Medical Records and the Law

446 CHAPTER 13: ELECTRONIC HEALTH RECORDSregulations to provide limited relief from proscriptions against physicianself-referrals for referrals in order to promote the adoption ofe-prescribing. 34 Using its separate legal authority under the Social SecurityAct, DHHS also proposed regulations that would create exceptionsto the self-referral prohibitions and permit certain nonmonetaryremuneration to physicians for the purpose of facilitating the adoptionof interoperable EHRs. 35Electronic Health Records SystemsThe EHR, maintained by healthcare providers, is a critical buildingblock for an EHR system, which can be defined to include the following:• Longitudinal collection of electronic health information for andabout persons• Immediate electronic access to person- and population-level informationby authorized users• Provision of knowledge and decision support that enhance the quality,safety, and efficiency of patient care• Support of efficient processes for healthcare delivery 36The healthcare system is moving rapidly toward EHRs maintained notjust by individual practitioners and institutions, but in a variety ofmulti-institutional and community-wide networks through whichmultiple authorized providers of direct and ancillary healthcare servicesmay contribute patient health information to, and retrieve data from,EHRs stored in provider databases or in centralized data warehouses.Acceptance of EHRs and EHR systems will continue to be higheramong institutional providers and large physician group practices, butsmaller practitioner groups will inevitably adopt EHRs as pressuresfrom government and private payors to use electronic information systemsincrease. 373470 Fed. Reg. 59182 (Oct. 11, 2005).3570 Fed. Reg. 59015 (Oct. 11, 2005).36Institute of Medicine, Key Capabilities, 1.37See Center for Studying Health System Change, Limited Information Technology for PatientCare in Physician Offices, Issue Brief No. 29 (Sept. 29, 2004) (showing that 60 percentof physicians in sole or relatively small practices use limited information technology,and more than 50 percent of physicians in large groups and medical school faculties usemore extensive information technology).