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Are You EHR Ready?

Resources for Electronic Health Records

The use of Electronic Health Record (EHR) systems in the United States has been growing dramatically in the last few years, primarily due to the Health Information Technology for Economic and Clinical Health (HITECH) Act and the Centers for Medicare & Medicaid Services (CMS) incentive programs.

Under the HITECH Act, eligible health care professionals and hospitals can qualify for CMS incentive payments when they adopt certified EHR technology and use it in a meaningful way. What is considered “meaningful use” is evolving in three stages:

  • Stage 1 (which began in 2011 and remains the starting point for all providers): “meaningful use” consists of transferring data to EHRs and being able to share information, including electronic copies and visit summaries for patients.
  • Stage 2 (to be implemented in 2014): “meaningful use” includes new standards such as online access for patients to their health information, and electronic health information exchange between providers.
  • Stage 3 (expected to be implemented in 2016): “meaningful use” includes demonstrating that the quality of health care has been improved.

A new study, reporting on recent data from the National Electronic Health Records Survey (affiliated with the National Ambulatory Medical Care Survey) illustrates the high rate of growth in EHR usage. According to the National Center for Health Statistics (NCHS) Data Brief, 72% of office-based physicians used EHR systems, up from 48% in 2009.   39.6% of office-based physicians reported having a system that met the criteria for a basic system, up from 22% in 2009.1

Chart showing growth of EHR system usage

A basic EHR allows for the collection of patient demographic data, problem lists, physician clinical notes, medication and allergy lists, computerized prescription orders, and the ability to view lab results and radiography images. Only basic EHR systems have the potential to be certified by the Office of the National Coordinator (ONC), a requirement if providers wish to apply for CMS meaningful use incentives.

Regarding meaningful use, the study showed that 66% of physicians intended to participate in the CMS incentive program.  Of that group, 27% had computerized systems with capabilities to support 13 of the Stage 1 Core Set objectives for meaningful use.

Another study, a 2012 reader poll by, also found EHR use high among inpatient care organizations.2  More than 86% of hospital respondents indicated they were using an EHR system. And those not currently using a system have planned to implement one shortly, with a majority (66.6%) indicating that their hospital would be up and running within the next year. Of all the hospitals surveyed, 72.4% specified that their EHR systems were certified for meaningful use.

CMS recently released the final rule for meaningful use Stage 2 which intends to increase health information exchange between providers and promote patient engagement by giving patients secure online access to their health information. Stage 2 also replaces the previous Stage 1 objectives to provide electronic copies of health information or discharge instructions to objectives that allow patients to access their health information online. Patients often require assistance in interpreting lab results or finding additional information about a diagnosis. This provides a unique opportunity for the medical librarian to become actively involved in the implementation of evidence based medicine into the EHR and to promote MedlinePlus Connect to link patient portals and electronic health record systems to MedlinePlus.

Medical librarians have the skills and knowledge to address issues impacting meaningful use and can be valuable partners as institutions continue to strive to meet the next stage’s requirements. We have expertise in the support of clinical decisions procedures, evidence based practices, and standardizations, including data exchange and authority controlled vocabulary, all necessary elements for the interoperability of the EHR.

Funded by the ONC, the HealthIT Workforce Development Program was created to train a new workforce of skilled health IT professionals who will be able to help providers implement electronic health records and achieve meaningful use. One of the components of the program provided grants to community colleges to rapidly create health IT academic programs or expand existing health IT training programs that can be completed in six months or less. One of our regional goals is to support the appropriate personnel at community college HIT institutions to integrate evidence based medicine and consumer health information into their program offerings by promoting MedlinePlus and MedlinePlus Connect.

As EHRs are becoming an integral part of providing quality health care, it is essential for medical librarians to be knowledgeable about various aspects of the EHR and be able to provide resources and information to both medical professionals and health consumers.  Further information on the HITECH Act and EHRs may be found on our MCR web site.

