2226: 2222: 2218: 2214: 2211: 2206: 2203: 2190: 2186: 2180: 2177: 2164: 2160: 2154: 2151: 2146: 2142: 2137: 2132: 2128: 2124: 2120: 2116: 2115:Resuscitation 2112: 2105: 2102: 2091:on 2016-01-09 2090: 2086: 2082: 2075: 2072: 2059: 2055: 2051: 2045: 2042: 2038: 2031: 2028: 2023: 2019: 2015: 2010: 2005: 2001: 1997: 1994:(4): 729–88. 1993: 1989: 1985: 1978: 1975: 1962: 1958: 1951: 1948: 1943: 1939: 1934: 1929: 1925: 1921: 1916: 1911: 1907: 1903: 1899: 1891: 1888: 1883: 1879: 1872: 1869: 1864: 1860: 1853: 1850: 1846: 1841: 1838: 1826:. 31 May 2017 1825: 1821: 1815: 1813: 1809: 1804: 1800: 1796: 1792: 1788: 1784: 1780: 1776: 1769: 1766: 1761: 1757: 1753: 1749: 1745: 1741: 1737: 1733: 1726: 1723: 1710: 1706: 1702: 1696: 1693: 1689: 1685: 1682: 1676: 1673: 1670: 1664: 1661: 1657: 1651: 1648: 1643: 1639: 1632: 1629: 1624: 1620: 1615: 1610: 1606: 1602: 1598: 1594: 1590: 1583: 1580: 1567: 1563: 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Retrieved 1021: 1012: 977: 973: 963: 953: 919: 911: 902:athenahealth 896: 873: 862: 853: 849: 836: 833: 829: 820: 800: 793: 782: 778: 773: 769: 767: 763: 756: 753: 746: 738: 729: 724: 717: 704: 688: 677: 673: 656: 636: 628: 620:Epic Systems 617: 607:As of 2018, 606: 594: 574: 561: 558: 549: 542: 533: 530: 526: 522: 502: 497: 489: 485: 464: 455: 451: 442: 407: 357: 354: 350: 342: 328: 308: 305: 291: 282: 208: 202: 190: 178: 167:111–5 (text) 148: 140: 137:Legal status 131: 111: 107: 103: 95: 87: 78: 67: 56: 20: 15: 4207:Telenursing 4027:Blue Button 3999:health care 3997:In absentia 3499:. p. 3 3279:4 September 3000:4 September 2978:4 September 2195:4 September 2169:4 September 1510:Millman J. 1022:www.cms.gov 744:standards. 4283:Categories 4080:Health 2.0 3665:2019-08-06 3641:2019-08-06 3614:2019-08-06 3589:2019-08-06 3564:2019-08-06 3560:. 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