Free Online Resources for Electronic Health Records

 Office of the National Coordinator for Health Information Technology (ONC)
The ONC site is designed as a “resource for the entire health system to support the adoption of health information technology and the promotion of nationwide health information exchange to improve health care.”  It covers all aspects of HIT and EHRs and includes funding opportunities for community colleges and career training programs, descriptions of current HITECH adoption programs in action, HIE awards and programs by state, and current news about policies, regulations and meaningful use. provides in-depth information on EHRs with separate sections for medical professionals, patients, and policy makers.  The site is easy to navigate to find the desired information and is presented in an understandable and interesting manner.  The section for Patients & Families is an excellent consumer resource, providing a basic introduction to both Health IT and EHRs.

The Official Web Site for the Medicare and Medicaid Electronic Health Records (EHR) Incentive Programs
This site focuses on medical professionals and provides an introduction to the Medicare and Medicaid incentive payment programs, guides for registration and the certification of meaningful use for eligible professionals, hospitals, and critical access hospitals; plus links to the appropriate application sites, Stage 1 and 2 meaningful use specification sheets, clinical quality measures, and many additional resources for clinicians and hospitals participating in the incentive program.

MedlinePlus Connect
MedlinePlus Connect: Technical Information

HealthIT Buzz – The Latest on Health Information Technology from the ONC

Information Week Healthcare
A newsletter designed for IT professionals, the healthcare section focuses on the business aspects of health IT, including electronic medical records, clinical information systems, computerized physician order entry, security, privacy issues, and other industry concerns.

The American Health Information Management Association (AHIMA) is the association of health information management (HIM) professionals. This site provides information on certification for Health Informatics and Information Management professionals and lists accredited degree programs.  The resources section provides quality information on all aspects of health information management.

Healthcare Information and Management Systems Society focuses on providing global leadership for the optimal use of information technology (IT) and management systems for the betterment of healthcare. They produce several e-newsletters including Healthcare IT News and Government Health IT News, and provide information on all major topics related to health IT.


NLM Tools for EHR Certification and Meaningful Use
The National Library of Medicine provides free access to vocabulary standards, applications, and related tools that can be used to meet US EHR certification criteria and to achieve meaningful use of EHRs. The following are resources either created by or supported by NLM that can be used for providing patient-specific education materials, e-prescribing, and creating, exchanging, and interpreting standardized lists of problems, medications, and test results.

Value Set Authority Center (VSAC)
VSAC will be the official repository for Value Sets that support 2014 Meaningful Use Clinical Quality Measures (CQMs). The VSAC will provide Certified EHR implementers the ability to search for and retrieve these value sets both through a graphical user interface as well as the application programming interface that can be implemented into an automated system.  The VSAC provides downloadable access to all official versions of vocabulary value sets contained in clinical quality measures that support Meaningful Use Stage 2

RxNorm is designated as the vocabulary for medications. RxNorm, a standardized nomenclature for clinical drugs and drug delivery devices, is produced by the National Library of Medicine (NLM). RxNorm provides standard names for clinical drugs and links its names to many of the drug vocabularies commonly used in pharmacy management and drug interaction software, including those of First Databank, Micromedex, MediSpan, Gold Standard, and Multum. By providing links between these vocabularies, RxNorm can process messages between systems not using the same software and vocabulary.

SNOMED CT® – Systematized Nomenclature of Medicine – Clinical Terminology ®
SNOMED CT is designated as the vocablualry for medical conditions and symptoms.  SNOMED CT is a comprehensive clinical terminology that is freely available to US users through NLM.

LOINC® – Logical Observation Identifiers Names and Codes
LOINC is designated as the vocabulary for reporting lab test results. LOINC provides a universal set of codes in the domain of laboratory and other clinical observations. LOINC can simplify integrating lab test results into an EHR system.


1Hsiao CJ, Hing E. Use and characteristics of electronic health record systems among office-based physician practices: United States, 2001–2012. NCHS Data Brief, no 111. Hyattsville, MD: National Center for Health Statistics. 2012.  Available from:

2Murphy, K.  Inpatient EHR Use Among Hospitals, Providers. (2012) Retrieved December 3, 2012 from

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